Obstetrics and Fetal Medicine Department, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France.
Université de Paris, Paris, France.
Ultrasound Obstet Gynecol. 2021 Oct;58(4):576-581. doi: 10.1002/uog.23685. Epub 2021 Sep 13.
Cytomegalovirus (CMV) maternal primary infection (MPI) in early pregnancy is the main risk factor for congenital CMV (cCMV) infection with long-term sequelae. Our aim was to evaluate, in a single center offering CMV serology screening at 11-14 gestational weeks, secondary prevention of cCMV by administration of high-dosage maternal oral valacyclovir (VACV) in the first trimester of pregnancy.
This was a case-control study in a longitudinal cohort of pregnancies with CMV-MPI diagnosed prior to 14 weeks of gestation by serology screening (immunoglobulin (Ig) M and IgG measurement and IgG avidity) between 2009 and 2020. From October 2019 onwards, all women presenting at our center with MPI before 14 weeks' gestation were offered treatment with high-dosage oral VACV (8 g/day, 4 g twice/day). We used propensity score matching to compare fetal infection rates in cases treated with maternal oral VACV (8 g/day) with those in untreated controls. Fetal infection was assessed following amniocentesis at 17-22 weeks of gestation, by polymerase chain reaction (PCR) analysis of amniotic fluid for viral DNA.
Of 310 cases of CMV-MPI identified, 269 underwent amniocentesis for PCR. Of these, 66 were offered, and 65 accepted, treatment with VACV. From the remaining untreated cases, we selected 65 controls, matched for proportion of periconceptional infections and gestational age at amniocentesis. VACV was initiated at a median gestational age of 12.71 (interquartile range (IQR), 10.00-13.86) weeks and the median duration of treatment was 35 (IQR, 26-54) days. On multivariate logistic regression, fetal infection was lower in the treated group (odds ratio, 0.318 (95% CI, 0.120-0.841); P = 0.021). One treated patient developed acute renal failure 4 weeks after initiation of VACV therapy, but this resolved within 5 days after treatment was stopped.
This study confirms the acceptability, tolerance and benefit of secondary prevention by VACV of cCMV infection in a clinical setting with a well-established routine maternal serum screening policy in the first trimester of pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
妊娠早期巨细胞病毒（CMV）原发感染（MPI）是导致先天性 CMV（cCMV）感染并伴有长期后遗症的主要危险因素。我们的目的是在一家提供 11-14 孕周 CMV 血清学筛查的中心，评估在妊娠早期给予高剂量母体口服缬昔洛韦（VACV）治疗以预防 cCMV。
这是一项回顾性队列研究，纳入了 2009 年至 2020 年间通过血清学筛查（免疫球蛋白（Ig）M 和 IgG 检测及 IgG 亲和性）在 14 孕周前诊断为 CMV-MPI 的孕妇。自 2019 年 10 月起，我们中心对所有在 14 孕周前出现 MPI 的孕妇，均给予高剂量口服 VACV（8g/天，4g 分两次服用）治疗。我们使用倾向评分匹配来比较接受母体口服 VACV（8g/天）治疗的病例与未接受治疗的对照组的胎儿感染率。通过对妊娠 17-22 周的羊水进行聚合酶链反应（PCR）分析以检测病毒 DNA，评估胎儿感染情况。
在 310 例 CMV-MPI 病例中，有 269 例行羊膜穿刺术进行 PCR。其中 66 例接受了 VACV 治疗，65 例接受了治疗。在其余未接受治疗的病例中，我们选择了 65 例匹配围孕期感染比例和羊膜穿刺术时孕周的对照组。VACV 中位起始孕周为 12.71（四分位距（IQR），10.00-13.86）周，中位治疗时间为 35（IQR，26-54）天。多变量逻辑回归显示，治疗组胎儿感染率较低（比值比，0.318（95%CI，0.120-0.841）；P=0.021）。1 例接受治疗的患者在开始 VACV 治疗后 4 周出现急性肾衰竭，但在停药后 5 天内恢复。
这项研究证实了在妊娠早期有良好的母体血清筛查政策的临床环境下，使用 VACV 进行 cCMV 感染的二级预防是可行的，且具有可接受性、耐受性和益处。© 2021 年国际妇产科超声学会。
