Guidelines on CMV congenital infection

Area of Science:

• Obstetrics and Gynecology
• Neonatology
• Infectious Diseases

Background:

• Congenital cytomegalovirus (CMV) infection affects 0.6-0.7% of newborns, being the primary cause of infection-related congenital neurological handicap.
• Vertical transmission occurs in about 30% of cases, with symptomatic newborns facing a higher risk of severe neurological sequelae.

Purpose of the Study:

• To review aspects of cytomegalovirus infection in pregnant women and their infants.
• To discuss diagnostic challenges, management strategies, and the need for further research on interventions.

Main Methods:

• Review of current literature on congenital CMV infection.
• Analysis of diagnostic tests, including serology and avidity assays.
• Evaluation of management options and public health implications.

Main Results:

• Diagnosis of primary CMV infection relies on IgG, IgM, and avidity tests, but interpretation can be complex.
• Amniocentesis is recommended for confirming vertical transmission if seroconversion or ultrasound markers are present.
• Fetal prognosis is strongly linked to the presence of brain damage; pregnancy termination is discouraged without confirmed fetal anomalies.

Conclusions:

• Systematic CMV screening in pregnant women is not advised; testing should be reserved for high-risk cases or suspected primary infections.
• The efficacy of antiviral drugs and CMV hyperimmune globulin (HIG) requires cautious interpretation and further validation.
• Public health interventions require further establishment of the burden of congenital CMV disease and the value of preventive measures.