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Amniocentesis to diagnose congenital cytomegalovirus infection following maternal primary infection.

Publication ,  Journal Article
Dinsmoor, MJ; Fette, LM; Hughes, BL; Rouse, DJ; Saade, GR; Reddy, UM; Allard, D; Mallett, G; Thom, EA; Gyamfi-Bannerman, C; Varner, MW ...
Published in: Am J Obstet Gynecol MFM
July 2022

BACKGROUND: Congenital cytomegalovirus infection following maternal primary cytomegalovirus infection affects approximately 0.4% of newborns in the United States but may be hard to diagnose prenatally. OBJECTIVE: To evaluate the current sensitivity and specificity of amniocentesis in detecting congenital cytomegalovirus infection. STUDY DESIGN: Secondary analysis of a multicenter randomized placebo-controlled trial designed to evaluate whether cytomegalovirus hyperimmune globulin reduces congenital cytomegalovirus infection in neonates of individuals diagnosed with primary cytomegalovirus infection before 24 weeks of gestation. At randomization, subjects had no clinical evidence of fetal infection. Eligible subjects were randomized to monthly infusions of cytomegalovirus hyperimmune globulin or placebo until delivery. Although not required by the trial protocol, amniocentesis following randomization was permitted. The fetuses and neonates were tested for the presence of cytomegalovirus at delivery. Comparisons were made between those with and without amniocentesis and between those with cytomegalovirus-positive and negative results, using chi-square or Fisher exact test for categorical variables and the Wilcoxon rank sum test or t test for continuous variables. A P value of <.05 was considered significant. RESULTS: From 2012 to 2018, 397 subjects were included, of whom 55 (14%) underwent amniocentesis. Cytomegalovirus results were available for 53 fetuses and neonates. Fourteen amniocenteses were positive (25%). Gestational age at amniocentesis was similar between those with and without cytomegalovirus present, as was the interval between maternal diagnosis and amniocentesis. The prevalence of fetal or neonatal infection was 26% (14/53). The neonates of all 12 subjects with a positive amniocentesis and available results had cytomegalovirus infection confirmed at delivery, as did 2 neonates from the group of 41 subjects with a negative amniocentesis, with a sensitivity of 86% (95% confidence interval, 57-98), specificity of 100% (95% confidence interval, 91-100), positive predictive value of 100% (95% confidence interval, 74-100), and negative predictive value of 95% (95% confidence interval, 83-99). Amniocentesis-positive pregnancies were delivered at an earlier gestational age (37.4 vs 39.6 weeks; P<.001) and had lower birthweights (2583±749 vs 3428±608 g, P=.004) than amniocentesis-negative pregnancies. CONCLUSION: Amniocentesis results are an accurate predictor of congenital cytomegalovirus infection.

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Published In

Am J Obstet Gynecol MFM

DOI

EISSN

2589-9333

Publication Date

July 2022

Volume

4

Issue

4

Start / End Page

100641

Location

United States

Related Subject Headings

  • Pregnancy Complications, Infectious
  • Pregnancy
  • Infectious Disease Transmission, Vertical
  • Infant, Newborn
  • Infant
  • Humans
  • Female
  • Cytomegalovirus Infections
  • Cytomegalovirus
  • Amniocentesis
 

Citation

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Dinsmoor, M. J., Fette, L. M., Hughes, B. L., Rouse, D. J., Saade, G. R., Reddy, U. M., … Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network. (2022). Amniocentesis to diagnose congenital cytomegalovirus infection following maternal primary infection. Am J Obstet Gynecol MFM, 4(4), 100641. https://doi.org/10.1016/j.ajogmf.2022.100641
Dinsmoor, Mara J., Lida M. Fette, Brenna L. Hughes, Dwight J. Rouse, George R. Saade, Uma M. Reddy, Donna Allard, et al. “Amniocentesis to diagnose congenital cytomegalovirus infection following maternal primary infection.Am J Obstet Gynecol MFM 4, no. 4 (July 2022): 100641. https://doi.org/10.1016/j.ajogmf.2022.100641.
Dinsmoor MJ, Fette LM, Hughes BL, Rouse DJ, Saade GR, Reddy UM, et al. Amniocentesis to diagnose congenital cytomegalovirus infection following maternal primary infection. Am J Obstet Gynecol MFM. 2022 Jul;4(4):100641.
Dinsmoor, Mara J., et al. “Amniocentesis to diagnose congenital cytomegalovirus infection following maternal primary infection.Am J Obstet Gynecol MFM, vol. 4, no. 4, July 2022, p. 100641. Pubmed, doi:10.1016/j.ajogmf.2022.100641.
Dinsmoor MJ, Fette LM, Hughes BL, Rouse DJ, Saade GR, Reddy UM, Allard D, Mallett G, Thom EA, Gyamfi-Bannerman C, Varner MW, Goodnight WH, Tita ATN, Costantine MM, Swamy GK, Heyborne KD, Chien EK, Chauhan SP, El-Sayed YY, Casey BM, Parry S, Simhan HN, Napolitano PG, Macones GA, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network. Amniocentesis to diagnose congenital cytomegalovirus infection following maternal primary infection. Am J Obstet Gynecol MFM. 2022 Jul;4(4):100641.
Journal cover image

Published In

Am J Obstet Gynecol MFM

DOI

EISSN

2589-9333

Publication Date

July 2022

Volume

4

Issue

4

Start / End Page

100641

Location

United States

Related Subject Headings

  • Pregnancy Complications, Infectious
  • Pregnancy
  • Infectious Disease Transmission, Vertical
  • Infant, Newborn
  • Infant
  • Humans
  • Female
  • Cytomegalovirus Infections
  • Cytomegalovirus
  • Amniocentesis