Treatment of pregnant women with CMV-specific hyperimmune globulin is safe, and the findings of this nonrandomized study suggest that it may be effective in the treatment and prevention of congenital CMV infection. A controlled trial of this agent may now be appropriate.

In animal studies, exposure to organochlorine pesticides such as DDT and its metabolite DDE is associated with adverse reproductive outcomes. Human studies have, however, yielded inconsistent results. The authors analyzed data from the Child Health and Development Studies, a longitudinal follow-up study of 20,754 pregnancies in women living in the San Francisco Bay area in the years 1959-1967. Relationships were sought between maternal serum levels of DDT and DDE and preterm birth, small-for-gestational-age (SGA) birth, birth weight, and gestational age in 420 males. Multivariate logistic regression analysis was used for data on preterm and SGA births, and linear regression analysis for birth weight and gestational age.The median maternal serum levels of DDE and DDT were 43 and 11 g/L, respectively, figures several times higher than current concentrations in the United States. The adjusted odds ratio for preterm birth was 1.28 (95% confidence interval [CI], 0.73-2.23) for DDE and 0.94 (95% CI, 0.50-1.78) for DDT. For SGA birth, the odds ratios were 0.75 (95% CI, 0.44-1.26) for DDE and 0.69 (95% CI, 0.73-1.27) for DDT. No significant relationships or even trends were found between maternal serum concentrations of DDT or DDE and birth weight or length of gestation. None of the reproductive outcomes were significantly associated with the DDE:DTT ratio.These findings do not rule out the possibility that serum pesticide levels may have modest effects on reproductive outcomes, but there is no epidemiologic support for strong causal relationships between DDT or DDE and unfavorable outcomes in male infants. Further studies are appropriate because of the major current role of DDT in preventing malaria.

Primary maternal CMV infection and fetal or neonatal disease are associated with sonographically thickened placentas, which respond to administration of hyperimmune globulin. These observations suggest that many of the manifestations of fetal and neonatal disease are caused by placental insufficiency.

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There is great interest in new procedures for morbid obesity that could offer lower morbidity than current options. Early experience with the TOGa procedure indicates that this transoral approach may be safe and feasible. Further experience with the device and technique should improve anatomic and functional outcomes in the future. Additional studies are underway.

The outcomes of the infants born to HIG-treated mothers support the efficacy of HIG as a treatment for CMV-infected fetuses with ultrasound cerebral abnormalities.

We provide a literature review of prenatal diagnosis of PS to identify ultrasound features that may be supportive in the diagnosis of this rare disease, helping in making a differential diagnosis with the other possible craniosynostosis syndromes and in suggesting gene molecular testing.

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