Comprehensive review and update of cytomegalovirus infection in pregnancy

Abstract

Key Content Cytomegalovirus (CMV) is the most common cause of congenital viral infections; 75–90% of infections are asymptomatic at birth but 10–25% of infants will develop neurological sequelae. Diagnosis of primary maternal CMV in pregnancy should be based on seroconversion in pregnancy (de novo appearance of virus‐specific immunoglobulin G [IgG] in the serum of pregnant women who were previously seronegative) or on detection of specific immunoglobulin M (IgM) and IgG antibodies in association with low IgG avidity. Primary maternal infection is associated with a 30–40% risk of intrauterine transmission and fetal infection, with 20–25% of those infected developing sequelae postnatally. Prenatal diagnosis of fetal CMV is imperfect and based on amniocentesis performed at least 7 weeks after presumed maternal infection and after 21 weeks of gestation. The presence of radiologic findings by ultrasound in combination with CMV DNA viral load in amniotic fluid may have prognostic significance for risk of neurologic sequelae. Learning objectives To understand the prevalence, diagnosis and implications of CMV infection in pregnancy. To explore the management options in a pregnancy affected by congenital CMV. Ethical issues Should routine screening for CMV be recommended in pregnancy? How should termination counselling be conducted following prenatal confirmation of fetal infection with amniocentesis?

The Intergenerational Effects of Intimate Partner Violence in Pregnancy: Mediating Pathways and Implications for Prevention

“…Finally, alongside these general mechanisms, particular infective agents can have specific effects on neurodevelopment, for example, in the cases of cytomegalovirus (CMV) and zika virus (e.g. Navti et al, 2016).…”

“…This makes infection in the context of P-IPV a situation of particular risk of adverse offspring outcomes. Finally, alongside these general mechanisms, particular infective agents can have specific effects on neurodevelopment, for example, in the cases of cytomegalovirus and Zika virus (e.g., Navti, Hughes, Tang, & Konje, 2016).…”

Infections in pregnancy

“…CMV infection after 27 weeks is usually asymptomatic, despite transmission rate of 80% (To et al., 2009). In those with previous exposure to CMV, the transmission risk is 1–2.2% (Navti et al., 2016).…”

“…Between 10 and 15% of asymptomatic babies will develop progressive sensorineural hearing difficulty. In the UK, CMV has been implicated in 12% of sensorineural hearing loss and 8% of cerebral palsy (Navti et al., 2016).…”

“…In secondary care, fetal infection can be confirmed with amniocentesis performed after 21 weeks’ gestation once 7 weeks has elapsed since exposure; this will help to confirm the diagnosis of congenital CMV (Navti et al., 2016).…”