Intrauterine transmission and clinical outcome of 248 pregnancies with primary cytomegalovirus infection in relation to gestational age

Enders, Gisela; Daiminger, Anja; Bäder, Ursula; Exler, Simone; Enders, Martin

doi:10.1016/j.jcv.2011.07.005

Cited by 270 publications

(232 citation statements)

References 14 publications

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“…[12][13][14][15][16][17][18][19][20] We report important data concerning the rate of maternal-fetal transmission before and during pregnancy and confirm that symptomatic congenital CMV infections are hardly observed if maternal infection occurs after 14 WG. We found far fewer maternal symptoms than previously reported (21% in our cohort vs 68-73.5% in Revello et al 17,21,22 and 60% in Nigro et al 22 ).…”

Section: Discussionsupporting

confidence: 70%

“…He found a vertical transmission rate in the preconceptional and periconceptional groups of 0/3 (0%) and 9/20 (45%), respectively. Using the same definition, Enders 15 found a vertical transmission rate in the preconceptional and periconceptional groups of 4/24 (16.7%) and 10/26 (38.5%), respectively. Revello et al in 2002 analyzed the risk of maternal transmission associated 'with primary CMV infection acquired <3 months before the last menstrual period (preconceptional infection) or in the first 4 weeks after the last menstrual period (periconceptional infection)'.…”

Section: Discussionmentioning

confidence: 98%

“…In their literature review, Revello et al did not find any symptomatic cases when the maternal infection occurred in the third trimester, and less than 5% were symptomatic in second trimester cases. 21 Gindes et al, 19 Feldman et al 16 and Enders et al, 15 respectively, reported 20, 17 and 36 cases of infected fetuses after 25 weeks of gestation, and none were symptomatic at birth. In our series, we did not find symptomatic cases when maternal infection occurred after 14 weeks of gestation (20 infected newborns).…”

Section: Discussionmentioning

confidence: 99%

“…Each subject included had maternal primary CMV infection assessed by serology analysis and precise gestational dating. Subjects were classified in different subgroups according to the time of maternal infection: preconceptional (2 months to 3 weeks before the date of conception), periconceptional (3 weeks before to 3 weeks after the date of conception), or first (3-14 weeks of gestation [WG]), second (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) or third trimester of pregnancy (28 WG up to delivery). Subjects with imprecise date of maternal infection were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

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A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome

et al. 2013

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Objective To analyze the outcome of maternal primary cytomegalovirus (CMV) infection.Methods Retrospective analysis of a cohort of 238 patients with maternal primary CMV infection detected at routine screening. The cases were managed with serial ultrasound (US) scans, and amniocentesis was performed in 36.1% of cases. All prenatal results were confirmed at birth. ResultsThe average age was 31.9 (18-44) years. Patients were symptomatic in 21% of cases. The rate of intrauterine transmission was 24.9%, and it was 8.8%, 19%, 30.6%, 34.1% and 40% in the preconceptional period, the periconceptional period, and the first, second and third trimesters of pregnancy, respectively (p = 0.025). There was a significantly higher risk of US abnormalities when maternal infection occurred during the preconceptional or periconceptional period and the first trimester compared with later (p < 0.001). Because of US abnormalities, pregnancy was terminated in 18 cases at the parents' request. Three infected newborns were symptomatic; all three cases were suspected at US before birth. We did not observe any symptomatic fetal infection when maternal infection occurred after 14 weeks of gestation. A number of clinically asymptomatic cases (5.5%) developed hearing loss. ConclusionThe rate of materno fetal transmission is linearly correlated to the gestational age at infection. No severe case of congenital infection was observed if maternal infection occurred after 14 weeks of gestation.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome

et al. 2013

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“…29 CSN infection of newborn mice consistently results in widespread, focal, non-necrotizing encephalitis and defects in brain development. 28 It should be stated that the neonatal mouse CNS is embryologically equivalent to the human fetus at 15 weeks of gestation and that HCMV infection in humans is most frequently acquired during the early periods of the second trimester of pregnancy; 30 therefore, CNS disease in newborn mice closely mimics that associated with vertically transmitted HCMV infection in humans. 22 Finally, mice infected with MCMV during the neonatal period exhibit neurobehavioral sequelae, such as impaired performance on a stationary balance beam and sensorineural hearing loss, as adult animals (Britt WJ, 2014, unpubl.…”

mentioning

confidence: 99%

Immunobiology of congenital cytomegalovirus infection of the central nervous system—the murine cytomegalovirus model

et al. 2014

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Congenital human cytomegalovirus infection is a leading infectious cause of long-term neurodevelopmental sequelae, including mental retardation and hearing defects. Strict species specificity of cytomegaloviruses has restricted the scope of studies of cytomegalovirus infection in animal models. To investigate the pathogenesis of congenital human cytomegalovirus infection, we developed a mouse cytomegalovirus model that recapitulates the major characteristics of central nervous system infection in human infants, including the route of neuroinvasion and neuropathological findings. Following intraperitoneal inoculation of newborn animals with mouse cytomegalovirus, the virus disseminates to the central nervous system during high-level viremia and replicates in the brain parenchyma, resulting in a focal but widespread, non-necrotizing encephalitis. Central nervous system infection is coupled with the recruitment of resident and peripheral immune cells as well as the expression of a large number of pro-inflammatory cytokines. Although infiltration of cellular constituents of the innate immune response characterizes the early immune response in the central nervous system, resolution of productive infection requires virus-specific CD8 1 T cells. Perinatal mouse cytomegalovirus infection results in profoundly altered postnatal development of the mouse central nervous system and long-term motor and sensory disabilities. Based on an enhanced understanding of the pathogenesis of this infection, prospects for novel intervention strategies aimed to improve the outcome of congenital human cytomegalovirus infection are proposed.

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Preliminary Results From the US Zika Pregnancy Registry

Muller

2017

JAMA

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Intrauterine transmission and clinical outcome of 248 pregnancies with primary cytomegalovirus infection in relation to gestational age

Cited by 270 publications

References 14 publications

A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome

A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome

Immunobiology of congenital cytomegalovirus infection of the central nervous system—the murine cytomegalovirus model

Preliminary Results From the US Zika Pregnancy Registry

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