Association of Mother-Infant Cytomegalovirus Infection, Rome, Italy.
Pediatric Unit, University of L'Aquila, Italy.
Clin Infect Dis. 2020 Sep 12;71(6):1491-1498. doi: 10.1093/cid/ciz1030.
After primary maternal cytomegalovirus (CMV) infection during pregnancy, infants are at risk for disease.
Factors predictive of infant outcome were analyzed in a database of 304 pregnant women with primary infection. These women were enrolled between 2010 and 2017 and delivered 281 infants, of whom 108 were CMV infected. Long term follow-up occurred for 173 uninfected and 106 infected infants at age 4 years (range, 1-8 years). One hundred fifty-seven women were treated with an average of 2 doses (range, 1-6 doses) of high-dose hyperimmune globulin (HIG: 200 mg/kg/infusion). We used a regression model to define predictors of fetal infection, symptoms at birth, and long-term sequelae; 31 covariates were tested.
Four factors predicted fetal infection: a 1.8-fold increase (30% vs 56%) in the rate of congenital infection without HIG (adjusted odds ratio [AOR], 5.2; P < .0001), a 1.8-fold increase (32% vs 56%) associated with maternal viral DNAemia prior to HIG administration (AOR, 3.0; P = .002), abnormal ultrasounds (AOR, 59; P = .0002), and diagnosis of maternal infection by seroconversion rather than avidity (AOR, 3.3; P = .007). Lack of HIG and abnormal ultrasounds also predicted symptoms (P = .001). Long-term sequelae were predicted by not receiving HIG (AOR, 13.2; P = .001), maternal infection in early gestation (odds ratio [OR], 0.9; P = .017), and abnormal ultrasounds (OR, 7.6; P < .003). Prevalence and copy/number of DNAemia declined after HIG.
Maternal viremia predicts fetal infection and neonatal outcome. This may help patient counseling. High-dose HIG may prevent fetal infection and disease and is associated with the resolution of DNAemia.
孕妇原发性巨细胞病毒（CMV）感染后，婴儿有患病风险。
对 2010 年至 2017 年间 304 名原发性感染孕妇的数据库中的婴儿结局预测因素进行分析。这些孕妇共分娩 281 名婴儿，其中 108 名 CMV 感染。173 名未感染和 106 名感染婴儿在 4 岁时（1-8 岁）进行了长期随访。157 名女性接受了平均 2 剂（1-6 剂）高剂量免疫球蛋白（HIG：200mg/kg/输注）治疗。我们使用回归模型来定义胎儿感染、出生时症状和长期后遗症的预测因素；测试了 31 个协变量。
四个因素预测胎儿感染：未使用 HIG 的先天性感染率增加 1.8 倍（30%对 56%）（调整优势比[OR]，5.2；P<0.0001），HIG 前母体病毒 DNA 血症增加 1.8 倍（32%对 56%）（OR，3.0；P=0.002），超声异常（OR，59；P=0.0002），以及通过血清转化而不是亲和力诊断母体感染（OR，3.3；P=0.007）。缺乏 HIG 和超声异常也预测了症状（P=0.001）。未接受 HIG（OR，13.2；P=0.001）、孕早期母体感染（OR，0.9；P=0.017）和超声异常（OR，7.6；P<0.003）预测了长期后遗症。HIG 后病毒血症和 DNA 拷贝/数量下降。
母体病毒血症预测胎儿感染和新生儿结局。这可能有助于患者咨询。高剂量 HIG 可能预防胎儿感染和疾病，并与 DNA 血症的消退相关。
