Is Neonatal Viremia a Possible Predictor of the Timing of Maternal Infection in Asymptomatic Congenital Cytomegalovirus Infection? A Retrospective Study.

Background

Asymptomatic congenital cytomegalovirus (acCMV) infections represent 85-90% of all congenital CMV infection. The incidence of late-onset sequelae in these cases significantly contribute to the burden of CMV disease. The timing of maternal infection (TMI) has been identified as the main predictor of late-onset sequelae in acCMV infants, and follow-up programs in Europe are currently calibrated according to the TMI. Our aim was to evaluate neonatal viremia as a possible predictor of the TMI in acCMV infections.

Methods

Plasma viral loads (PVLs) were assessed in the first month of life in a population of acCMV-infected newborns delivered by women who suffer a primary CMV infection during pregnancy. TMI was assigned to a trimester of pregnancy according to the maternal serological screening. PVLs were evaluated in relation to the TMI and gestational age (GA) at birth.

Results

One hundred and ten newborns were, respectively, assigned to preconceptional (6.4%), 1st (27.3%), 2nd (38.2%), and 3rd (28.2%) trimester infections. Median neonatal PVLs values were significantly different between groups (p < 0.001). First-trimester infections exhibited significantly higher PVLs when compared with third-trimester ones (p < 0.001). Overall, PVLs showed an inverse correlation with GA at birth (p = 0.003).

Conclusions

Median neonatal PVLs are significantly higher in 1st trimester infections if compared with 3rd trimester ones, but a wide overlap between PVL values prevent their possible use as a predictor of the TMI. In our population, a significant inverse relationship, mainly dependent on 1st and 2nd trimester infections, is demonstrated between PVLs and GA. Overall, fetal viremia is already decreasing weeks before the term of pregnancy.