Cytomegalovirus and pregnancy

Abstract

Cytomegalovirus remains the most common congenital infection worldwide, with approximately 1% of all newborns infected in utero. Of those infected in utero, approximately 10% will have signs and symptoms of cytomegalovirus infection at birth and develop sequelae, especially mental retardation, hearing deficit, or both. Recent data indicate that more than 90% of symptomatic infections or infections causing sequelae occur following a primary maternal infection during pregnancy. The overall risk of delivering an infant who will develop significant handicaps following a primary maternal infection is between 10% and 20%. Between 1% and 2% of seronegative women may acquire a primary cytomegalovirus infection during pregnancy, but seronegative women at high risk include day-care workers, who have a 10% to 20% annual infection rate, and the seronegative mothers of infected children under 2 years of age, 50% of whom will acquire cytomegalovirus annually from their children. Adolescents are another group who may have a high infection rate during pregnancy. Although a cytomegalovirus vaccine is still many years from introduction, these observations strengthen the need and feasibility for a cytomegalovirus vaccine. Pending vaccine development and evaluation, several possible strategies for intervention to prevent primary infection for high-risk pregnancies are suggested.