Congenital cytomegalovirus infection: a long-standing problem still seeking a solution

The purpose of this study was to review the accuracy of current tests used for the diagnosis of in utero cytomegalovirus infection and to discuss the potential value of preconceptional and postconceptional screening programs for prevention of congenital infection.

A computer-assisted search was performed for relevant English language publications between 1987 and 1994. We identified 119 cases of suspected intrauterine cytomegalovirus infection in which either amniotic fluid or fetal blood had been analyzed antenatally.

Congenital cytomegalovirus infection affects 0.5% to 2.5% of all newborns. The rate of transmission to the fetus after primary infection during pregnancy ranges from 15% to 50%. Of the fetuses infected in utero, 10% exhibit congenital cytomegalovirus syndrome. Evaluation of 119 cases of suspected infection has shown that polymerase chain reaction and cultures of amniotic fluid are the most reliable tests for prenatally determining the presence of viral particles. However, efficacy of routine antenatal screening in reducing the rate of fetal disease is limited.

It is concluded that at present the accuracy of tests used for the diagnosis of in utero cytomegalovirus infection is undetermined. Serologic screening of all pregnant women is of limited value and at present is not recommended.