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Fetal abnormalities, uterine secretion predictive of congenital CMV in pregnant women
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Fetal abnormalities and the presence of cytomegalovirus DNA in uterine cervical secretion were both independent predictors of congenital cytomegalovirus in pregnant women, researchers in Japan found.
“It is well known that ultrasound fetal abnormalities, including ventriculomegaly, microcephaly, intracranial calcification, fetal growth restriction, pleural effusion, ascites, hepatosplenomegaly and periventricular/intestinal high echogenicity are closely associated with fetal CMV infection,” Kenji Tanimura, MD, PhD, of the department of obstetrics and gynecology, Kobe University Graduate School of Medicine, Kobe, Japan, and colleagues wrote. “PCR assay for CMV-DNA in the amniotic fluid are highly sensitive and specific for fetal CMV infection, though amniocentesis is essentially an invasive procedure with a risk of rupture for the membranes. However, no study has evaluated whether a positive PCR result for CMV-DNA in maternal urine or uterine cervical secretion is a predictive factor for congenital CMV infection.”
Researchers evaluated ultrasound findings, serum CMV IgM, IgG, IgG avidity index and C7-HRP tests, and conducted PCR assays to detect CMV-DNA in the serum, urine and uterine cervical secretion of 300 women with CMV infections. Tanimura and colleagues performed univariate and multivariable logistic regression analyses to identify predictive factors for congenital CMV.
PCR assays identified congenital infection in 22 women, the researchers reported. Univariate analyses identified several factors associated with possible infection, including fetal abnormalities (OR = 35.2; 95% CI, 11.3-109.9), maternal flu-like symptoms (OR = 2.5; 95% CI, 1-6.2), positive plasma C7-HRP assay (OR = 15.3; 95% CI, 2-115.3), serum titers of CMV IgM (OR = 1.3; 95% CI, 1.1-1.4), CMV IgG AI less than 40% (OR = 8.2; 95% CI, 3.2-20.9) and positive PCR results in uterine cervical secretion (OR = 18; 95% CI, 6.7-48.7). The presence of CMV-DNA in cervical uterine secretion (OR = 16.4; 95% CI, 5-54.1) and fetal abnormalities detected by ultrasound (OR = 31.9; 95% CI, 8.5-120.3) were independent factors of congenital CMV infection, according to a multivariate analysis.
“The results of the present study suggest that maternal universal screening of CMV IgG and CMV IgM followed by ultrasound examinations and PCR assays for CMV-DNA in the cervical secretion only for women with positive CMV IgM may be useful to determine pregnancies with higher risks of fetal CMV infection cost-effectively,” the researchers wrote. “The early assessment and detection may lead to accurate diagnosis as well as early commencement of antiviral therapy.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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