Timing of primary maternal cytomegalovirus infection and rates of vertical transmission and fetal consequences

被引:118
作者
Chatzakis, Christos [1 ]
Ville, Yves [2 ]
Makrydimas, George [3 ]
Dinas, Konstantinos [1 ]
Zavlanos, Apostolos [1 ]
Sotiriadis, Alexandros [1 ]
机构
[1] Aristotle Univ Thessaloniki, Dept Obstet & Gynecol 2, Fac Med, Ippokrateio Hosp Thessaloniki, Thessaloniki, Greece
[2] Paris Descartes Univ, Dept Obstet & Maternal Fetal Med, Necker Enfants Malad Hosp, AP HP, Paris, France
[3] Univ Hosp Ioannina, Dept Obstet & Gynecol, Ioannina, Greece
关键词
cytomegalovirus; magnetic resonance imaging findings; neuro-developmental delay; neurologic symptoms; primary infection; sensorineural hearing loss; timing; ultrasonography findings; vertical transmission; PRENATAL-DIAGNOSIS; NEURONAL DIFFERENTIATION; HEARING-LOSS; IN-UTERO; PREGNANCY; RISK; CELLS; EPIDEMIOLOGY; METAANALYSIS; REPLICATION;
D O I
10.1016/j.ajog.2020.05.038
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: Cytomegalovirus infection is the most frequent congenital infection and a major cause of long-term neurologic morbidity. The aim of this meta-analysis was to calculate the pooled rates of vertical transmission and fetal impairments according to the timing of primary maternal infection. DATA SOURCES: From inception to January 2020, MEDLINE, Scopus, Cochrane Library, and gray literature sources were used to search for related studies. STUDY ELIGIBILITY CRITERIA: Cohort and observational studies reporting the timing of maternal cytomegalovirus infections and rate of vertical transmission or fetal impairments were included. The primary outcomes were vertical transmission and fetal insult, defined as either prenatal findings from the central nervous system leading to termination of pregnancy or the presence of neurologic symptoms at birth. The secondary outcomes included sensorineural hearing loss or neurodevelopmental delay at follow-up and prenatal central nervous system ultrasonography findings. STUDY APPRAISAL AND SYNTHESIS METHODS: The pooled rates of the outcomes of interest with their 95% confidence intervals (CI) were calculated for primary maternal infection at the preconception period, periconception period, first trimester, second trimester, and third trimester. RESULTS: A total of 17 studies were included. The pooled rates of vertical transmission (10 studies, 2942 fetuses) at the preconception period, periconception period, first trimester, second trimester, and third trimester were 5.5% (95% CI, 0.1-10.8), 21.0% (95% CI, 8.4-33.6), 36.8% (95% CI, 31.9-41.6), 40.3% (95% CI, 35.5-45.1), and 66.2% (95% CI, 58.2-74.1), respectively. The pooled rates of fetal insult in case of transmission (10 studies, 796 fetuses) were 28.8% (95% CI, 2.4-55.1), 19.3% (95% CI, 12.2-26.4), 0.9% (95% CI, 0-2.4%), and 0.4% (95% CI, 0-1.5), for maternal infection at the periconception period, first trimester, second trimester, and third trimester, respectively. The pooled rates of sensorineural hearing loss for maternal infection at the first, second, and third trimester were 22.8% (95% CI, 15.4-30.2), 0.1% (95% CI, 0-0.8), and 0% (95% CI, 0-0.1), respectively. CONCLUSION: Vertical transmission after maternal primary cytomegalovirus infection increases with advancing pregnancy, starting from the preconception period. However, severe fetal impairments are rare after infection in the first trimester of pregnancy.
引用
收藏
页码:870 / +
页数:25
相关论文
共 58 条
[1]  
[Anonymous], 2014, Cochrane handbook for systematic reviews of interventions version 5.1.0
[2]  
[Anonymous], 2019, NEWCASTLE OTTAWA SCA
[3]   Vertically transmitted cytomegalovirus infection in newborn preterm infants [J].
Balcells, Carla ;
Botet, Francesc ;
Gayete, Sonia ;
Angeles Marcos, M. ;
Dorronsoro, Izaskun ;
de Alba, Concepcion ;
Figueras-Aloy, Josep .
JOURNAL OF PERINATAL MEDICINE, 2016, 44 (05) :485-490
[4]   Anticytomegalovirus IgG avidity in pregnancy:: A 2-year prospective study [J].
Bodéus, M ;
Van Ranst, M ;
Bernard, P ;
Hubinont, C ;
Goubau, P .
FETAL DIAGNOSIS AND THERAPY, 2002, 17 (06) :362-366
[5]   Increased risk of cytomegalovirus transmission in utero during late gestation [J].
Bodéus, M ;
Hubinont, C ;
Goubau, P .
OBSTETRICS AND GYNECOLOGY, 1999, 93 (05) :658-660
[6]   Human cytomegalovirus in utero transmission: Follow-up of 524 maternal seroconversions [J].
Bodeus, Monique ;
Kabamba-Mukadi, Benoit ;
Zech, Francis ;
Hubinont, Corinne ;
Bernard, Pierre ;
Goubau, Patrick .
JOURNAL OF CLINICAL VIROLOGY, 2010, 47 (02) :201-202
[7]   Neuropathogenesis of Congenital Cytomegalovirus Infection: Disease Mechanisms and Prospects for Intervention [J].
Cheeran, Maxim C. -J. ;
Lokensgard, James R. ;
Schleiss, Mark R. .
CLINICAL MICROBIOLOGY REVIEWS, 2009, 22 (01) :99-+
[8]   Neural precursor cell susceptibility to human cytomegalovirus diverges along glial or neuronal differentiation pathways [J].
Cheeran, MCJ ;
Hu, SX ;
Ni, HT ;
Sheng, W ;
Palmquist, JM ;
Peterson, PK ;
Lokensgard, AR .
JOURNAL OF NEUROSCIENCE RESEARCH, 2005, 82 (06) :839-850
[9]   Pre- and periconceptional primary cytomegalovirus infection:: risk of vertical transmission and congenital disease [J].
Daiminger, A ;
Bäder, U ;
Enders, G .
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 2005, 112 (02) :166-172
[10]   Prenatal diagnosis of congenital cytomegalovirus infection in 189 pregnancies with known outcome [J].
Enders, G ;
Bäder, U ;
Lindemann, L ;
Schalasta, G ;
Daiminger, A .
PRENATAL DIAGNOSIS, 2001, 21 (05) :362-377