Update on treatment of cytomegalovirus infection in pregnancy and of the newborn with congenital cytomegalovirus.
The purpose of this review is to assess the recent studies of therapy of pregnant women and neonates, aimed at preventing the consequences of congenital cytomegalovirus (CMV) infection.



A recent randomized controlled trial of treatment of CMV during pregnancy with hyperimmune globulin did not show significant efficacy in prevention of foetal infection and morbidity, although there was a trend towards improvement with treatment. Trials of antiviral therapy of the mother during pregnancy have involved small numbers only, confounded by ethical and practical difficulties, and further studies are needed to demonstrate whether or not antivirals are useful and well tolerated in this setting.Antiviral treatment of neonatal CMV acquired congenitally has been studied in well controlled trials and the antiviral valganciclovir has shown efficacy in reducing the more severe outcomes. Trials are ongoing of the use of antivirals in less severe disease, although results are likely to take several years.



Congenital CMV infection is the most frequent cause of congenital malformation in developed countries, with a symptomatic prevalence of 0.64% of all live births. Infection may result in neurodevelopmental delay, foetal or neonatal death, and most frequently, sensorineural hearing loss. Successful control of viral infections during pregnancy and in the newborn period is essential in reducing early and late morbidity and mortality. Control of congenital CMV infection may be via primary prevention methods such as reducing contact with the pathogen, improved hygiene - both for the pregnant mother and for the neonate, or secondary prevention via reduction of vertical transmission from mother to foetus and reduction in consequences of infection by treatment of infected pregnant women and infected neonates.
aSerology and Virology Division, SEALS Pathology, Prince of Wales Hospital bSchool of Biotechnology and Biomolecular Sciences cSchool of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
William D
WD
Rawlinson
Stuart T
ST
Hamilton
Wendy J
WJ
van Zuylen
D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000151:congenital / Q000188:drug therapy* / Q000635:transmission; D005260:Female; D005315:Fetal Diseases / Q000517:prevention & control; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
D007136:Immunoglobulins