Early primary cytomegalovirus infection in pregnancy: Maternal hyperimmunoglobulin therapy improves outcomes among infants at 1 year of age

Silvia Visentin, Renzo Manara, Laura Milanese, Anna Da Roit, Gabriella Forner, Eleonora Salviato, Valentina Citton, Fioretta Marciani Magno, Eva Orzan, Carla Morando, Riccardo Cusinato, Carlo Mengoli, Giorgio Palu, Mario Ermani, Roberto Rinaldi, Erich Cosmi, Nadia Gussetti

Research output: Contribution to journalArticle

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Abstract

Background. Primary cytomegalovirus (CMV) infection during pregnancy is the leading infectious cause of congenital neurological disabilities. Early CMV infection carries a higher risk of adverse neonatal outcome (sensorineural hearing loss or neurological deficits). Intravenous hyperimmunoglobulin (HIG) therapy seems to be promising, but its efficacy needs further investigation. Methods. Since 2002, we have enrolled consecutively all pregnant women with early (ie, before gestational week 17) CMV infection. Beginning in 2007, all women were offered treatment with HIG (200 UI per kilogram of maternal weight, in a single intravenous administration). Outcome of infants was evaluated at the age of 1 year. Results. Of the 592 women with early primary CMV infection, amniocentesis for CMV DNA detection was performed for 446. Of the 92 CMV-positive fetuses, pregnancy was terminated for 24, HIG was administered to mothers of 31, and no treatment was received by mothers of 37. Fetuses of treated mothers did not differ from fetuses of nontreated mothers according to mother's age, gestational week of infection, CMV load, or detection of abnormal ultrasonography findings. At the 1-year evaluation, 4 of 31 infants with treated mothers (13%; 95% confidence interval [CI], 1%-25%) and 16 of 37 infants with nontreated mothers (43%; 95% CI, 27%-59%) presented with poor outcomes (P <.01, by the 2-Tailed Fisher exact test). Conclusions. HIG treatment improved the outcome of fetuses from women who had primary CMV infection before gestational week 17.

Original languageEnglish
Pages (from-to)497-503
Number of pages7
JournalClinical Infectious Diseases
Volume55
Issue number4
DOIs
Publication statusPublished - Aug 15 2012

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Cytomegalovirus Infections
Mothers
Pregnancy
Fetus
Cytomegalovirus
Therapeutics
Surrogate Mothers
Confidence Intervals
Amniocentesis
Sensorineural Hearing Loss
Intravenous Administration
Gestational Age
Pregnant Women
Ultrasonography
Weights and Measures
DNA

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

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Early primary cytomegalovirus infection in pregnancy : Maternal hyperimmunoglobulin therapy improves outcomes among infants at 1 year of age. / Visentin, Silvia; Manara, Renzo; Milanese, Laura; Da Roit, Anna; Forner, Gabriella; Salviato, Eleonora; Citton, Valentina; Magno, Fioretta Marciani; Orzan, Eva; Morando, Carla; Cusinato, Riccardo; Mengoli, Carlo; Palu, Giorgio; Ermani, Mario; Rinaldi, Roberto; Cosmi, Erich; Gussetti, Nadia.

In: Clinical Infectious Diseases, Vol. 55, No. 4, 15.08.2012, p. 497-503.

Research output: Contribution to journalArticle

Visentin, S, Manara, R, Milanese, L, Da Roit, A, Forner, G, Salviato, E, Citton, V, Magno, FM, Orzan, E, Morando, C, Cusinato, R, Mengoli, C, Palu, G, Ermani, M, Rinaldi, R, Cosmi, E & Gussetti, N 2012, 'Early primary cytomegalovirus infection in pregnancy: Maternal hyperimmunoglobulin therapy improves outcomes among infants at 1 year of age', Clinical Infectious Diseases, vol. 55, no. 4, pp. 497-503. https://doi.org/10.1093/cid/cis423
Visentin, Silvia ; Manara, Renzo ; Milanese, Laura ; Da Roit, Anna ; Forner, Gabriella ; Salviato, Eleonora ; Citton, Valentina ; Magno, Fioretta Marciani ; Orzan, Eva ; Morando, Carla ; Cusinato, Riccardo ; Mengoli, Carlo ; Palu, Giorgio ; Ermani, Mario ; Rinaldi, Roberto ; Cosmi, Erich ; Gussetti, Nadia. / Early primary cytomegalovirus infection in pregnancy : Maternal hyperimmunoglobulin therapy improves outcomes among infants at 1 year of age. In: Clinical Infectious Diseases. 2012 ; Vol. 55, No. 4. pp. 497-503.
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abstract = "Background. Primary cytomegalovirus (CMV) infection during pregnancy is the leading infectious cause of congenital neurological disabilities. Early CMV infection carries a higher risk of adverse neonatal outcome (sensorineural hearing loss or neurological deficits). Intravenous hyperimmunoglobulin (HIG) therapy seems to be promising, but its efficacy needs further investigation. Methods. Since 2002, we have enrolled consecutively all pregnant women with early (ie, before gestational week 17) CMV infection. Beginning in 2007, all women were offered treatment with HIG (200 UI per kilogram of maternal weight, in a single intravenous administration). Outcome of infants was evaluated at the age of 1 year. Results. Of the 592 women with early primary CMV infection, amniocentesis for CMV DNA detection was performed for 446. Of the 92 CMV-positive fetuses, pregnancy was terminated for 24, HIG was administered to mothers of 31, and no treatment was received by mothers of 37. Fetuses of treated mothers did not differ from fetuses of nontreated mothers according to mother's age, gestational week of infection, CMV load, or detection of abnormal ultrasonography findings. At the 1-year evaluation, 4 of 31 infants with treated mothers (13{\%}; 95{\%} confidence interval [CI], 1{\%}-25{\%}) and 16 of 37 infants with nontreated mothers (43{\%}; 95{\%} CI, 27{\%}-59{\%}) presented with poor outcomes (P <.01, by the 2-Tailed Fisher exact test). Conclusions. HIG treatment improved the outcome of fetuses from women who had primary CMV infection before gestational week 17.",
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T2 - Maternal hyperimmunoglobulin therapy improves outcomes among infants at 1 year of age

AU - Visentin, Silvia

AU - Manara, Renzo

AU - Milanese, Laura

AU - Da Roit, Anna

AU - Forner, Gabriella

AU - Salviato, Eleonora

AU - Citton, Valentina

AU - Magno, Fioretta Marciani

AU - Orzan, Eva

AU - Morando, Carla

AU - Cusinato, Riccardo

AU - Mengoli, Carlo

AU - Palu, Giorgio

AU - Ermani, Mario

AU - Rinaldi, Roberto

AU - Cosmi, Erich

AU - Gussetti, Nadia

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N2 - Background. Primary cytomegalovirus (CMV) infection during pregnancy is the leading infectious cause of congenital neurological disabilities. Early CMV infection carries a higher risk of adverse neonatal outcome (sensorineural hearing loss or neurological deficits). Intravenous hyperimmunoglobulin (HIG) therapy seems to be promising, but its efficacy needs further investigation. Methods. Since 2002, we have enrolled consecutively all pregnant women with early (ie, before gestational week 17) CMV infection. Beginning in 2007, all women were offered treatment with HIG (200 UI per kilogram of maternal weight, in a single intravenous administration). Outcome of infants was evaluated at the age of 1 year. Results. Of the 592 women with early primary CMV infection, amniocentesis for CMV DNA detection was performed for 446. Of the 92 CMV-positive fetuses, pregnancy was terminated for 24, HIG was administered to mothers of 31, and no treatment was received by mothers of 37. Fetuses of treated mothers did not differ from fetuses of nontreated mothers according to mother's age, gestational week of infection, CMV load, or detection of abnormal ultrasonography findings. At the 1-year evaluation, 4 of 31 infants with treated mothers (13%; 95% confidence interval [CI], 1%-25%) and 16 of 37 infants with nontreated mothers (43%; 95% CI, 27%-59%) presented with poor outcomes (P <.01, by the 2-Tailed Fisher exact test). Conclusions. HIG treatment improved the outcome of fetuses from women who had primary CMV infection before gestational week 17.

AB - Background. Primary cytomegalovirus (CMV) infection during pregnancy is the leading infectious cause of congenital neurological disabilities. Early CMV infection carries a higher risk of adverse neonatal outcome (sensorineural hearing loss or neurological deficits). Intravenous hyperimmunoglobulin (HIG) therapy seems to be promising, but its efficacy needs further investigation. Methods. Since 2002, we have enrolled consecutively all pregnant women with early (ie, before gestational week 17) CMV infection. Beginning in 2007, all women were offered treatment with HIG (200 UI per kilogram of maternal weight, in a single intravenous administration). Outcome of infants was evaluated at the age of 1 year. Results. Of the 592 women with early primary CMV infection, amniocentesis for CMV DNA detection was performed for 446. Of the 92 CMV-positive fetuses, pregnancy was terminated for 24, HIG was administered to mothers of 31, and no treatment was received by mothers of 37. Fetuses of treated mothers did not differ from fetuses of nontreated mothers according to mother's age, gestational week of infection, CMV load, or detection of abnormal ultrasonography findings. At the 1-year evaluation, 4 of 31 infants with treated mothers (13%; 95% confidence interval [CI], 1%-25%) and 16 of 37 infants with nontreated mothers (43%; 95% CI, 27%-59%) presented with poor outcomes (P <.01, by the 2-Tailed Fisher exact test). Conclusions. HIG treatment improved the outcome of fetuses from women who had primary CMV infection before gestational week 17.

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