Diagnosis of and Screening for Cytomegalovirus Infection in Pregnant Women

Abstract

No single diagnostic test for cytomegalovirus (CMV) infection is currently available for pregnant women at all stages of gestation. Improved accuracy in estimating the timing of primary infections can be used to identify women at higher risk of giving birth to congenitally infected infants. A diagnostic algorithm utilizing immunoglobulin G (IgG), IgM, and IgG avidity was used to prospectively screen serum from 600 pregnant women enrolled from two groups: <20 weeks gestation (n ‫؍‬ 396) or >20 weeks gestation (n ‫؍‬ 204). PCR testing of urine and/or blood was performed on all seropositive women (n ‫؍‬ 341). The majority (56.8%) of women were CMV IgG seropositive, with 5.5% being also CMV IgM positive. In the IgM-positive women, 1.2% had a low-avidity IgG, indicating a primary CMV infection and a high risk of intrauterine transmission. Two infants with asymptomatic CMV infection were born of mothers who had seroconverted in the second trimester of pregnancy. Baseline, age-stratified CMV serostatus was established from 1,018 blood donors. Baseline seropositivity from a blood donor population increased with age from 34.9% seroprevalence at less than 20 years of age to 72% seroprevalence at 50 years of age. Women at high risk of intrauterine transmission of CMV were identified at all stages of gestation. Women infected with CMV during late gestation may be more likely to transmit the virus, so failure to detect seroconversions in late gestation may result in failure to detect infected neonates.Human cytomegalovirus (CMV) is the most common cause of congenital malformation resulting from viral intrauterine infection in developed countries (12,21,48). Primary CMV infection occurs in 0.15 to 2.0% of all pregnancies and may be transmitted to the fetus in up to 40% of cases (48). Up to 15% of intrauterine CMV infections result in symptomatic congenital disease at birth, and 10 to 15% of those born with asymptomatic congenital CMV will develop significant clinical sequelae in infancy (7,10,18). In utero transmission of CMV can occur during primary maternal infection, reactivation, or reinfection of seropositive mothers. Most concern centers on primary maternal infection, due to the potential for significant fetal damage when the infection is acquired and transmitted during the first trimester (30, 48). Perinatal infections can result through virus transmission from many parts of the birth canal (39); however, the majority of these infections are asymptomatic (43).The usefulness of prenatal testing for CMV has been questioned due to the absence of clearly effective intervention (1, 27) and to evidence for severe congenital malformation resulting from viral reactivation (6,8,20). Continuing advancements in technology, however, mean reliable and inexpensive serologic tests are available, prenatal diagnostic procedures with acceptable negative predictive values (NPV) can be performed, and trials of neonatal antiviral treatments are ongoing (25,34,37,50,52). Proposed diagnostic algorithms have focused on first-trimester screeni...

Frequency of Human Cytomegalovirus and Human Herpesvirus-1 Antigens in Product of Conceptus Tissues of Pregnant Women With Spontaneous Abortion

“…The current study had demonstrated that HCMV infection in pregnant women with spontaneous abortion was 36%, this result is comparable with result of a study done in Erbil city, which found that the seropositivity was 30.05% (18) . However, other studies showed higher rate than result of present study, which reported a detection rates ranged between 62.3% and 81.1% (19,20) . When compare to studies conducted in Arabic countries such as Tunisia, where a 96.3% seroprevalence of HCMV antibody was reported among 404 Tunisian pregnant women (21) .…”

“…Human cytomegalovirus is found universally throughout all geographic locations and in all socioeconomic groups (19) . Also, this result agrees with Pechaham et al 2001 (29) .…”

Human cytomegalovirus infection in women of childbearing age throughout Fars Province - Iran: a population-based cohort study

“…IgG prevalence is between 40% to 100%; while IgM seroprevalence rate is between 0% to 10%, depending on the variability of viral accessibility and its circulation rate in the community (Ray and Mahajan,1997;Mustakangas et al, 2000;Turbadkar et al, 2000;Brooks et al, 2001;Munro et al, 2005). As previously mentioned, our study indicated that IgG seroprevalence rate was 93.0 % that is comparable with those of developing countries (90% -100%) (Brooks et al, 2001;Munro et al, 2005).…”

“…IgG prevalence is between 40% to 100%; while IgM seroprevalence rate is between 0% to 10%, depending on the variability of viral accessibility and its circulation rate in the community (Ray and Mahajan,1997;Mustakangas et al, 2000;Turbadkar et al, 2000;Brooks et al, 2001;Munro et al, 2005). As previously mentioned, our study indicated that IgG seroprevalence rate was 93.0 % that is comparable with those of developing countries (90% -100%) (Brooks et al, 2001;Munro et al, 2005). In contrast, IgM seroprevalence rate 5.4% is very close to that reported in developed countries (3%-5.5%) (Ray and Mahajan,1997;Mustakangas et al, 2000;Turbadkar et al, 2000;Munro et al, 2005).These findings indicated the fact that by the age of 44 almost 93% of women had encountered hCMV, while active infection due to viral circulation occurred in 5.4% of the cases during child-bearing age.…”

Seroprevalence of Cytomegalovirus Antibodies and Primary Infection among Women and Infants in Iran: A Meta-Analysis

“…Patients with T cell immunodeficiency particularly fetus, preterm neonates, transplant receivers as well as HIV infected patients are at a higher risk of CMV infection. This virus is the most common factor for congenital and prenatal infections (5)(6)(7)(8)(9)(10).…”