title: Intrauterine growth restriction caused by underlying congenital cytomegalovirus infection.
abstract: BACKGROUND
  Human cytomegalovirus (HCMV) is the major viral etiology of congenital infection and birth defects. Fetal transmission is high (30%-40%) in primary maternal infection, and symptomatic babies have permanent neurological, hearing, and vision defects. Recurrent infection is infrequently transmitted (2%) and largely asymptomatic. Congenital infection is also associated with intrauterine growth restriction (IUGR).
  
  
  METHODS
  To investigate possible underlying HCMV infection in cases of idiopathic IUGR, we studied maternal and cord sera and placentas from 19 pregnancies. Anti-HCMV antibodies, hypoxia-related factors, and cmvIL-10 were measured in sera. Placental biopsy specimens were examined for viral DNA, expression of infected cell proteins, and pathology.
  
  
  RESULTS
  Among 7 IUGR cases, we identified 2 primary and 3 recurrent HCMV infections. Virus replicated in glandular epithelium and lymphatic endothelium in the decidua, cytotrophoblasts, and smooth muscle cells in blood vessels of floating villi and the chorion. Large fibrinoids with avascular villi, edema, and inflammation were significantly increased. Detection of viral proteins in the amniotic epithelium indicated transmission in 2 cases of IUGR with primary infection and 3 asymptomatic recurrent infections.
  
  
  CONCLUSIONS
  Congenital HCMV infection impairs placental development and functions and should be considered as an underlying cause of IUGR, regardless of virus transmission to the fetus.
authors.affiliation: Department of Cell and Tissue Biology, School of Dentistry, University of California San Francisco, San Francisco, California.
authors.forename: Lenore
authors.initials: L
authors.lastname: Pereira
authors.forename: Matthew
authors.initials: M
authors.lastname: Petitt
authors.forename: Alex
authors.initials: A
authors.lastname: Fong
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Tsuge
authors.forename: Takako
authors.initials: T
authors.lastname: Tabata
authors.forename: June
authors.initials: J
authors.lastname: Fang-Hoover
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Maidji
authors.forename: Martin
authors.initials: M
authors.lastname: Zydek
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhou
authors.forename: Naoki
authors.initials: N
authors.lastname: Inoue
authors.forename: Sanam
authors.initials: S
authors.lastname: Loghavi
authors.forename: Samuel
authors.initials: S
authors.lastname: Pepkowitz
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Kauvar
authors.forename: Dotun
authors.initials: D
authors.lastname: Ogunyemi
mesh_terms: D057134:Antibodies, Neutralizing / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D003586:Cytomegalovirus Infections / Q000150:complications*; D004279:DNA, Viral; D005260:Female; D005317:Fetal Growth Retardation / Q000821:virology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D010865:Pilot Projects; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000473:pathology*; D012698:Serologic Tests
chemical_list: D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral; D004279:DNA, Viral; D007074:Immunoglobulin G
keywords: HCMV; IUGR; amnion; blood vessels; chorion; congenital; fetus; placenta; pregnancy; villi