Cytomegalovirus and Pregnancy: A Narrative Review

Abstract

Cytomegalovirus (CMV) infection is the most common congenital infection worldwide, affecting between 0.7% and 1% of all live births. Approximately 11% of infected newborns are symptomatic at birth, and between 30% and 40% of these are at risk of developing long-term neurological sequelae. Until recently, the lack of an effective treatment did not justify universal testing of pregnant women. In recent years, however, valacyclovir at a dose of 8 g/day has been shown to be effective in preventing vertical transmission, and ganciclovir has been shown to be effective in preventing long-term sequelae in the treatment of symptomatic neonates. The aim of this article is to review congenital CMV infection, from its epidemiology to its treatment, using the most recent studies in the literature, and to help in the decision to modify protocols for universal testing of pregnant women according to the possibilities of each locality.

Keywords: cytomegalovirus; pregnancy; serology; transmission; treatment.

Figure 1

Flowchart of the serology screening of intrauterine cytomegalovirus infection until 14 weeks of gestation.

Figure 2

Ultrasonographic findings in a fetus with intrauterine cytomegalovirus infection. (A) Transabdominal ultrasound showing periventricular calcifications. (B) Transvaginal ultrasound showing periventricular calcifications. (C) Microcephaly. (D) Placentomegaly.

Figure 3

T2-weighted MRI in axial view of fetal skull showing mild ventriculomegaly and cortical atrophy (arrow).

Figure 4

Categorization of intrauterine cytomegalovirus infection according to Khalil et al. [31].

Figure 5

Computed tomography axial view of a newborn skull with intrauterine cytomegalovirus infection showing periventricular calcifications (A) and moderate ventriculomegaly (B).

Figure 6

Flowchart of treatment in both fetus and newborn with intrauterine cytomegalovirus infection.