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Purpose

The purpose of National Cytomegalovirus Registry for Pregnant Women is to develop a database of pregnant women in the U.S. who develop a congenital infection during pregnancy.

Other purposes of the registry include: raising the awareness of CMV among obstetricians, defining the impact of the infection nationally, and assist with vaccine and treatment development and research. Patient management consultation will be available, if requested by obstetricians.

Background

In the U.S., by age 70 years, nearly everyone acquires a CMV infection. Among Caucasian women between 18 and 40 years of age, approximately 60% are seronegative (have never had a CMV infection). Approximately 20% of African American women are seronegative. Regardless of race, between 0.5% and 3.0% of infants are congenitally infected with CMV; about 90% of these infants are asymptomatic and have no known sequelae. Approximately 10% of congenitally infected infants manifest a wide range of signs and symptoms. The most important sequelae of symptomatic congenital infection are mental impairment and deafness.

Symptomatic congenital infection of the fetus usually occurs when a woman’s first CMV infection occurs during pregnancy. In the United States approximately 60% of pregnant women are seronegative and between 1% and 2% will have a primary infection during pregnancy. The rate of CMV transmission to the fetus after a primary maternal infection during pregnancy is between 25% and 75% depending on gestational time of infection. Currently, in the United States, approximately 40,000 children are born with a congenital CMV infection each year. Of these, about 4,000 have symptoms at birth and will have severe sequelae including death, mental impairment, and/or deafness.

Congenital CMV is screened for in nearly all pregnancies via ultrasound examinations. Manifestations of fetal CMV infections include placental thickening, organomegaly, pyelectasis, megaloureter, ascites, fetal hydrops, abnormality of amniotic fluid, hepatomegaly, splenomegaly, microcephaly, cerebral ventriculomegaly, intracranial calcifications, hyperdense image in thalamic arteries, periventricular echodensities, hepatic echodensities, intestinal echodensities, and cystic structures in the germinal zone. When one or more of these abnormalities are identified via ultrasound, an amniocentesis is usually done to confirm a congenital CMV infection. Fetal symptoms, as evidence by ultrasound plus virus in the amniotic fluid, are almost always due to a primary CMV infection during pregnancy.

Currently many women with an infected fetus are being treated with passive immunization but outcomes are not being systematically evaluated.

References

  1. Guerra, B., Simonazzi, G., Puccetti, C., Lanari, M., Farina, A., Lazzarotto, T., and Rizzo, N. (2008). Ultrasound prediction of symptomatic congenital cytomegalovirus infection. Am. J. Obstet.
    Gynecol. /198, /380 e 1-7.
  2. Kenneson, A., and Cannon, M.J. (2007). Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev.
    Med. Virol. /17/, 253-276.
  3. Nigro, G., Adler, S.P., La Torre, R., and Best, A.M. (2005). Passive immunization during pregnancy for congenital cytomegalovirus infection.
    N. Engl. J. Med. /353,/ 1350-1362.
  4. Bodéus, M., Zech, F., Hubinont, C., Bernard, P., and Goubau, P.
    (2010). Human cytomegalovirus in utero transmission: Follow-up of 524 maternal seroconversions. J. Clin. Virol. /47/, 201-202.
  5. Fowler, K.B., Stagno, S., Pass, R.F., Britt, W.J., Boll, T.J., and Alford, C.A. (1992). The outcome of congenital cytomegalovirus infection in relation to maternal antibody status.
    N. Engl. J. Med. /326/, 663–667.

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