Fetal cytomegalovirus infection

• Published in: Best practice & research. Clinical obstetrics & gynaecology 2017-01, Vol.38, p.97-107
• Main Authors: Leruez-Ville, Marianne, M.D., PhD, Ville, Yves, M.D., FRCOG
• Format: Article
• Language: English
• Subjects: Acyclovir - analogs & derivatives; Acyclovir - therapeutic use; Amniotic Fluid - virology; Antibodies, Viral - blood; Antiviral Agents - therapeutic use; Ascites - diagnostic imaging; Ascites - etiology; cytomegalovirus; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - congenital; Cytomegalovirus Infections - diagnosis; Cytomegalovirus Infections - drug therapy; DNA, Viral - analysis; Female; Fetal Diseases - diagnosis; Fetal Diseases - drug therapy; fetus; Humans; Hydrocephalus - diagnostic imaging; Hydrocephalus - etiology; Hydrops Fetalis - diagnostic imaging; Hydrops Fetalis - etiology; hyperimmune globulin; imaging; Immunization, Passive; Immunoglobulin G - blood; Immunoglobulin M - blood; Infectious Disease Transmission, Vertical - prevention & control; Lissencephaly - diagnostic imaging; Lissencephaly - etiology; Microcephaly - diagnostic imaging; Microcephaly - etiology; Obstetrics and Gynecology; Oligohydramnios - diagnostic imaging; Oligohydramnios - etiology; Polyhydramnios - diagnostic imaging; Polyhydramnios - etiology; Porencephaly - diagnostic imaging; Porencephaly - etiology; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - drug therapy; Seroconversion; serology; Ultrasonography, Prenatal; valaciclovir; Valine - analogs & derivatives; Valine - therapeutic use
• ISSN: 1521-6934; 1532-1932
• DOI: 10.1016/j.bpobgyn.2016.10.005

Cytomegalovirus (CMV) congenital infection affects 0.7% of live births worldwide and is the leading cause of congenital neurological handicap of infectious origin. However, systematic screening for this infection has not been implemented in pregnancy or at birth in any country. This apparent paradox had been justified by persisting gaps in the knowledge of this congenital infection: uncertain epidemiological data, difficulty in the diagnosis of maternal infection, absence of validated prenatal prognostic markers, unavailability of an efficient vaccine and scarcity of data available on the treatment. However, in the last decade, new data have emerged towards better management of this congenital infection, including solid epidemiological data, good evidence for the accuracy of diagnosis of maternal CMV infection and good evidence for the feasibility of predicting the outcome of fetal infection by a combination of fetal imaging and fetal laboratory parameters. There is also some evidence that valaciclovir treatment of mothers carrying an infected fetus is feasible, safe and might be effective. This review provides an update on the evidence for diagnosis, prognosis and treatment of congenital infection in the antenatal period. These suggest a benefit to a proactive approach for prenatal congenital infections.