Third Department of Pediatrics, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece.
Fourth Department of Internal Medicine, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece.
J Matern Fetal Neonatal Med. 2021 Jun;34(12):2025-2029. doi: 10.1080/14767058.2019.1651277. Epub 2019 Aug 11.
Cytomegalovirus (CMV) is the most common congenital viral infection and is regarded as the leading nongenetic cause of sensorineural hearing loss. Currently, international consensuses discourage prenatal screening of pregnant women. However, in few countries mainly in Southern Europe, screening of pregnant women for CMV infection is common practice. Management of women found with IgG+/IgM + and IgG avidity titers in the grey zone during first trimester causes significant stress to both families and health care workers.
Pregnant women referred to our outpatient clinic with the diagnosis of acute CMV infection (IgM+/IgG+) during early pregnancy (gestational age ≤ 14 weeks) and IgG avidity in the grey zone were prospectively followed. The administration of CMV-HIG was offered and follow-up included fetal U/S, amniocentesis for CMV-DNA detection and MRI when appropriate. All neonates were examined by urine PCR and prospectively followed according to existing recommendations.
Ninety women (mean age 30.8 years) were retrospectively analyzed. Most (79.6%) received CMV-HIG. Four women terminated pregnancy (2 unrelated to CMV reasons and 2 because of CMV-positive amniotic fluid). Eighty-seven babies were born asymptomatic. Two newborns were diagnosed with congenital CMV infection. The overall transmission rate was 4.4%; 4.3 5.6% for those receiving or not CMV-HIG. No adverse outcomes were detected during follow-up (median 24 months). Maternal age, parity, detection of maternal CMV-viremia upon diagnosis, delay between diagnosis and consultation, gestational week of first consultation, administration of CMV-HIG and number of doses were not associated with the risk of vertical CMV transmission.
Vertical transmission of CMV infection in pregnancies with acute CMV-infection and IgG avidity titers in the grey zone during first trimester was 4.4%, higher than that in infants born post nonprimary infection (NPI) during pregnancy. More powered studies are needed to prove a significant reduction in transmission using CMV-HIG.
巨细胞病毒（CMV）是最常见的先天性病毒感染，被认为是感音神经性听力损失的主要非遗传原因。目前，国际共识不鼓励对孕妇进行产前筛查。然而，在少数国家，主要是在南欧，对孕妇进行 CMV 感染筛查是常见做法。在妊娠早期（妊娠周龄≤14 周）发现 IgG+/IgM+和 IgG 亲和力滴度处于灰色区域的孕妇的管理，会给家庭和医护人员带来巨大压力。
在妊娠早期（妊娠周龄≤14 周）诊断为急性 CMV 感染（IgM+/IgG+）且 IgG 亲和力处于灰色区域的孕妇被转诊至我们的门诊进行前瞻性随访。我们为孕妇提供 CMV-HIG，并进行胎儿超声检查、CMV-DNA 检测的羊膜穿刺术和适当的 MRI。所有新生儿均通过尿 PCR 检查，并根据现有建议进行前瞻性随访。
90 名女性（平均年龄 30.8 岁）进行了回顾性分析。大多数（79.6%）接受了 CMV-HIG。4 名孕妇终止妊娠（2 例与 CMV 无关，2 例因羊水 CMV 阳性）。87 名婴儿出生时无症状。2 名新生儿被诊断为先天性 CMV 感染。总传播率为 4.4%；接受或不接受 CMV-HIG 的传播率分别为 4.3%和 5.6%。在随访期间（中位时间 24 个月）未发现不良结局。母亲年龄、产次、诊断时母体 CMV 病毒血症的检测、诊断与咨询的时间间隔、首次咨询时的妊娠周数、CMV-HIG 的使用和剂量均与垂直 CMV 传播的风险无关。
在妊娠早期急性 CMV 感染和 IgG 亲和力滴度处于灰色区域的孕妇中，CMV 感染的垂直传播率为 4.4%，高于妊娠中非原发性感染（NPI）后出生的婴儿。需要更多的研究来证明使用 CMV-HIG 可显著降低传播率。
