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Aust N Z J Obstet Gynaecol. 2016 Feb;56(1):9-18. doi: 10.1111/ajo.12408. Epub 2015 Sep 22.

Congenital cytomegalovirus infection in pregnancy: a review of prevalence, clinical features, diagnosis and prevention.

Author information

1
Serology and Virology Division (SAViD), Department of Microbiology, SEALS, Prince of Wales Hospital, Randwick, Australia.
2
School of Medical Sciences, Faculty of Medicine, University of New South Wales, Randwick, Australia.
3
Australian Centre for Perinatal Science, University of New South Wales, Randwick, Australia.
4
School of Biotechnology and Biomolecular Sciences, Faculty of Science, University of New South Wales, Randwick, Australia.
5
Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, Australia.
6
School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
7
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Sydney, New South Wales, Australia.

Abstract

Human cytomegalovirus (CMV) is under-recognised, despite being the leading infectious cause of congenital malformation, affecting ~0.3% of Australian live births. Approximately 11% of infants born with congenital CMV infection are symptomatic, resulting in clinical manifestations, including jaundice, hepatosplenomegaly, petechiae, microcephaly, intrauterine growth restriction and death. Congenital CMV infection may cause severe long-term sequelae, including progressive sensorineural hearing loss and developmental delay in 40-58% of symptomatic neonates, and ~14% of initially asymptomatic infected neonates. Up to 50% of maternal CMV infections have nonspecific clinical manifestations, and most remain undetected unless specific serological testing is undertaken. The combination of serology tests for CMV-specific IgM, IgG and IgG avidity provide improved distinction between primary and secondary maternal infections. In pregnancies with confirmed primary maternal CMV infection, amniocentesis with CMV-PCR performed on amniotic fluid, undertaken after 21-22 weeks gestation, may determine whether maternofetal virus transmission has occurred. Ultrasound and, to a lesser extent, magnetic resonance imaging are valuable tools to assess fetal structural and growth abnormalities, although the absence of fetal abnormalities does not exclude fetal damage. Diagnosis of congenital CMV infection at birth or in the first 3 weeks of an infant's life is crucial, as this should prompt interventions for prevention of delayed-onset hearing loss and neurodevelopmental delay in affected infants. Prevention strategies should also target mothers because increased awareness and hygiene measures may reduce maternal infection. Recognition of the importance of CMV in pregnancy and in neonates is increasingly needed, particularly as therapeutic and preventive interventions expand for this serious problem.

KEYWORDS:

congenital infection; cytomegalovirus; fetal diseases; hygiene; pregnancy; sensorineural hearing loss

PMID:
26391432
DOI:
10.1111/ajo.12408
[Indexed for MEDLINE]

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