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Amniocentesis to diagnose congenital cytomegalovirus infection following maternal primary infection. American journal of obstetrics & gynecology MFM Dinsmoor, M. J., Fette, L. M., Hughes, B. L., Rouse, D. J., Saade, G. R., Reddy, U. M., Allard, D., Mallett, G., Thom, E. A., Gyamfi-Bannerman, C., Varner, M. W., Goodnight, W. H., Tita, A. T., Costantine, M. M., Swamy, G. K., Heyborne, K. D., Chien, E. K., Chauhan, S. P., El-Sayed, Y. Y., Casey, B. M., Parry, S., Simhan, H. N., Napolitano, P. G., Macones, G. A., Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network 2022: 100641

Abstract

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 CMV infection. Study Design Secondary analysis of a multicenter randomized placebo-controlled trial designed to evaluate whether CMV hyperimmune globulin (HIG) reduces congenital CMV in the neonates of individuals diagnosed with primary CMV infection prior to 24 weeks of gestation. At randomization, subjects had no clinical evidence of fetal infection. Eligible subjects were randomized to monthly infusions of CMV HIG 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 CMV at delivery. Comparisons were made between those with or without amniocentesis and between those with a CMV-positive or negative result, using chi-square test or Fisher's exact test for categorical variables and the Wilcoxon rank sum test or t-test for continuous variables. A P-value of < 0.05 was considered significant. Results From 2012-2018, 397 subjects were included, of whom 55 (14%) underwent amniocentesis. CMV results were available for 53 fetuses and neonates. Fourteen amniocenteses were positive (25%). The gestational age at amniocentesis was similar between those with and without CMV 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 CMV infection confirmed at delivery, as did 2 of the 41 subjects with a negative amniocentesis, for a sensitivity of 86% (95%CI 57-98%), specificity of 100% (95%CI 91-100%), positive predictive value of 100% (95%CI 74-100%) and negative predictive value of 95% (95%CI 83-99%). Amniocentesis-positive pregnancies delivered at an earlier gestational age (37.4 vs 39.6 weeks, P <0.001) and had a lower birthweight (2583 ± 749 vs 3428 ± 608 grams, P=0.004) than amniocentesis-negative pregnancies. Conclusion Amniocentesis results are an accurate predictor of congenital CMV infection.

View details for DOI 10.1016/j.ajogmf.2022.100641

View details for PubMedID 35526782