title: Prediction of fetal infection in cases with cytomegalovirus immunoglobulin M in the first trimester of pregnancy: a retrospective cohort.
abstract: BACKGROUND
  Interpretation of positive cytomegalovirus (CMV) immunoglobulin M (IgM) in the first trimester of pregnancy is ill-defined. We aimed to quantify the risk of fetal transmission in women with positive CMV IgM in the first trimester.
  
  
  METHODS
  A retrospective cohort of women (2009-2011) was tested for CMV immunoglobulin G (IgG) and IgM before 14 weeks of gestation. IgG avidity was tested with 2 assays (LIAISON and VIDAS). CMV polymerase chain reaction (PCR) was done in maternal serum, amniotic fluid, or neonatal urine at birth.
  
  
  RESULTS
  A total of 4931 consecutive women were screened; 201 presented with positive or equivocal IgM and with high, intermediate, or low IgG avidity in 58.7%, 18.9%, and 22.3%, respectively. In 72 women with low or intermediate avidity, fetal transmission was 23.6%. In multivariate analysis, positive CMV PCR in maternal serum, decreasing avidity index with both LIAISON and VIDAS, and low IgG titers were all associated with fetal transmission (odds ratio [OR], 12.38 [95% confidence interval {CI}, 1.77-86.33], P = .011; OR, 0.16 [95% CI, .03-.95], P = .044; OR, 0.54 [95% CI, .11-.88], P = .028; and OR, 0.27 [95% CI, .29-.84], P = .010, respectively).
  
  
  CONCLUSIONS
  This study demonstrates a significant association between the risk of vertical transmission and the avidity index combined with CMV PCR in maternal serum or IgG titers. This allows calculation of incremental risk of fetal transmission upon which informed choice can be based and could lead to a better pickup rate of fetal infection while decreasing unnecessary invasive procedures.
authors: Laboratory of Virology, Hôpital Necker-Enfants-malades, Assistance Publique-Hôpitaux de Paris (AP-HP)-University Paris Descartes, Sorbonne Paris Cité, Paris. marianne.leruez@nck.aphp.fr
authors: Marianne
authors: M
authors: Leruez-Ville
authors: Yann
authors: Y
authors: Sellier
authors: Laurent J
authors: LJ
authors: Salomon
authors: Julien J
authors: JJ
authors: Stirnemann
authors: François
authors: F
authors: Jacquemard
authors: Yves
authors: Y
authors: Ville
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D000915:Antibody Affinity; D016009:Chi-Square Distribution; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000635:transmission; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D018445:Infectious Disease Transmission, Vertical; D015999:Multivariate Analysis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D011261:Pregnancy Trimester, First; D012189:Retrospective Studies
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M