title: Congenital Cytomegalovirus Infection: Prognostic Value of Maternal DNAemia at Amniocentesis.
abstract: BACKGROUND
  Human Cytomegalovirus (HCMV) is the most common cause of childhood hearing loss and can lead to neurodevelopmental delay. To date, few studies have examined the correlation between maternal viremia and congenital HCMV infection. The aim of our study was to ascertain if HCMV DNA in the peripheral blood of pregnant women with primary HCMV infection at the time of amniocentesis may have a prognostic value in terms of congenital infection and neonatal symptomatic disease.
  
  
  METHODS
  We performed a prospective observational study of pregnant women referred to our maternal-fetal medicine division with suspected HCMV infection. Primary infection was diagnosed based on seroconversion for HCMV and/or HCMV immunoglobulin M-positive and low or moderate HCMV immunoglobulin G avidity. At the time of amniocentesis, maternal blood samples were collected and analyzed by means of real-time polymerase chain reaction to determine the presence of viral DNAemia. Fetuses and newborns were evaluated for the presence of congenital infection and symptomatic disease.
  
  
  RESULTS
  A total of 239 pregnant women were enrolled; 32 blood samples (13.4%) were positive, and 207 (86.6%) were negative for HCMV DNA. The overall rate of transmission was 23.4%. Fifteen infected patients (26.8%) were symptomatic. Vertical transmission occurred in 14 women (43.8%) with positive and 42 (20.3%) with negative results for HCMV DNAemia (P = .006; odds ratio, 3.06; 95% confidence interval, 1.41-6.64). Symptomatic infection occurred in 6 (42.9%) infected fetuses or newborns from women with and in 9 (21.4%) from women without viral DNAemia (P = .16).
  
  
  CONCLUSIONS
  Maternal viremia at amniocentesis is associated with a 3-fold greater chance of congenital infection, but it is not correlated with symptomatic disease.
authors.affiliation: Department of Medical and Surgical Sciences, Division of Obstetrics and Prenatal Medicine, and giuliana.simonazzi@unibo.it.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Simonazzi
authors.affiliation: Department of Medical and Surgical Sciences, Division of Obstetrics and Prenatal Medicine, and.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cervi
authors.affiliation: Department of Medical and Surgical Sciences, Division of Obstetrics and Prenatal Medicine, and.
authors.forename: Alice
authors.initials: A
authors.lastname: Zavatta
authors.affiliation: Department of Medical and Surgical Sciences, Division of Obstetrics and Prenatal Medicine, and.
authors.forename: Laura
authors.initials: L
authors.lastname: Pellizzoni
authors.affiliation: Department of Medical and Surgical Sciences, Division of Obstetrics and Prenatal Medicine, and.
authors.forename: Brunella
authors.initials: B
authors.lastname: Guerra
authors.affiliation: Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, and.
authors.forename: Marianna
authors.initials: M
authors.lastname: Mastroroberto
authors.affiliation: Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, and.
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Morselli-Labate
authors.affiliation: Department of Specialised, Experimental, and Diagnostic Medicine, Division of Microbiology and Virology, St Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Gabrielli
authors.affiliation: Department of Medical and Surgical Sciences, Division of Obstetrics and Prenatal Medicine, and.
authors.forename: Nicola
authors.initials: N
authors.lastname: Rizzo
authors.affiliation: Department of Specialised, Experimental, and Diagnostic Medicine, Division of Microbiology and Virology, St Orsola-Malpighi Hospital, University of Bologna, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Lazzarotto
mesh_terms: D000649:Amniocentesis; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000401:mortality / Q000635:transmission* / Q000821:virology*; D004279:DNA, Viral; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D016017:Odds Ratio; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011379:Prognosis; D011446:Prospective Studies; D019562:Viral Load; D014766:Viremia / Q000821:virology*
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral
keywords: Human Cytomegalovirus Primary Infection in Pregnancy; congenital infection; maternal viremia; prenatal diagnosis; symptomatic congenital disease.