Maternal-fetal cytomegalovirus infection: from diagnosis to therapy

Cytomegalovirus (CMV) is the most common and serious congenital infection, because it occurs after both primary and recurrent infection in pregnancy and is a major cause of childhood deafness and neurological handicap. Fetal transmission generally occurs in 30-60% of women acquiring a primary infection or in 0.5-2% of women with preconceptional immunity. Following primary maternal infection, approximately one-third of the CMV-infected infants will have disease at birth or develop severe sequelae, which include convulsive or spastic syndromes, mental retardation and auditory and visual impairment. Routine antepartum and in pregnancy serological screening should be essential for avoiding doubtful interpretations of CMV-IgM results in pregnancy. Detection of quantitative CMV DNA in the amniotic fluid and accurate ultrasound examinations are needed in pregnant women with suspected primary infection. Being not yet available a vaccine and uncertain the results of postnatal ganciclovir therapy, CMV hyperimmunoglobulin appears to be the only safe and valid approach for prevention of congenital CMV disease.