Recent Advances in the Prevention and Treatment of Congenital Cytomegalovirus Infections
Section snippets
Primary Versus Recurrent Maternal Infection
Nearly all symptomatic congenital infections occur when a woman sustains a primary infection with CMV either during or just before pregnancy.2 Infection appears to be associated with progressively increasing viral transmission rates by gestational age, but infections early in gestation probably result in more severe congenital disease.3, 4 If infection occurs after conception, approximately 50% of fetuses will become infected, and approximately one-half of those will have symptoms at birth.3 If
Prevention of Maternal Infection during Pregnancy
Possible approaches to preventing congenital CMV infections include changes in hygienic behavior for seronegative pregnant women, administration of CMV hyperimmune globulin (HIG) to pregnant women with a primary infection, and vaccines administered to girls or women well before pregnancy.
Two studies were done to determine whether changing protective behaviors prevents child-to-mother transmission of CMV during pregnancy.15, 16 One studied 166 seronegative mothers with a child <36 months of age
Prenatal Therapy
Despite advances in the diagnosis of maternal–fetal CMV infection, an effective therapy is unavailable. Pregnancy termination is often offered as an option when affected or infected fetuses are identified by ultrasonography or amniocentesis, respectively. Recent case reports have focused on the safe administration of oral ganciclovir to mothers of CMV-infected fetuses. An HIV-positive woman was treated with intravenous ganciclovir from 30 to 34 weeks’ gestation, followed by neonatal plasma
Development of the Hemochorial Human Placenta
IUGR associated with congenital CMV disease suggests placental deficiencies. Knowledge of the cellular and molecular processes involved in development of the human placenta is a prerequisite to understanding how infection impairs functions.45 The embryo’s acquisition of a supply of maternal blood is a critical hurdle in pregnancy maintenance. The mechanics of this process are accomplished by cytotrophoblasts, which are specialized epithelial cells of the placenta. Placentation, a stepwise
Acknowledgments
Lenore Pereira laboratory studies were supported by NIH grants AI46657 and AI53782, Thrasher Research Fund grant No. 02821-7, University of California San Francisco Academic Senate. We thank Mary McKenney for editing the manuscript.
References (81)
- et al.
Congenital cytomegalovirus infection following first trimester maternal infection: symptoms at birth and outcome
J Clin Virol
(2006) Molecular epidemiology of cytomegalovirus: viral transmission among children attending a day care center, their parents, and caretakers
J Pediatr
(1988)- et al.
Hearing loss in children with congenital cytomegalovirus infection born to mothers with preexisting immunity
J Pediatr
(2006) - et al.
Congenital cytomegalovirus (CMV) infection and hearing deficit
J Clin Virol
(2006) - et al.
Prevention of child-to-mother transmission of cytomegalovirus among pregnant women
J Pediatr
(2004) - et al.
Hyperimmunoglobulin therapy for a twin fetus with cytomegalovirus infection and growth restriction
Am J Obstet Gynecol
(1999) - et al.
From infection to autoimmunity
J Autoimmun
(2001) - et al.
Prevention of transfusion-acquired cytomegalovirus infections in newborn infants
J Pediatr
(1981) - et al.
Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial
J Pediatr
(2003) - et al.
Ganciclovir therapy for symptomatic congenital cytomegalovirus infection in infants: a two-regimen experience
J Pediatr
(1994)
Genetic risks of antiviral nucleoside analogues: a survey
Antiviral Res
Insights into viral transmission at the uterine-placental interface
Trends Microbiol
Trophoblast pseudo-vasculogenesis: faking it with endothelial adhesion receptors
Curr Opin Cell Biol
Vascular endothelial growth factor ligands and receptors that regulate human cytotrophoblast survival are dysregulated in severe preeclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome
Am J Pathol
Human cytotrophoblasts promote endothelial survival and vascular remodeling through secretion of Ang2, PlGF, and VEGF-C
Dev Biol
Maternal arterial connections to the placental intervillous space during the first trimester of human pregnancy: the Boyd collection revisited
Am J Obstet Gynecol
Oxygen regulates human cytotrophoblast differentiation and invasion: implications for endovascular invasion in normal pregnancy and in pre-eclampsia
J Reprod Immunol
Patterns of human cytomegalovirus infection in term placentas: a preliminary analysis
J Clin Virol
Pathogenesis and prenatal diagnosis of human cytomegalovirus infection
J Clin Virol
Maternal antibodies enhance or prevent cytomegalovirus infection in the placenta by neonatal fc receptor-mediated transcytosis
Am J Pathol
Invasive cytotrophoblasts manifest evidence of oxidative stress in preeclampsia
Am J Pathol
Fetal and neonatal origins of altered brain development
Early Hum Dev
Vaccines for the 21st Century: A Tool for Decisionmaking
The outcome of congenital cytomegalovirus infection in relation to maternal antibody status
N Engl J Med
Passive immunization during pregnancy for congenital cytomegalovirus infection
N Engl J Med
Preconceptional primary human cytomegalovirus infection and risk of congenital infection
J Infect Dis
Intrauterine transmission of cytomegalovirus to infants of women with preconceptional immunity
N Engl J Med
Anticytomegalovirus (anti-CMV) immunoglobulin G avidity in identification of pregnant women at risk of transmitting congenital CMV infection
Clin Diagn Lab Immunol
Neonatal cytomegalovirus blood load and risk of sequelae in symptomatic and asymptomatic congenitally infected newborns
Pediatrics
Value of cytomegalovirus (CMV) IgG avidity index for the diagnosis of primary CMV infection in pregnant women
J Infect Dis
Placental enlargement is predictive of a primary maternal cytomegalovirus infection and fetal disease
Clin Infect Dis
Cytomegalovirus infection
Pediatr Rev
Prevention of child-to-mother transmission of cytomegalovirus by changing behaviors: a randomized controlled trial
Pediatr Infect Dis J
Immunity induced by primary human cytomegalovirus infection protects against secondary infection among women of childbearing age
J Infect Dis
Safety and immunogenicity of the Towne strain cytomegalovirus vaccine
Pediatr Infect Dis J
A subunit cytomegalovirus vaccine based on recombinant envelope glycoprotein B and a new adjuvant
J Infect Dis
Placental transfer of ganciclovir in a woman with acquired immunodeficiency syndrome and cytomegalovirus disease
Pediatr Infect Dis J
Ganciclovir
N Engl J Med
Successful use of oral ganciclovir for the treatment of intrauterine cytomegalovirus infection in a renal allograft recipient
Transpl Infect Dis
Renal transplantation one week after conception
Transplantation
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2023, Ageing Research ReviewsPregnancy and viral infections: Mechanisms of fetal damage, diagnosis and prevention of neonatal adverse outcomes from cytomegalovirus to SARS-CoV-2 and Zika virus
2021, Biochimica et Biophysica Acta - Molecular Basis of DiseaseCitation Excerpt :It is known that CMV replicates in cytotrophoblasts, and that CMV infection interferes with cytotrophoblasts differentiation and invasion, inhibits the proper development of new villi and leads to placental edema/fibrosis and impaired transport of oxygen and nutritive substances to the fetus, which may contribute to IUGR [10–15]. This means that although CMV-associated fetal disorders are for sure related to a direct infection of the fetus, such abnormal development and function of the placenta may also strongly contribute to disease development and severity [10–12]. In addition, such CMV-related impairment of placental function may in some cases lead to IUGR even if viral transmission to the fetus does not actually occur [11].
N<sup>o</sup> 240-Infection à cytomégalovirus pendant la grossesse
2018, Journal of Obstetrics and Gynaecology CanadaNo. 240-Cytomegalovirus Infection in Pregnancy
2018, Journal of Obstetrics and Gynaecology Canada