title: Placental enlargement in women with primary maternal cytomegalovirus infection is associated with fetal and neonatal disease.
abstract: BACKGROUND
  Serological testing for primary maternal cytomegalovirus (CMV) infection during pregnancy is not routine, but ultrasound studies are routine. Therefore, we evaluated placental thickening in women with primary CMV infection during pregnancy.
  
  
  METHODS
  The study included 92 women with primary CMV infection during pregnancy and 73 CMV-seropositive pregnant women without primary CMV infection. Neonatal CMV transmission was determined by CMV culture of urine samples. Thirty-two women were treated with CMV hyperimmune globulin to either prevent or treat intrauterine CMV infection. Maximal placental thickness was measured by longitudinal (nonoblique) scanning with the ultrasound beam perpendicular to the chorial dish. Programmed placental ultrasound evaluations were performed from 16 to 36 weeks of gestation.
  
  
  RESULTS
  At each measurement between 16 and 36 weeks of gestation, women with primary CMV infection who had a fetus or newborn with CMV disease had placentas that were significantly thicker than those of women with primary CMV infection who did not have a diseased fetus or newborn (P<.0001); the latter group, in turn, had placentas that were significantly thicker than those of seropositive control subjects (P<.0001). For both women with and women without diseased fetuses or newborns, receipt of hyperimmune globulin after primary CMV infection was associated with statistically significant reductions in placental thickness (P<.001). Placental vertical thickness values, which are predictive of primary maternal infection, were observed at each measurement from 16 to 36 weeks of gestation, and cutoff values ranged from 22 mm to 35 mm, with the best sensitivity and specificity at 28 and 32 weeks of gestation.
  
  
  CONCLUSIONS
  Primary maternal CMV infection and fetal or neonatal disease are associated with sonographically thickened placentas, which respond to administration of hyperimmune globulin. These observations suggest that many of the manifestations of fetal and neonatal disease are caused by placental insufficiency.
authors.affiliation: Department of Gynecological Sciences, Perinatology, and Child Health, La Sapienza University, Rome, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: La Torre
authors.forename: Giovanni
authors.initials: G
authors.lastname: Nigro
authors.forename: Manuela
authors.initials: M
authors.lastname: Mazzocco
authors.forename: Al M
authors.initials: AM
authors.lastname: Best
authors.forename: Stuart P
authors.initials: SP
authors.lastname: Adler
mesh_terms: D000328:Adult; D003586:Cytomegalovirus Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005260:Female; D005315:Fetal Diseases / Q000517:prevention & control / Q000821:virology; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D016756:Immunoglobulins, Intravenous; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000517:prevention & control; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D010920:Placenta / Q000000981:diagnostic imaging / Q000821:virology*; D010922:Placenta Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000821:virology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000821:virology*; D016216:Ultrasonography, Prenatal
chemical_list: D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; C045781:cytomegalovirus-specific hyperimmune globulin