Prenatal predictors of adverse perinatal outcome in congenital cytomegalovirus infection: a retrospective multicenter study

Abstract

Objectives To identify predictors of adverse perinatal outcome in congenital cytomegalovirus (CMV) infection. Methods In a multicenter study fetuses with congenital CMV infection diagnosed by PCR on amniotic fluid and normal prenatal imaging at the time of diagnosis were included. Primary outcome was the occurrence of structural anomalies at follow-up ultrasound or prenatal magnetic resonance imaging (MRI). Secondary outcomes were the occurrence of anomalies detected exclusively postnatally and the rate of symptomatic infection. Results One hundred and four fetuses with congenital CMV were included in the study. Anomalies were detected at follow-up ultrasound or MRI in 18.3% (19/104) cases. Additional anomalies were found after birth in 11.9% (10/84) of cases and 15.5% (13/85) of newborns showed clinical symptoms related to CMV infection. There was no difference in either maternal age (p=0.3), trimester (p=0.4) of infection and prenatal therapy (p=0.4) between fetuses with or whiteout anomalies at follow-up. Conversely, median viral load in the amniotic fluid was higher in fetuses with additional anomalies at follow-up (p=0.02) compared to those without. At multivariate logistic regression analysis, high viral load in the amniotic fluid, defined as ≥100,000 copies/mL was the only independent predictor for the occurrence of anomalies detected exclusively at follow-up ultrasound assessment or MRI, with an OR of 3.12. Conclusions Viral load in the amniotic fluid is a strong predictor of adverse perinatal outcome in congenital CMV infection. The results of this study emphasize the importance of adequate follow up even in case of negative neurosonography to better predict postnatal adverse outcomes of infected newborns, especially in amniotic fluid high viral load.

Prognostic Value of Amniotic Fluid Viral Load to Predict Adverse Outcome in Pregnancies Complicated by Congenital Cytomegalovirus Infection: A Multicenter Study

“…We have previously reported that in fetuses with congenital CMV infection and no structural anomalies detected at prenatal imaging, the risk of symptomatic infection and long-term sequelae related to the infection is lower when compared to what was reported in studies not considering the role of fetal imaging in predicting the prognosis [11,15]. Some anomalies related to congenital CMV infection, especially those involving neuronal migration, such as microcephaly, are difficult to identify prenatally, thus making prediction of the short-term outcome of these fetuses challenging [26,27].…”

“…It remains the most common non-genetic cause of sensorineural hearing loss in infants [6][7][8]. Prenatal diagnosis of congenital CMV infection is accomplished through the identification of the virus in the amniotic fluid (AF) obtained at second trimester amniocentesis, at least 6-8 weeks after suspected maternal infection [9][10][11][12].…”

Effectiveness and safety of prenatal valacyclovir for congenital cytomegalovirus infection: systematic review and meta‐analysis

“…The risk of adverse events related to CMV once the infection is acquired by the fetus is low, thus requiring a large number of cases to demonstrate the efficacy of a given intervention. Furthermore, we could not perform subgroup analyses according to the magnitude of maternal viremia, type of CMV infection (primary vs non‐primary) or presence of ultrasound signs of the infection, as this information was not reported extensively in the included studies 31 . Finally, we could not elucidate the role of prenatal valacyclovir therapy in altering the risk of vertical transmission following maternal infection in the second and third trimesters of pregnancy because only one study with a very small number of included cases explored this outcome.…”

Fetal brain biometry and cortical development after maternal SARS‐CoV‐2 infection in pregnancy: A prospective case–control study

“…Maternal viral infections like Zika virus or cytomegalovirus may extensively impair prenatal brain. 6 , 7 The role of maternal SARS‐CoV‐2 illness in the prenatal maturation and growth of the central nervous system (CNS) is mostly unknown at this time but there are evidences in newborns and infants of the existence of neurological complication induced by the infection. 8 , 9 Although this hypothesized association, there are no studies evaluated the impact of SARS‐CoV‐2 disease on prenatal brain development.…”