Outcome of congenital cytomegalovirus (cCMV) infection in the absence of routine CMV screening and third-trimester scan in North America is scarcely documented. The aim of this study was to assess the severe outcomes related to cCMV according to the indication for screening.
This was a retrospective study of 84 mother-child pairs followed for cCMV between 2003 and 2017 at CHU Sainte-Justine in Montreal, Canada. Prenatal ultrasound, neonatal symptoms, neuroimaging and severe outcomes (cerebral palsy, severe cognitive impairment, bilateral hearing loss or neonatal death) were reviewed.
Among 38 cases with abnormal prenatal ultrasound, 41.9% of live-born infants developed severe outcomes. Sixteen (42.1%) were detected in the third trimester. Among 16 cases diagnosed prenatally because of maternal history, all had normal prenatal ultrasound, and none developed severe outcomes. Among cases diagnosed postnatally because of neonatal symptoms, 25% developed severe outcomes. All infants who developed severe outcomes had moderate/severe neonatal symptoms.
Outcome of cCMV infection varies according to the reason for screening and timing of diagnosis. Any prenatal ultrasound anomaly might indicate a risk of severe outcome, and warrants a detailed ultrasound scan. However, late detection, or postnatal diagnosis, represented more than half of the cases, and awareness of this will help ensuring optimal management.
Cannon MJ, Schmid DS, Hyde TB. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Rev Med Virol 2010;20:202–13.
Colugnati FA, Staras SA, Dollard SC, Cannon MJ. Incidence of cytomegalovirus infection among the general population and pregnant women in the United States. BMC Infect Dis 2007;7:71.
Lamarre V, Gilbert NL, Rousseau C, Gyorkos TW, Fraser WD. Seroconversion for cytomegalovirus infection in a cohort of pregnant women in Quebec, 2010–2013. Epidemiol Infect 2016;144:1701–9.
Rawlinson WD, Boppana SB, Fowler KB, Kimberlin DW, Lazzarotto T, Alain S, et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis 2017;17:e177–88.
Yinon Y, Farine D, Yudin MH. No. 240-Cytomegalovirus infection in pregnancy. J Obstet Gynaecol Can 2018;40:e134–41.
Society for Maternal-Fetal Medicine, Hughes BL, Gyamfi-Bannerman C. Diagnosis and antenatal management of congenital cytomegalovirus infection. Am J Obstet Gynecol 2016;214:B5–11.
Vaudry W, Lee BE, Rosychuk RJ. Congenital cytomegalovirus infection in Canada: active surveillance for cases diagnosed by paediatricians. Paediatr Child Health 2014;19:e1–5.
Leruez-Ville M, Stirnemann J, Sellier Y, Guilleminot T, Dejean A, Magny JF, et al. Feasibility of predicting the outcome of fetal infection with cytomegalovirus at the time of prenatal diagnosis. Am J Obstet Gynecol 2016;215:342.e1–9.
Leyder M, Vorsselmans A, Done E, Van Berkel K, Faron G, Foulon I, et al. Primary maternal cytomegalovirus infections: accuracy of fetal ultrasound for predicting sequelae in offspring. Am J Obstet Gynecol 2016;215:638.e1–8.
Guerra B, Simonazzi G, Puccetti C, Lanari M, Farina A, Lazzarotto T, et al. Ultrasound prediction of symptomatic congenital cytomegalovirus infection. Am J Obstet Gynecol 2008;198:380.e1–7.
Faure-Bardon V, Magny JF, Parodi M, Couderc S, Garcia P, Maillotte AM, et al. Sequelae of congenital cytomegalovirus (cCMV) following maternal primary infection are limited to those acquired in the first trimester of pregnancy. Clin Infect Dis 2019;69:1526–32.
Lausman A, Kingdom J, Maternal Fetal Medicine Committee. Intrauterine growth restriction: screening, diagnosis, and management. J Obstet Gynaecol Can 2013;35:741–8.
Kakkar F, Boucoiran I. The Women and Children’s Infectious Diseases Center: an integrated approach to congenital infectious diseases. Clin Invest Med 2019;41:E211–2.
Delforge ML, Costa E, Brancart F, Goldman D, Montesinos I, Zaytouni S, et al. Presence of Cytomegalovirus in urine and blood of pregnant women with primary infection might be associated with fetal infection. J Clin Virol 2017;90:14–7.
Enders G, Daiminger A, Bader U, Exler S, Enders M. Intrauterine transmission and clinical outcome of 248 pregnancies with primary cytomegalovirus infection in relation to gestational age. J Clin Virol 2011;52:244–6.
Nigro G, Adler SP, La Torre R, Best AM, Congenital Cytomegalovirus Collaborating Group. Passive immunization during pregnancy for congenital cytomegalovirus infection. N Engl J Med 2005;353:1350–62.
Gunkel J, Nijman J, Verboon-Maciolek MA, Wolfs T, de Vries LS. International opinions and national surveillance suggest insufficient consensus regarding the recognition and management practices of infants with congenital cytomegalovirus infections. Acta Paediatr 2017;106:1493–8.
Grandjean Lapierre S, Vallieres E, Rabaamad L, Labrecque M, Chartrand C, Renaud C. Evaluation of the Abbott ARCHITECT cytomegalovirus IgM/IgG, rubella IgM/IgG, and syphilis treponemal antibodies enzyme immunoassays in a mother and child health center population. Diagn Microbiol Infect Dis 2019;94:231–5.
Minsart A, Smiljkovic M, Renaud C, Gagné M, Lamarre V, Kakkar F, et al. Use of cytomegalovirus-specific hyperimmunoglobulins in pregnancy: a retrospective cohort. J Obstet Gynaecol Can 2018;40:1409–16.
Luck SE, Wieringa JW, Blazquez-Gamero D, Henneke P, Schuster K, Butler K, et al. Congenital cytomegalovirus: a European expert consensus statement on diagnosis and management. Pediatr Infect Dis J 2017;36:1205–13.
Smiljkovic M, Renaud C, Tapiero B, Lamarre V, Kakkar F. Head ultrasound, CT or MRI? The choice of neuroimaging in the assessment of infants with congenital cytomegalovirus infection. BMC Pediatr 2019;19:180.
Giannattasio A, Di Costanzo P, De Matteis A, Milite P, De Martino D, Bucci L, et al. Outcomes of congenital cytomegalovirus disease following maternal primary and non-primary infection. J Clin Virol 2017;96:32–6.
Ancora G, Lanari M, Lazzarotto T, Venturi V, Tridapalli E, Sandri F, et al. Cranial ultrasound scanning and prediction of outcome in newborns with congenital cytomegalovirus infection. J Pediatr 2007;150:157–61.
Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997;39:214–23.
de Kleijn JL, van Kalmthout LWM, van der Vossen MJB, Vonck BMD, Topsakal V, Bruijnzeel H. Identification of pure-tone audiologic thresholds for pediatric cochlear implant candidacy: a systematic review. JAMA Otolaryngol Head Neck Surg 2018;144:630–8.
Lipitz S, Yinon Y, Malinger G, Yagel S, Levit L, Hoffman C, et al. Risk of cytomegalovirus-associated sequelae in relation to time of infection and findings on prenatal imaging. Ultrasound Obstet Gynecol 2013;41:508–14.
Benoist G, Salomon LJ, Jacquemard F, Daffos F, Ville Y. The prognostic value of ultrasound abnormalities and biological parameters in blood of fetuses infected with cytomegalovirus. Br J Obstet Gynaecol 2008;115:823–9.
Farkas N, Hoffmann C, Ben-Sira L, Lev D, Schweiger A, Kidron D, et al. Does normal fetal brain ultrasound predict normal neurodevelopmental outcome in congenital cytomegalovirus infection? Prenat Diagn 2011;31:360–6.
Birnbaum R, Ben-Sira L, Lerman-Sagie T, Malinger G. The use of fetal neurosonography and brain MRI in cases of cytomegalovirus infection during pregnancy: a retrospective analysis with outcome correlation. Prenat Diagn 2017;37:1335–42.
Cannie MM, Devlieger R, Leyder M, Claus F, Leus A, De Catte L, et al. Congenital cytomegalovirus infection: contribution and best timing of prenatal MR imaging. Eur Radiol 2016;26:3760–9.
Corresponding author: Dr. Isabelle Boucoiran, MD, MSc, Women and Children Infectious Diseases Center, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, H3T 1C5, QC, Canada; and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada, Tel.: +1 514 345-4931 #4909, Fax: +1 514 345-4878
The Journal of Perinatal Medicine is a truly international forum covering the entire field of perinatal medicine. It is an essential news source for all those obstetricians, neonatologists, perinatologists and allied health professionals who wish to keep abreast of progress in perinatal and related research.
01 Jan 1973
Eduardo Bancalari, Joseph Chappelle, Frank A. Chervenak, Vincenzo D'Addario, Mehmet R. Genc, Anne Greenough, Amos Grunebaum, Justin C. Konje, Asim Kurjak M.D., Roberto Romero and Ivica Zalud, MD PhD