Efficacy of Immunoglobulin Therapy for Secondary Prevention of Congenital Cytomegalovirus Infection: A Systematic Review and Meta-Analysis.

Congenital cytomegalovirus (cCMV) is the leading infectious cause of long-term neuro-sensory impairment. Aim of meta-analysis was to evaluate the efficacy of antenatal immunoglobulin therapy-particularly cytomegalovirus-specific hyperimmune globulin (HIG)-in preventing vertical transmission and congenital cytomegalovirus infection (cCMV) in pregnancies complicated by primary maternal CMV infection. A search of PubMed, Cochrane Library, Embase, Scopus, ScienceDirect, Taylor & Francis Online, Wiley Online Library, ClinicalTrials.gov, and Google Scholar identified randomized controlled trials, prospective or retrospective cohort studies including pregnant women with serologically confirmed primary CMV infection. Eligible interventions included antenatal CMV-specific or nonspecific immunoglobulins (vs placebo, usual care, historical controls, or no treatment), although all included studies evaluated CMV-specific HIG. Controlled studies showed no significant reduction in transmission (RR 0.73, 95% CI .54-1.00; P = .051) with moderate heterogeneity. The pooled transmission rate after HIG was 27.2%, with substantial heterogeneity. Current evidence does not support routine antenatal immunoglobulin to prevent cCMV.