Fourth Department of Internal Medicine, University General Hospital Attikon, National and Kapodistrian University of Athens, 12462 Athens, Greece.
Department of Infectious Diseases, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK.
Viruses. 2024 Aug 2;16(8):1241. doi: 10.3390/v16081241.
Primary cytomegalovirus infection during pregnancy has a high risk of vertical transmission, with severe fetal sequelae mainly associated with first-trimester infections. We conducted a retrospective analysis of 200 IU/kg cytomegalovirus-specific hyperimmune globulin (HIG), used in first-trimester maternal primary infections for congenital infection prevention. The primary outcome was vertical transmission, defined as neonatal viruria or positive amniocentesis if pregnancy was discontinued. HIG, initially administered monthly and since 2019 biweekly, was discontinued in negative amniocentesis cases. Women declining amniocentesis and positive amniocentesis cases with normal sonography were offered monthly HIG until delivery as a treatment strategy. The total transmission rate was 29.9% (32/107; 10 pregnancy terminations with positive amniocentesis, 18 completed pregnancies with positive amniocentesis and 4 declining amniocentesis). Maternal viremia was the only factor associated with fetal transmission (OR 4.62, 95% CI 1.55-13.74). The transmission rate was not significantly different whether HIG was started during the first or second trimester (28.2% vs. 33.3%; 0.58), or between monthly and biweekly subgroups (25.7% vs. 37.8%, 0.193). Pre-treatment maternal viremia could inform decisions as a predictor of congenital infection.
孕妇原发性巨细胞病毒感染具有较高的垂直传播风险，严重的胎儿后遗症主要与妊娠早期感染相关。我们对 200IU/kg 的巨细胞病毒特异性免疫球蛋白（HIG）进行了回顾性分析，用于预防妊娠早期母体原发性感染的先天性感染。主要结局是垂直传播，定义为新生儿病毒尿症或妊娠停止时羊水阳性。如果羊水阴性，HIG 初始每月给药，自 2019 年以来每两周给药一次，停药。拒绝羊膜穿刺术和羊水阳性但超声检查正常的孕妇，作为治疗策略，每月给予 HIG 直至分娩。总传播率为 29.9%（32/107；10 例因羊水阳性而终止妊娠，18 例因羊水阳性而完成妊娠，4 例拒绝羊水穿刺）。母体病毒血症是与胎儿传播唯一相关的因素（OR 4.62，95%CI 1.55-13.74）。HIG 起始于妊娠早期还是妊娠中期、每月或每两周分组之间的传播率无显著差异（28.2% vs. 33.3%；0.58；25.7% vs. 37.8%，0.193）。治疗前母体病毒血症可作为先天性感染的预测指标，为决策提供信息。
