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High-dose CMV hyperimmune globulin (HIG) and maternal CMV DNAemia independently predict infant outcome in pregnant women with a primary cytomegalovirus (CMV) infection.

Abstract

BACKGROUND

After a primary maternal CMV infection during pregnancy infants are at risk for disease.

METHODS

Factors predictive of infant outcome were analyzed in a database of 304 pregnant women with a primary infection. These were enrolled between 2010 and 2017 and delivered 281 infants, of whom 108 were CMV infected. Long term follow-up occurred for 173 uninfected and 106 infected infants at age 4 years (range 1 to 8 years). 157 women were treated with an average of 2 doses (range 1 to 6) of high dose hyperimmune globulin (HIG: 200 mg/kg/infusion). We used a regression model to define predictors of fetal infection, symptoms at birth, and long-term sequelae. 31 covariates were tested.

RESULTS

Four factors predicted fetal infection: a 1.8 fold increase (30% vs. 56%) in the rate of congenital infection without HIG (P<0.0001, adjusted odd ratio (AOR) =5.2), a 1.8 fold increase (32% vs. 56%) associated with maternal viral DNAemia prior to HIG administration (P=0.002, AOR=3.0), abnormal ultrasounds (P=0.0002, AOR=54.2), and diagnosis of maternal infection via seroconversion rather than avidity (P=0.007, AOR=3.3). Lack of HIG and abnormal ultrasounds also predicted symptoms (P=0.001). Long term sequelae were predicted by not receiving HIG (P=0.001, AOR=13.2), maternal infection in early gestation (P=0.017, OR = 0.9), and abnormal ultrasounds (P<0.003, OR =7.6). Prevalence and copy/number of DNAemia declined after HIG.

CONCLUSIONS

Maternal viremia predicts fetal infection and neonatal outcome. This may help patient counseling. High-dose HIG may prevent fetal infection and disease, and is associated with the resolution of DNAemia.

Authors+Show Affiliations

Non-profit Association Mother-Infant Cytomegalovirus Infection (AMICI), Rome, Italy. Pediatric Unit, University of L'Aquila, Italy.CMV Research Foundation, Richmond, VA, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31628849

Citation

Nigro, Giovanni, et al. "High-dose CMV Hyperimmune Globulin (HIG) and Maternal CMV DNAemia Independently Predict Infant Outcome in Pregnant Women With a Primary Cytomegalovirus (CMV) Infection." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 2019.
Nigro G, Adler SP, Congenital Cytomegalic Disease Collaborating Group. High-dose CMV hyperimmune globulin (HIG) and maternal CMV DNAemia independently predict infant outcome in pregnant women with a primary cytomegalovirus (CMV) infection. Clin Infect Dis. 2019.
Nigro, G., & Adler, S. P. (2019). High-dose CMV hyperimmune globulin (HIG) and maternal CMV DNAemia independently predict infant outcome in pregnant women with a primary cytomegalovirus (CMV) infection. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, doi:10.1093/cid/ciz1030.
Nigro G, Adler SP, Congenital Cytomegalic Disease Collaborating Group. High-dose CMV Hyperimmune Globulin (HIG) and Maternal CMV DNAemia Independently Predict Infant Outcome in Pregnant Women With a Primary Cytomegalovirus (CMV) Infection. Clin Infect Dis. 2019 Oct 20; PubMed PMID: 31628849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-dose CMV hyperimmune globulin (HIG) and maternal CMV DNAemia independently predict infant outcome in pregnant women with a primary cytomegalovirus (CMV) infection. AU - Nigro,Giovanni, AU - Adler,Stuart P, AU - ,, Y1 - 2019/10/20/ PY - 2019/05/08/received PY - 2019/10/20/entrez PY - 2019/10/20/pubmed PY - 2019/10/20/medline KW - Cytomegalovirus KW - DNAemia KW - Hyper immunoglobulins KW - Pregnancy JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. N2 - BACKGROUND: After a primary maternal CMV infection during pregnancy infants are at risk for disease. METHODS: Factors predictive of infant outcome were analyzed in a database of 304 pregnant women with a primary infection. These were enrolled between 2010 and 2017 and delivered 281 infants, of whom 108 were CMV infected. Long term follow-up occurred for 173 uninfected and 106 infected infants at age 4 years (range 1 to 8 years). 157 women were treated with an average of 2 doses (range 1 to 6) of high dose hyperimmune globulin (HIG: 200 mg/kg/infusion). We used a regression model to define predictors of fetal infection, symptoms at birth, and long-term sequelae. 31 covariates were tested. RESULTS: Four factors predicted fetal infection: a 1.8 fold increase (30% vs. 56%) in the rate of congenital infection without HIG (P<0.0001, adjusted odd ratio (AOR) =5.2), a 1.8 fold increase (32% vs. 56%) associated with maternal viral DNAemia prior to HIG administration (P=0.002, AOR=3.0), abnormal ultrasounds (P=0.0002, AOR=54.2), and diagnosis of maternal infection via seroconversion rather than avidity (P=0.007, AOR=3.3). Lack of HIG and abnormal ultrasounds also predicted symptoms (P=0.001). Long term sequelae were predicted by not receiving HIG (P=0.001, AOR=13.2), maternal infection in early gestation (P=0.017, OR = 0.9), and abnormal ultrasounds (P<0.003, OR =7.6). Prevalence and copy/number of DNAemia declined after HIG. CONCLUSIONS: Maternal viremia predicts fetal infection and neonatal outcome. This may help patient counseling. High-dose HIG may prevent fetal infection and disease, and is associated with the resolution of DNAemia. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/31628849/High-dose_CMV_hyperimmune_globulin_(HIG)_and_maternal_CMV_DNAemia_independently_predict_infant_outcome_in_pregnant_women_with_a_primary_cytomegalovirus_(CMV)_infection L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciz1030 DB - PRIME DP - Unbound Medicine ER -