Current practices of management of maternal and congenital Cytomegalovirus infection during pregnancy after a maternal primary infection occurring in first trimester of pregnancy: Systematic review

Abstract

Introduction Congenital CMV infection is the first worldwide cause of congenital viral infection but systematic screening of pregnant women and newborns for CMV is still debated in many countries. Objectives This systematic review aims to provide the state of the art on current practices concerning management of maternal and congenital CMV infection during pregnancy, after maternal primary infection (PI) in first trimester of pregnancy. Data sources Electronically searches on databases and hand searches in grey literature. Study eligibility criteria and participants Primary outcome was listing biological, imaging, and therapeutic management interventions in two distinct populations: population 1 are pregnant women with PI, before or without amniocentesis; population 2 are pregnant women with congenitally infected fetuses (after positive amniocentesis). Secondary outcome was pregnancy outcome in population 2. Results Out of 4,134 studies identified, a total of 31 studies were analyzed, with 3,325 pregnant women in population 1 and 1,021 pregnant women in population 2, from 7 countries (Belgium, France, Germany, Israel, Italy, Spain and USA). In population 1, ultrasound (US) examination frequency was 0.75/month, amniocentesis in 82% cases, maternal viremia in 14% and preventive treatment with hyperimmune globulins (HIG) or valaciclovir in respectively 14% and 4% women. In population 2, US examination frequency was 1.5/month, magnetic resonance imaging (MRI) in 44% cases at 32 weeks gestation (WG), fetal blood sampling (FBS) in 24% at 28 WG, and curative treatment with HIG or valaciclovir in respectively 9% and 8% patients. Conclusions This systematic review illustrates management of maternal and congenital CMV during pregnancy in published and non-published literature, in absence of international consensus. Systematic review registration PROSPERO CRD42019124342

Cost‐effectiveness of screening and valacyclovir‐based treatment strategies for first‐trimester cytomegalovirus primary infection in pregnant women in France

“…Regarding management of pregnancies, we made the following assumptions. After diagnosis of fetal infection by amniocentesis, specific ultrasound monitoring is performed and the TOP rate after detection of T1 PI depends on the presence of ultrasound abnormalities (TOP rate, 42% with and 23% without US abnormalities) 25 . The rate of TOP after detection of NPI with abnormal ultrasound findings is unknown, but we applied a linear distribution to estimate this parameter from the available published data for PI (Table 2).…”

“…All parameters (probabilities of occurrence and costs) are described and the relevant literature cited in Table 2 and Tables S1 and S2. It was assumed that management of pregnant women with T1 PI and their CMV‐infected fetus is performed as recommended in a recent systematic review 25 .…”

Congenital Cytomegalovirus in Algiers, Algeria, a Descriptive Case Series Study

“…The data on this side effect is poor; we found two cases reporting convulsive seizures after using gancyclovir in a man diagnosed with acquired immunodeficiency syndrome and a disseminated cytomegalovirus infection patient who experienced seizures following ganciclovir administration. Seizures began one month after initiation of therapy and worsened with increasing dosages [38,39]. For all congenital CMV infections, a neurodevelopmental, neurosensory, and ophthalmological follow-up is required.…”

Congenital cytomegalovirus infection with brainstem hemorrhage and polymicrogyria: Necropsic and histopathological findings

“…The rate of transmission to the fetus increases as pregnancy progresses, with the highest risk in the third trimester. However, fetal exposure in the first months of gestation carries a higher probability of sequelae 4 . Clinically it is characterized by the presence of chorioretinitis, ventriculomegaly, periventricular or intracerebral calcifications, sensorineural hearing loss, and developmental delay, although the pathologic spectrum includes many other manifestations 5 .…”

“…However, fetal exposure in the first months of gestation carries a higher probability of sequelae. 4 Clinically it is characterized by the presence of chorioretinitis, ventriculomegaly, periventricular or intracerebral calcifications, sensorineural hearing loss, and developmental delay, although the pathologic spectrum includes many other manifestations. 5 Prenatal diagnosis combines maternal serology with amniocentesis.…”