Department of Women's Health, University of Tübingen, Tübingen, Germany.
Laboratory Prof. Gisela Enders & Colleagues MVZ and Institute of Virology, Infectiology and Epidemiology e.V, Stuttgart, Germany.
Ultrasound Obstet Gynecol. 2019 Mar;53(3):383-389. doi: 10.1002/uog.19164. Epub 2019 Feb 8.
To examine the efficacy of biweekly hyperimmunoglobulin (HIG) administration to prevent maternal-fetal transmission of cytomegalovirus (CMV) in women with primary first-trimester CMV infection.
This was a prospective observational study of women with confirmed primary CMV infection in the first trimester who had the first HIG administration at or before 14 weeks' gestation. All women had biweekly HIG treatment until 20 weeks' gestation at a dose of 200 IU/kg of maternal body weight. Each subject underwent amniocentesis at least 6 weeks after first presentation at about 20 weeks. Primary outcome was maternal-fetal transmission at the time of amniocentesis, and secondary outcome was the frequency of congenital CMV infection at birth. The results were compared with a historic cohort of women with first-trimester CMV infection who did not undergo HIG treatment and who had amniocentesis at about 20 weeks.
Subjects were 40 pregnant women with a primary CMV infection, with a median gestational age at first presentation of 9.6 (range, 5.1-14.3) weeks. On average, HIG administration started at 11.1 weeks and continued until 16.6 weeks. Within this interval, HIG was administered between two and six times in each patient. While CMV immunoglobulin-G (IgG) monitoring showed periodic fluctuations during biweekly HIG administration cycles, high CMV-IgG avidity indices remained stable over the whole treatment period. Maternal-fetal transmission before amniocentesis occurred in only one of the 40 cases (2.5% (95% CI, 0-13.2%)). At delivery, two additional subjects were found to have had late-gestation transmission. Considering all three cases with maternal-fetal transmission, the transmission rate was 7.5% (95% CI, 1.6-20.4%) in our 40 cases. All infected neonates were asymptomatic at birth. The matched historical control group consisted of 108 pregnancies. Thirty-eight transmissions (35.2% (95% CI, 26.2-45.0%)) occurred in the control group, which was significantly higher (P < 0.0001) than the transmission rate in the HIG treatment group.
After a primary maternal CMV infection in the first trimester, biweekly HIG administration at a dose of 200 IU/kg prevents maternal-fetal transmission up to 20 weeks' gestation. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
研究在初次妊娠早期原发性巨细胞病毒（CMV）感染的妇女中，每两周给予高免疫球蛋白（HIG）预防 CMV 母婴传播的疗效。
这是一项前瞻性观察性研究，纳入初次妊娠早期确诊原发性 CMV 感染的妇女，她们在妊娠 14 周前或之前接受第一次 HIG 治疗。所有妇女均接受 HIG 治疗，直至妊娠 20 周，剂量为 200IU/kg 母体体重。每位受试者在初次就诊后至少 6 周，即在妊娠 20 周左右进行羊膜穿刺术。主要结局为羊膜穿刺术时的母婴传播，次要结局为出生时先天性 CMV 感染的频率。结果与未接受 HIG 治疗且在妊娠 20 周左右进行羊膜穿刺术的初次妊娠早期 CMV 感染妇女的历史队列进行比较。
受试者为 40 例原发性 CMV 感染孕妇，中位初次就诊时孕周为 9.6（5.1-14.3）周。平均而言，HIG 治疗于 11.1 周开始，并持续至 16.6 周。在此期间，每位患者的 HIG 治疗次数为 2-6 次。虽然 CMV 免疫球蛋白-G（IgG）监测显示在每两周 HIG 治疗周期中周期性波动，但高 CMV-IgG 亲和力指数在整个治疗期间保持稳定。在羊膜穿刺术之前，只有 40 例中的 1 例（2.5%（95%CI，0-13.2%））发生母婴传播。在分娩时，另外 2 例发现存在晚期传播。考虑到所有 3 例母婴传播的病例，在我们的 40 例病例中，传播率为 7.5%（95%CI，1.6-20.4%）。所有感染的新生儿出生时均无症状。匹配的历史对照组包括 108 例妊娠。对照组中发生了 38 例传播（35.2%（95%CI，26.2-45.0%）），明显高于 HIG 治疗组（P<0.0001）。
在初次妊娠早期原发性 CMV 感染后，每两周给予 200IU/kg 的 HIG 可预防直至妊娠 20 周的母婴传播。版权所有©2018ISUOG。由 John Wiley & Sons Ltd 出版。
