Faculty of Medicine, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Greece.
Department of Obstetrics and Maternal-Fetal Medicine, Paris Descartes University, Necker-Enfants Malades Hospital, AP-HP, Paris, France.
Am J Obstet Gynecol. 2020 Dec;223(6):870-883.e11. doi: 10.1016/j.ajog.2020.05.038. Epub 2020 May 24.
Cytomegalovirus infection is the most frequent congenital infection and a major cause of long-term neurologic morbidity. The aim of this meta-analysis was to calculate the pooled rates of vertical transmission and fetal impairments according to the timing of primary maternal infection.
From inception to January 2020, MEDLINE, Scopus, Cochrane Library, and gray literature sources were used to search for related studies.
Cohort and observational studies reporting the timing of maternal cytomegalovirus infections and rate of vertical transmission or fetal impairments were included. The primary outcomes were vertical transmission and fetal insult, defined as either prenatal findings from the central nervous system leading to termination of pregnancy or the presence of neurologic symptoms at birth. The secondary outcomes included sensorineural hearing loss or neurodevelopmental delay at follow-up and prenatal central nervous system ultrasonography findings.
The pooled rates of the outcomes of interest with their 95% confidence intervals (CI) were calculated for primary maternal infection at the preconception period, periconception period, first trimester, second trimester, and third trimester.
A total of 17 studies were included. The pooled rates of vertical transmission (10 studies, 2942 fetuses) at the preconception period, periconception period, first trimester, second trimester, and third trimester were 5.5% (95% CI, 0.1-10.8), 21.0% (95% CI, 8.4-33.6), 36.8% (95% CI, 31.9-41.6), 40.3% (95% CI, 35.5-45.1), and 66.2% (95% CI, 58.2-74.1), respectively. The pooled rates of fetal insult in case of transmission (10 studies, 796 fetuses) were 28.8% (95% CI, 2.4-55.1), 19.3% (95% CI, 12.2-26.4), 0.9% (95% CI, 0-2.4%), and 0.4% (95% CI, 0-1.5), for maternal infection at the periconception period, first trimester, second trimester, and third trimester, respectively. The pooled rates of sensorineural hearing loss for maternal infection at the first, second, and third trimester were 22.8% (95% CI, 15.4-30.2), 0.1% (95% CI, 0-0.8), and 0% (95% CI, 0-0.1), respectively.
Vertical transmission after maternal primary cytomegalovirus infection increases with advancing pregnancy, starting from the preconception period. However, severe fetal impairments are rare after infection in the first trimester of pregnancy.
巨细胞病毒感染是最常见的先天性感染，也是长期神经发育障碍的主要原因。本荟萃分析的目的是根据母体原发性感染的时间计算垂直传播和胎儿损伤的累积率。
从建立到 2020 年 1 月，使用 MEDLINE、Scopus、Cochrane 图书馆和灰色文献来源搜索相关研究。
纳入报告母体巨细胞病毒感染时间和垂直传播或胎儿损伤率的队列和观察性研究。主要结局为垂直传播和胎儿损伤，定义为导致妊娠终止的中枢神经系统产前发现或出生时存在神经症状。次要结局包括随访时的感觉神经性听力损失或神经发育迟缓以及产前中枢神经系统超声检查结果。
为原发性母体感染的孕前、围孕期、孕早期、孕中期和孕晚期计算感兴趣结局的累积率及其 95%置信区间（CI）。
共纳入 17 项研究。孕前、围孕期、孕早期、孕中期和孕晚期垂直传播（10 项研究，2942 例胎儿）的累积率分别为 5.5%（95%CI，0.1-10.8）、21.0%（95%CI，8.4-33.6）、36.8%（95%CI，31.9-41.6）、40.3%（95%CI，35.5-45.1）和 66.2%（95%CI，58.2-74.1）。如果发生传播，胎儿损伤的累积率（10 项研究，796 例胎儿）分别为 28.8%（95%CI，2.4-55.1）、19.3%（95%CI，12.2-26.4）、0.9%（95%CI，0-2.4%）和 0.4%（95%CI，0-1.5%），母体感染分别发生在围孕期、孕早期、孕中期和孕晚期。母体在孕早期、孕中期和孕晚期感染后感觉神经性听力损失的累积率分别为 22.8%（95%CI，15.4-30.2）、0.1%（95%CI，0-0.8）和 0%（95%CI，0-0.1）。
母体原发性巨细胞病毒感染后垂直传播率随妊娠进展而增加，从孕前开始。然而，妊娠早期感染后严重的胎儿损伤很少见。
