Citomegalovirus infection in pregnancy
DOI:
https://doi.org/10.6016/ZdravVestn.3220Keywords:
seroconversion, fetal infection, antiviral agents, hyperimmune globulin, screeningAbstract
Cytomegalovirus (CMV) is the most common viral cause of in utero foetal infection. The virus is neurotropic, so it mainly causes neurological complications. It represents the most common non-genetic cause of sensorineural hearing loss, neurological abnormalities, and mental retardation, and is the cause of prematurity, intrauterine foetal death and neonatal mortality. The infection is confirmed by detecting CMV-specific IgM and IgG antibodies, and IgG antibody avidity is used for determining the onset of infection. The presence of the virus is detected by PCR. Congenital infection is the result of viraemia during primary or secondary maternal infection. An intrauterine infection may present itself with characteristic ultrasound features. Prenatal diagnosis of congenital CMV infection is carried out by amniocentesis. Up to 15% of infants of mothers with a confirmed infection during pregnancy are symptomatic at birth. In symptomatic newborns, 40-60% suffer permanent sequelae, the most common of which is sensorineural hearing loss. Counseling a pregnant woman with primary CMV infection is difficult as we cannot accurately predict the foetal outcome based on the currently available data and research results. Estimates of the severity of the infection and possible consequences are based primarily on the timing of the infection, the presence and type of foetal abnormality, and on laboratory parameters. Routine treatment of pregnant women with confirmed CMV infection with the virostatic valacyclovir or with hyperimmune globulins is not recommended in the absence of sufficient evidence of their effectiveness. All pregnant women should be informed about the risks of CMV infection and the preventive measures to protect themselves against CMV infection in pregnancy. The review article summarizes the known facts regarding screening, diagnosis and treatment of cytomegalovirus infection in pregnancy, citing the latest findings and evidence, and presents an adaptation of foreign guidelines for good clinical practice in Slovenia.
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