Role of prenatal diagnosis and counseling in the management of 735 pregnancies complicated by primary human cytomegalovirus infection: A 20-year experience

Maria Grazia Revello, Elisa Fabbri, Milena Furione, Maurizio Zavattoni, Daniele Lilleri, Beatrice Tassis, Aida Quarenghi, Chiara Cena, Alessia Arossa, Laura Montanari, Vanina Rognoni, Arsenio Spinillo, Giuseppe Gerna

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Background: The burden of congenital human cytomegalovirus (HCMV) infection is well recognized. However, screening for maternal infection remains controversial in view of diagnostic challenges, counseling difficulties, and absence of medical treatment. Objective: To assess the role of prenatal diagnosis and counseling in the management of pregnancy complicated by primary HCMV infection. Study design: Retrospective study aimed at investigating diagnostic features, options, and pregnancy outcome in 735 women with primary HCMV infection over a period of 20 years (1990-2009). Results: Overall, 25.6% women were found to be seronegative before the actual pregnancy. However, none were informed about HCMV infection and potential prevention strategies. Diagnosis of primary HCMV infection was achieved by seroconversion in 44.4% cases and by different combinations of virus-specific IgM, low IgG avidity, and DNAemia in 43.9% cases. Non-specific symptoms and/or haematological/biochemical alterations were recalled by 73.5% women. The onset of infection could be established, and counseling adjusted accordingly in >90% cases. The overall rate of vertical transmission was 37.1%, ranging from 5.6% for preconceptional infections to 64.1% for third trimester infections. Amniocentesis was chosen by 43.1% women, whereas pregnancy termination was requested by 15.6%. Conclusions: Reference virology centers and ad hoc trained and experienced physicians are required for accurate diagnosis of primary infection in pregnancy and ensuing counseling. Prenatal diagnosis has a central role in the management of pregnancies complicated by primary HCMV infection. HCMV-seronegative women should receive adequate information.

Original languageEnglish
Pages (from-to)303-307
Number of pages5
JournalJournal of Clinical Virology
Volume50
Issue number4
DOIs
Publication statusPublished - Apr 2011

Fingerprint

Cytomegalovirus Infections
Prenatal Diagnosis
Counseling
Pregnancy
Infection
Virology
Amniocentesis
Third Pregnancy Trimester
Pregnancy Outcome
Cytomegalovirus
Immunoglobulin M
Retrospective Studies
Immunoglobulin G
Mothers
Viruses
Physicians

Keywords

  • Congenital infection
  • Counseling
  • HCMV
  • Pregnancy
  • Prenatal diagnosis
  • Primary infection

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

Cite this

@article{d66e2f68e921471b8f66ea5206a51fe1,
title = "Role of prenatal diagnosis and counseling in the management of 735 pregnancies complicated by primary human cytomegalovirus infection: A 20-year experience",
abstract = "Background: The burden of congenital human cytomegalovirus (HCMV) infection is well recognized. However, screening for maternal infection remains controversial in view of diagnostic challenges, counseling difficulties, and absence of medical treatment. Objective: To assess the role of prenatal diagnosis and counseling in the management of pregnancy complicated by primary HCMV infection. Study design: Retrospective study aimed at investigating diagnostic features, options, and pregnancy outcome in 735 women with primary HCMV infection over a period of 20 years (1990-2009). Results: Overall, 25.6{\%} women were found to be seronegative before the actual pregnancy. However, none were informed about HCMV infection and potential prevention strategies. Diagnosis of primary HCMV infection was achieved by seroconversion in 44.4{\%} cases and by different combinations of virus-specific IgM, low IgG avidity, and DNAemia in 43.9{\%} cases. Non-specific symptoms and/or haematological/biochemical alterations were recalled by 73.5{\%} women. The onset of infection could be established, and counseling adjusted accordingly in >90{\%} cases. The overall rate of vertical transmission was 37.1{\%}, ranging from 5.6{\%} for preconceptional infections to 64.1{\%} for third trimester infections. Amniocentesis was chosen by 43.1{\%} women, whereas pregnancy termination was requested by 15.6{\%}. Conclusions: Reference virology centers and ad hoc trained and experienced physicians are required for accurate diagnosis of primary infection in pregnancy and ensuing counseling. Prenatal diagnosis has a central role in the management of pregnancies complicated by primary HCMV infection. HCMV-seronegative women should receive adequate information.",
keywords = "Congenital infection, Counseling, HCMV, Pregnancy, Prenatal diagnosis, Primary infection",
author = "Revello, {Maria Grazia} and Elisa Fabbri and Milena Furione and Maurizio Zavattoni and Daniele Lilleri and Beatrice Tassis and Aida Quarenghi and Chiara Cena and Alessia Arossa and Laura Montanari and Vanina Rognoni and Arsenio Spinillo and Giuseppe Gerna",
year = "2011",
month = "4",
doi = "10.1016/j.jcv.2010.12.012",
language = "English",
volume = "50",
pages = "303--307",
journal = "Journal of Clinical Virology",
issn = "1386-6532",
publisher = "Elsevier",
number = "4",

}

TY - JOUR

T1 - Role of prenatal diagnosis and counseling in the management of 735 pregnancies complicated by primary human cytomegalovirus infection

T2 - A 20-year experience

AU - Revello, Maria Grazia

AU - Fabbri, Elisa

AU - Furione, Milena

AU - Zavattoni, Maurizio

AU - Lilleri, Daniele

AU - Tassis, Beatrice

AU - Quarenghi, Aida

AU - Cena, Chiara

AU - Arossa, Alessia

AU - Montanari, Laura

AU - Rognoni, Vanina

AU - Spinillo, Arsenio

AU - Gerna, Giuseppe

PY - 2011/4

Y1 - 2011/4

N2 - Background: The burden of congenital human cytomegalovirus (HCMV) infection is well recognized. However, screening for maternal infection remains controversial in view of diagnostic challenges, counseling difficulties, and absence of medical treatment. Objective: To assess the role of prenatal diagnosis and counseling in the management of pregnancy complicated by primary HCMV infection. Study design: Retrospective study aimed at investigating diagnostic features, options, and pregnancy outcome in 735 women with primary HCMV infection over a period of 20 years (1990-2009). Results: Overall, 25.6% women were found to be seronegative before the actual pregnancy. However, none were informed about HCMV infection and potential prevention strategies. Diagnosis of primary HCMV infection was achieved by seroconversion in 44.4% cases and by different combinations of virus-specific IgM, low IgG avidity, and DNAemia in 43.9% cases. Non-specific symptoms and/or haematological/biochemical alterations were recalled by 73.5% women. The onset of infection could be established, and counseling adjusted accordingly in >90% cases. The overall rate of vertical transmission was 37.1%, ranging from 5.6% for preconceptional infections to 64.1% for third trimester infections. Amniocentesis was chosen by 43.1% women, whereas pregnancy termination was requested by 15.6%. Conclusions: Reference virology centers and ad hoc trained and experienced physicians are required for accurate diagnosis of primary infection in pregnancy and ensuing counseling. Prenatal diagnosis has a central role in the management of pregnancies complicated by primary HCMV infection. HCMV-seronegative women should receive adequate information.

AB - Background: The burden of congenital human cytomegalovirus (HCMV) infection is well recognized. However, screening for maternal infection remains controversial in view of diagnostic challenges, counseling difficulties, and absence of medical treatment. Objective: To assess the role of prenatal diagnosis and counseling in the management of pregnancy complicated by primary HCMV infection. Study design: Retrospective study aimed at investigating diagnostic features, options, and pregnancy outcome in 735 women with primary HCMV infection over a period of 20 years (1990-2009). Results: Overall, 25.6% women were found to be seronegative before the actual pregnancy. However, none were informed about HCMV infection and potential prevention strategies. Diagnosis of primary HCMV infection was achieved by seroconversion in 44.4% cases and by different combinations of virus-specific IgM, low IgG avidity, and DNAemia in 43.9% cases. Non-specific symptoms and/or haematological/biochemical alterations were recalled by 73.5% women. The onset of infection could be established, and counseling adjusted accordingly in >90% cases. The overall rate of vertical transmission was 37.1%, ranging from 5.6% for preconceptional infections to 64.1% for third trimester infections. Amniocentesis was chosen by 43.1% women, whereas pregnancy termination was requested by 15.6%. Conclusions: Reference virology centers and ad hoc trained and experienced physicians are required for accurate diagnosis of primary infection in pregnancy and ensuing counseling. Prenatal diagnosis has a central role in the management of pregnancies complicated by primary HCMV infection. HCMV-seronegative women should receive adequate information.

KW - Congenital infection

KW - Counseling

KW - HCMV

KW - Pregnancy

KW - Prenatal diagnosis

KW - Primary infection

UR - http://www.scopus.com/inward/record.url?scp=79952622108&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952622108&partnerID=8YFLogxK

U2 - 10.1016/j.jcv.2010.12.012

DO - 10.1016/j.jcv.2010.12.012

M3 - Article

C2 - 21277825

AN - SCOPUS:79952622108

VL - 50

SP - 303

EP - 307

JO - Journal of Clinical Virology

JF - Journal of Clinical Virology

SN - 1386-6532

IS - 4

ER -