Abstract
Background:
Primary human cytomegalovirus (CMV) infection during pregnancy is a major cause of congenital malformation. We detected primary CMV infection in pregnant Korean women by using an algorithm that comprises CMV IgG, IgM, and IgG avidity tests.
Methods:
During a 2-month period, 744 pregnant women who were at 10-19 weeks of gestation were consecutively enrolled in this study. Human anti-CMV IgG and IgM levels in their sera were determined by chemiluminescence immunoassays. Serum samples from the women who were positive for CMV IgG and IgM were assayed by the ARCHITECT CMV IgG avidity test in order to distinguish primary from non-primary CMV infection. Gross examination of the neonates of the women who were positive for CMV IgM was conducted.
Results:
The seroprevalence of CMV IgG and IgM was estimated to be 98.1% and 1.7%, respectively. The samples from all the women who were positive for CMV IgM or with grey zone results contained high avidity CMV IgG. Seven women with positive CMV IgG and IgM results who completed follow-up up to delivery showed no gross evidence of in utero CMV transmission.
Conclusions:
Maternal primary CMV infection was not detected in any of the pregnant women included in this study cohort. CMV IgG avidity test enabled the identification of women who were at a low risk of transmitting CMV infection and provided informative for subsequent pregnancy outcomes. Compared to previous studies, the seroprevalence of CMV IgG antibody across pregnant Korean women remained unchanged.
REFERENCES
1.Stagno S., Pass RF., Cloud G., Britt WJ., Henderson RE., Walton PD, et al. Primary cytomegalovirus infection in pregnancy. Incidence, transmission to fetus, and clinical outcome. JAMA. 1986. 256:1904–8.
2.Stagno S., Pass RF., Alford CA. Perinatal infections and maldevelopment. Birth Defects Orig Artic Ser. 1981. 17:31–50.
3.Stagno S., Whitley RJ. Herpesvirus infections of pregnancy. Part I: cytomegalovirus and epstein-barr virus infections. N Engl J Med. 1985. 313:1270–4.
4.Munro SC., Hall B., Whybin LR., Leader L., Robertson P., Maine GT, et al. Diagnosis of and screening for cytomegalovirus infection in pregnant women. J Clin Microbiol. 2005. 43:4713–8.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
5.Boppana SB., Fowler KB., Britt WJ., Stagno S., Pass RF. Symptomatic congenital cytomegalovirus infection in infants born to mothers with preexisting immunity to cytomegalovirus. Pediatrics. 1999. 104:55–60.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
6.Boppana SB., Rivera LB., Fowler KB., Mach M., Britt WJ. Intrauterine transmission of cytomegalovirus to infants of women with preconceptional immunity. N Engl J Med. 2001. 344:1366–71.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
7.Gaytant MA., Rours GI., Steegers EA., Galama JM., Semmekrot BA. Congenital cytomegalovirus infection after recurrent infection: case reports and review of the literature. Eur J Pediatr. 2003. 162:248–53.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
8.Lagrou K., Bodeus M., Van Ranst M., Goubau P. Evaluation of the new architect cytomegalovirus immunoglobulin M (IgM), IgG, and IgG avidity assays. J Clin Microbiol. 2009. 47:1695–9.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
9.Park HK. Study of cytomegalovirus and Herpes simplex virus antibodies in Korean pregnant women with complement fixation test. Ewha Med J. 1984. 7:191–7. (박혜경. 한국인 임산부의 cytomegalovirus와 Herpes simplex virus의 보체결합항체 보유에 관한 연구. 이화의대지 1984;7:191-7.).
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
10.Sohn YM., Park KI., Lee C., Han DG., Lee WY. Congenital cytomegalovirus infection in Korean population with very high prevalence of maternal immunity. J Korean Med Sci. 1992. 7:47–51.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
11.Crofts N., Maskill W., Gust ID. Evaluation of enzyme-linked immunosorbent assays: a method of data analysis. J Virol Methods. 1988. 22:51–9.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
12.Huang ES., Alford CA., Reynolds DW., Stagno S., Pass RF. Molecular epidemiology of cytomegalovirus infections in women and their infants. N Engl J Med. 1980. 303:958–62.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
13.Kenneson A., Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol. 2007. 17:253–76.
![crossref](/image/icon/bnr_ref_cross.gif)
![crossref](/image/icon/bnr_ref_cross.gif)
14.Kim S., Choi SJ. Two cases of prenatal diagnosis of congenital cytomegalovirus infection. Korean J Obstet Gynecol. 2004. 47:564–8. (김산 및 최상준. 산전에 진단된 태아 거대바이러스 감염 2예. 대한산부인과학회지 2004;47:564-8.).
15.Cho GJ., Oh MJ., Chung JW., Chung OS., Lee JK., Hur JY, et al. A case of congenital cytomegalovirus infection with severe hydrocephalus in prenatal ultrasonography. Korean J Obstet Gynecol. 2004. 47:2224–8. (조금준, 오민정, 정재원, 정언석, 이재관, 허준용 등. 산전 초음파상중증의 태아 수두증 소견을 보인 선천성 거대세포바이러스 감염1예.대한산부인과학회지 2004;47:2224-8.).
Fig. 1.
Distribution of cytomegalovirus IgG concentrations in pregnant women.
Abbreviation: AU, arbitrary units.
![kjlm-29-557f1.tif](/upload/SynapseXML/0039kjlm/thumb/kjlm-29-557f1.gif)
Table 1.
Characteristics of the women with positive results both on cytomegalovirus IgG and IgM serological tests
Case no. | Age (yr) | Gestational age from LMP | Body weight (kg) | CMV IgG | CMV IgM | CMV IgG avidity | Neonatal exam∗ | ||||
---|---|---|---|---|---|---|---|---|---|---|---|
Weeks | Days | AU/mL | Interpretation | Signal to cutoff ratio | Interpretation | % | Interpretation | ||||
1 | 31 | 16 | 4 | 47.5 | 87.9 | Positive | 1.6 | Positive | 85.0 | High | Normal |
2 | 37 | 17 | 2 | 58.2 | >250.0 | Positive | 1.5 | Positive | 94.7 | High | Normal |
3 | 27 | 17 | 2 | 54.0 | 92.4 | Positive | 1.1 | Positive | 88.5 | High | Normal |
4 | 36 | 15 | 0 | 53.7 | 101.0 | Positive | 1.0 | Grey zone | 65.2 | High | Normal |
5 | 39 | 17 | 0 | 52.4 | 247.4 | Positive | 0.9 | Grey zone | 81.2 | High | Normal |
6 | 26 | 17 | 4 | 61.2 | >250.0 | Positive | 1.9 | Positive | 97.7 | High | Not done |
7 | 28 | 16 | 1 | 63.5 | 237.9 | Positive | 1.4 | Positive | 98.1 | High | Not done |
8 | 34 | 16 | 1 | 48.0 | 184.6 | Positive | 0.9 | Grey zone | 91.3 | High | Normal |
9 | 24 | 16 | 2 | 99.0 | 94.2 | Positive | 1.2 | Positive | 98.2 | High | Not done |
10 | 33 | 16 | 3 | 44.1 | >250.0 | Positive | 1.0 | Positive | 74.6 | High | Not done |
11 | 26 | 16 | 2 | 59.3 | 167.0 | Positive | 1.0 | Positive | 90.0 | High | Not done |
12 | 23 | 15 | 0 | 64.0 | 140.1 | Positive | 1.1 | Positive | 80.6 | High | Normal |
13 | 28 | 15 | 3 | 79.0 | >250.0 | Positive | 1.2 | Positive | Not done | Not done |