Viruses | Free Full-Text | Evaluation of Congenital Cytomegalovirus Infection in Pregnant Women Admitted to a University Hospital in Istanbul
1. Introduction
2. Materials and Methods
The study cohort comprised 141 pregnant women, ranging from 19 to 45 years, who visited the Istanbul Faculty of Medicine’s Prenatal Diagnosis and Treatment Center due to sonographic indications of potential congenital infection. These patients, who had undergone extensive fetal anatomical screenings in our clinic, exhibited signs such as ventriculomegaly, ventricular synechiae, mega cisterna magna, abnormalities in the corpus callosum, polyhydramnios, microcephaly, an echogenic bowel, intrauterine growth retardation, and non-immune hydrops fetalis. Only those presenting these anomalies and screened for cytomegalovirus, excluding other congenital infections, were considered for the study. The inclusion criteria encompassed pregnant women with preliminary sonographic diagnoses of fetal anomalies and devoid of substance abuse, smoking, and alcohol consumption since their last menstrual period. Subjects were excluded if they demonstrated normal ultrasound results, had active sexually transmitted diseases, underwent artificial fertilization, or were in a consanguineous marriage.
On average, the ELISA and PCR tests were carried out at 25 weeks of gestation (between 22 and 32 weeks) in response to the findings of the amniocentesis. At the same time, we recommended fetal karyotyping and array CGH. If necessary, whole-exome sequencing was also suggested. This approach was deemed appropriate as fetal findings are a part of the differential diagnosis, regardless of other signs pointing toward a genetic disease risk, such as cortical dysplasia, congenital heart disease, and fetal growth restriction. It is noteworthy that no additional prenatal infections or genetic disorders were diagnosed in our study group aside from CMV DNA positivity, which signifies isolated prenatal CMV positivity.
We collected maternal serum and amniotic fluid samples simultaneously from pregnant women to detect CMV. These samples were promptly transported to the Department of Medical Microbiology laboratories at Istanbul Medical Faculty. We used the real-time PCR method to identify CMV DNA in the amniotic fluid. Additionally, we employed the ELISA method to detect CMV IgM, IgG, and IgG avidity in the maternal serum.
We tested the maternal serum samples using an automated Triturus ELISA instrument (Grifols, Madrid, Spain), following the manufacturer’s guidance. Commercial CMV ELISA IgM, IgG, and IgG avidity kits (Vircell, Granada, Spain) were used in the process. After birth, urine samples were collected and promptly sent to the laboratories at Istanbul Medical Faculty’s Department of Medical Microbiology.
We used the QIAsymphony SP-AS device (QIAGEN, Hilden, Germany) to extract DNA from the amniotic fluid samples for the quantitative detection of CMV DNA. The process involved utilizing the Artus® CMV QS-RGQ Kit (QIAGEN, Hilden, Germany) and implementing the real-time PCR method in the Rotor-Gene Q device (QIAGEN, Hilden, Germany) according to the manufacturer’s guidelines. Moreover, the automated extraction of CMV DNA from 1200 μL amniotic fluid samples was carried out using the QIAsymphony DSP Virus/Pathogen Midi Kit (QIAGEN, Hilden, Germany).
The Artus® CMV QS-RGQ kit is a commercially available kit for in vitro diagnostic use. It boasts an analytical sensitivity of 79.4 copies/mL and includes an internal control to identify false negatives. Each sample undergoes extraction after the addition of this internal control.
The description of the prenatal characteristics for CMV-positive cases was presented as a median, and frequency distributions were used for the data analysis.
The study adhered to the Declaration of Helsinki and received approval from the Ethics Committee of Istanbul University’s Faculty of Medicine. The approval was granted on 30 November 2021, under the protocol code 613315.
3. Results
The average age of the 124 patients testing negative for CMV DNA was 31.80 years, while that of the 17 patients testing positive was 32.05 years. No statistically significant difference was observed between the two groups (p > 0.05).
The previous childbirth history of these 17 mothers was 1.53 ± 1.17. Two (12%) of the positive cases resulted in fetal loss, seven (41%) resulted in pregnancy termination, and a live birth occured in eight (47%) of all cases. A total of 5 out of 8 of these children were boys and 3 were girls. The gestational age at delivery was 32 ± 3 weeks, and the types of delivery were 5 live births by caesarean section and 3 normal spontaneous births. The birth weight was 1.450 ± 432 g. The head circumference was 30.7 ± 1.2 cm. The type of feeding for 6 of these babies was breastfeeding, and 2 were given supplementary food.
For the pregnant women with inconclusive maternal CMV serology results (CMV IgM suspicious positive, CMV IgG-positive), we performed CMV IgG avidity testing in the serum and CMV PCR after amniocentesis as a confirmation measure after prenatal ultrasonography and fetal evaluation. Following prenatal pediatric evaluations of the live births from pregnancies that tested negative for CMV DNA during amniocentesis, no clinical CMV symptoms were detected. We also examined any abnormal fetal findings like a hyperechogenic bowel, ventriculomegaly, IUGR, and corpus callosum abnormality, among others, for potential alternative causes. The pregnancies resulting in live births returned negative results for CMV DNA according to amniocentesis, while conventional karyotyping came out normal. In the instance of advised pregnancy termination, the contributing factors included cerebellar hypoplasia, severe ventriculomegaly, corpus callosum abnormality, and non-immune hydrops fetalis.
Out of 141 pregnant women, all tested positive for CMV IgG antibodies, while 1.41% tested positive for CMV IgM antibodies. Low avidity was found in the maternal serum of the CMV IgM-positive samples. From the amniotic fluid samples of these women, 17 (12.05%) tested positive for CMV DNA. In 82% of cases with CMV PCR positivity detected using amniocentesis, an abnormality in the central nervous system was observed, making it the most common prenatal finding. Confirmatory diagnosis results for congenital CMV DNA from the urine samples after birth were positive in 8 out of 17 infants. Of the 17, 9 pregnancies were terminated due to severe findings. No confirmation was performed for the terminated pregnancies in our study.
4. Discussion
Our study’s limitations include its single-center design, CMV’s slow proliferation and latent features, and the sensitivity of the window period in patients with congenital anomalies. Other difficulties involve situations where serological tests are not conducted simultaneously and problems obtaining demographic data. Despite this, our data provide valuable insight for the combined evaluation of serological and viral load results from both amniocentesis and serum samples. We examined certain confounders that could cause anomalies, such as a latent virus being frequently reactivated or causing a reinfection in pregnancy, but we could not examine all factors, marking another limitation.
5. Conclusions
In conclusion, to anticipate the potential risk of a fetus’s CMV infection, especially in the first trimester, we recommend conducting maternal serological tests when the ultrasonographic findings indicate potential prenatal infections in the fetus or point to maternal contact/infection. However, serological tests being administered in the second trimester may not indicate maternal infections occurring early in the pregnancy. Furthermore, we stress the importance of the CMV IgG avidity test and CMV DNA PCR tests to differentiate acute from chronic disease and verify the infection when ultrasound detects anomalies in the fetus. Nevertheless, during periconceptional or early first-trimester maternal infection, high CMV IgG avidity may be observed at 20 weeks of pregnancy in CMV-seropositive mothers, making the identification of primary infection during pregnancy challenging. Infections occurring later in pregnancy are expected to have a substantially reduced impact on the fetus. We suggest performing CMV screening in pregnancy in all pregnant women, even seropositive women, at about 8 and 14 weeks of pregnancy.
Author Contributions
Conceptualization, H.K.U. and E.O.; data curation, H.K.U., T.S.S., D.T., M.O., G.Y., E.Y. and E.O.; formal analysis, H.K.U., T.S.S., K.S., D.T., M.O., M.D., E.Y., R.H., A.A. and E.O.; investigation, H.K.U. and E.O.; methodology, H.K.U. and E.O.; software, E.Y.; writing—original draft, H.K.U., T.S.S., K.S., D.T., M.O., M.D., E.Y., R.H., A.A. and E.O.; writing—review and editing, H.K.U., T.S.S., K.S., D.T., M.O., M.D., G.Y., E.Y., R.H., A.A. and E.O. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Istanbul University, Istanbul Faculty of Medicine (protocol code 613315 and date of approval: 30 November 2021).
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
To protect patient confidentiality, the data used in the study cannot be shared with third parties.
Acknowledgments
We would like to thank the physicians and staff of Istanbul Faculty of Medicine, the Department of Obstetrics and Gynecology, for their assistance with the study.
Conflicts of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
References
- Patrick, R.; Murray, K.S.R.; Michael, A.P. Human Herpesviruses. In Textbook of Medical Microbiology; Elsevier: Amsterdam, The Netherlands, 2016; pp. 425–446. [Google Scholar]
- Hodinka, R.L. Human Cytomegalovirus. In Manual of Clinical Microbiology; Carroll, K.C.J., James, H., Michael, A.P., Eds.; ASM Press: Washington, DC, USA, 2015; pp. 1718–1737. [Google Scholar]
- Flint, J.; Racaniello, V.R.; Rall, G.F.; Hatziioannou, T.; Skalka, A.M. Herpesviruses. In Principles of Virology; ASM Press: Washington, DC, USA, 2020; pp. 1521–1525. [Google Scholar]
- Murphy, E.; Shenk, T.E. Human cytomegalovirus genome. In Human Cytomegalovirus; Springer: Berlin/Heidelberg, Germany, 2008; pp. 1–19. [Google Scholar]
- Manicklal, S.; Emery, V.C.; Lazzarotto, T.; Boppana, S.B.; Gupta, R.K. The “silent” global burden of congenital cytomegalovirus. Clin. Microbiol. Rev. 2013, 26, 86–102. [Google Scholar] [CrossRef]
- Sahiner, F.; Cekmez, F.; Cetinkaya, M.; Kaya, G.; Kalayci, T.; Gunes, O.; Sener, K.; Yapar, M.; Tunc, T.; Ecemis, T.; et al. Congenital cytomegalovirus infections and glycoprotein B genotypes in live-born infants: A prevalence study in Turkey. Infect. Dis. 2015, 47, 465–471. [Google Scholar] [CrossRef]
- Satılmış, A.; Güra, A.; Ongun, H.; Mendilcioğlu, I.; Colak, D.; Oygür, N. CMV seroconversion in pregnants and the incidence of congenital CMV infection. Turk. J. Pediatr. 2007, 49, 30–36. [Google Scholar] [PubMed]
- Aynioglu, A.; Aynioglu, O.; Altunok, E.S. Seroprevalence of Toxoplasma gondii, rubella and Cytomegalovirus among pregnant females in north-western Turkey. Acta Clin. Belg. 2015, 70, 321–324. [Google Scholar] [CrossRef] [PubMed]
- Sert, Y.; Ozgu-Erdinc, A.S.; Saygan, S.; Engin Ustun, Y. Antenatal cytomegalovirus infection screening results of 32,188 patients in a tertiary referral center: A retrospective cohort study. Fetal Pediatr. Pathol. 2019, 38, 112–120. [Google Scholar] [CrossRef] [PubMed]
- Zeytinoğlu, A.; Terek, D.; Arslan, A.; Erensoy, S.; Bozdemir, T.; Yalaz, M.; Ergör, S.N.; Öğüt, M.F.; Kültürsay, N. Investigation of congenital CMV infection with the presence of CMV DNA in saliva samples of new born babies. Mikrobiyoloji Bul. 2019, 53, 53–60. [Google Scholar] [CrossRef] [PubMed]
- Cannon, M.J.; Schmid, D.S.; Hyde, T.B. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Rev. Med. Virol. 2010, 20, 202–213. [Google Scholar] [CrossRef] [PubMed]
- Navti, O.B.; Al-Belushi, M.; Konje, J.C. Cytomegalovirus infection in pregnancy–An update. Eur. J. Obstet. Gynecol. Reprod. Biol. 2021, 258, 216–222. [Google Scholar] [CrossRef] [PubMed]
- Leruez-Ville, M.; Ville, Y. Fetal cytomegalovirus infection. Best. Pract. Res. Clin. Obs. Gynaecol. 2017, 38, 97–107. [Google Scholar] [CrossRef] [PubMed]
- Carlson, A.; Norwitz, E.R.; Stiller, R.J. Cytomegalovirus infection in pregnancy: Should all women be screened? Rev. Obstet. Gynecol. 2010, 3, 172. [Google Scholar]
- Schleiss, M.R. Antiviral therapy of congenital cytomegalovirus infection. Semin. Pediatr. Infect. Dis. 2005, 16, 50–59. [Google Scholar] [CrossRef]
- Feigin, R.D.; Cherry, J.; Demmler-Harrison, G.J.; Kaplan, S.L. Textbook of Pediatric Infectious Diseases; Elsevier Health Sciences: Amsterdam, The Netherlands, 2009; Volume 1. [Google Scholar]
- Long, S.S.; Pickering, L.K.; Prober, C.G. Principles and Practice of Pediatric Infectious Diseases; LWW: Philadelphia, PA, USA, 2003. [Google Scholar]
- Dworsky, M.; Yow, M.; Stagno, S.; Pass, R.F.; Alford, C. Cytomegalovirus infection of breast milk and transmission in infancy. Pediatrics 1983, 72, 295–299. [Google Scholar] [CrossRef]
- Jim, W.-T.; Shu, C.-H.; Chiu, N.-C.; Kao, H.-A.; Hung, H.-Y.; Chang, J.-H.; Peng, C.-C.; Hsieh, W.-S.; Liu, K.-C.; Huang, F.-Y. Transmission of cytomegalovirus from mothers to preterm infants by breast milk. Pediatr. Infect. Dis. J. 2004, 23, 848–851. [Google Scholar] [CrossRef]
- Pass, R.F.; Fowler, K.B.; Boppana, S.B.; Britt, W.J.; Stagno, S. Congenital cytomegalovirus infection following first trimester maternal infection: Symptoms at birth and outcome. J. Clin. Virol. 2006, 35, 216–220. [Google Scholar] [CrossRef]
- Warren Levinson, P.C.-H.; Elizabeth, A.; Jesse Nussbaum, J.; Schwartz, B. Cytomegalovirus (CMV). In Review of Medical Microbiology & Immunology a Guide to Clinical Infectious Diseases; McGraw-Hill Education: New York, NY, USA, 2018; pp. 286–288. [Google Scholar]
- Coleman, J.L.; Steele, R.W. Preventing congenital Cytomegalovirus infection. Clin. Pediatr. 2017, 56, 1085–1094. [Google Scholar] [CrossRef]
- Malinger, G.; Lev, D.; Lerman-Sagie, T. Imaging of fetal cytomegalovirus infection. Fetal Diagn. Ther. 2011, 29, 117–126. [Google Scholar] [CrossRef]
- Dogan, Y.; Yuksel, A.; Kalelioglu, I.; Has, R.; Tatli, B.; Yildirim, A. Intracranial ultrasound abnormalities and fetal cytomegalovirus infection: Report of 8 cases and review of the literature. Fetal Diagn. Ther. 2011, 30, 141–149. [Google Scholar] [CrossRef]
- Bonalumi, S.; Trapanese, A.; Santamaria, A.; D’Emidio, L.; Mobili, L. Cytomegalovirus infection in pregnancy: Review of the literature. J. Prenat. Med. 2011, 5, 1–8. [Google Scholar] [PubMed]
- Ryan, K.J.; Ahmad, N.; Alspaugh, A.; Lawrence Drew, W.; Lagunoff, M.; Paul Pottinger, L.; Reller, B.; Reller, M.E.; Sterling, C.R.; Weissman, S. Herpesviruses. In Sherris & Ryan’s Medical Microbiology; Ryan, K.J., Ed.; McGraw Hill: New York, NY, USA, 2022; pp. 541–550. [Google Scholar]
- Bursal, A. Adnan Menderes Üniversitesi Uygulama Ve Araştırma Hastanesi’ne Başvuran Doğurgan Çağdaki Kadınların Rubella Ve CMV Seroprevalansının Retrospektif Olarak Araştırılması. In Aydın Adnan Menderes Üniversitesi Tıp Fakültesi Aile Hekimliği Anabilim Dalı; Aydın Adnan Menderes Üniversitesi: Aydın, Turkey, 2021. [Google Scholar]
- Çubuk, F.; Hasbek, M.; Kafa, A.H.T.; Çelik, C. Hastanemize Başvuran Gebelerde Toksoplazma, Rubella Virüs ve Sitomegalovirus Enfeksiyonları İçin Serolojik Göstergelerin Değerlendirilmesi. Türk Mikrobiyoloji Cemiy. Derg. 2020, 50, 211–217. [Google Scholar]
- Mappa, I.; D’Antonio, F.; Khalil, A.; De Vito, M.; Alameddine, S.; Capannolo, G.; di Mascio, D.; Rizzo, G.; ENSO group. Prognostic Value of Amniotic Fluid Viral Load to Predict Adverse Outcome in Pregnancies Complicated by Congenital Cytomegalovirus Infection: A Multicenter Study. Fetal Diagn. Ther. 2023, 50, 1–7. [Google Scholar] [CrossRef] [PubMed]
- Gülseren, Y.D.; Taşbent, F.E.; Özdemir, M. Gebelerde sitomegalovirüs ile rubella seroprevalansının ve yaşa bağlı dağılımının araştırılması. Türk Mikrobiyoloji Cemiy. Derg. 2019, 49, 154–161. [Google Scholar]
- Mehmet, O.B.U.T.; Doğan, Y.; Bademkiran, M.H.; Akgöl, S.; Kahveci, B.; Peker, N.; Uzundere, O.; Kaçar, C.K.; Özbek, E.; Talip, G.Ü.L. Diyarbakır ilindeki gebe kadınlarda toksoplazma, rubella ve sitomegalovirus seroprevalansı. Dicle Tıp Derg. 2019, 46, 189–194. [Google Scholar]
- Demir, E.; Dinç, H.Ö.; Özbey, D.; Akkuş, S.; Ergin, S.; Kocazeybek, B.S. İÜ-C Cerrahpaşa Tıp Fakültesi Hastanesi’ne Başvuran Hastalarda, 2013–2018 Yılları Arasında Toxoplasma gondii, Rubella ve Sitomegalovirus Seropozitifliği ile Avidite Test Sonuçlarının Retrospektif Olarak Değerlendirilmesi. Türk Mikrobiyoloji Cemiy. Derg. 2020, 50, 35–43. [Google Scholar]
- Altunal, L.N.; Esen, A.B.; Karagöz, G.; Yaşar, K.K. Seroprevalence of Toxoplasma Gondii, Rubella, and Cytomegalovirus Among Pregnant Refugees and Turkish Women: A Retrospective Comparative Study. South. Clin. Istanb. Eurasia 2018, 29, 235–239. [Google Scholar] [CrossRef]
- Şirin, M.C.; Agus, N.; Yilmaz, N.; Bayram, A.; Derici, Y.K.; Samlioglu, P.; Hanci, S.Y.; Dogan, G. Seroprevalence of Toxoplasma gondii, Rubella virus and Cytomegalovirus among pregnant women and the importance of avidity assays. Saudi Med. J. 2017, 38, 727. [Google Scholar] [CrossRef]
- Şahiner, F.; Honca, M.; Çekmez, Y.; Kubar, A.; Honca, T.; Fidanci, M.K.; Purtuloğlu, T.; Yapar, M. The role of maternal screening in diagnosing congenital cytomegalovirus infections in highly immune populations. Ir. J. Med. Sci. 2015, 184, 475–481. [Google Scholar] [CrossRef]
- Parlak, M.; Çim, N.; Erdin, B.N.; Güven, A.; Bayram, Y.; Yıldızhan, R. Seroprevalence of Toxoplasma, Rubella, and Cytomegalovirus among pregnant women in Van. Turk. J. Obstet. Gynecol. 2015, 12, 79. [Google Scholar] [CrossRef]
- Bakacak, M.; Bostancı, M.S.; Köstü, B.; Ercan, Ö.; Serin, S.; Avcı, F.; Bakacak, Z. Gebelerde Toxoplasma gondii, rubella ve sitomegalovirüs seroprevalansı. Dicle Med. J. 2014, 41, 326–331. [Google Scholar] [CrossRef]
- Inci, A.; Yener, C.; Güven, D. Bir devlet hastanesinde gebe kadınlarda toksoplazma, rubella ve sitomegalovirüs seroprevalansının araştırılması. Pamukkale Tıp Derg. 2014, 7, 143–146. [Google Scholar] [CrossRef]
- Zuhair, M.; Smit, G.S.A.; Wallis, G.; Jabbar, F.; Smith, C.; Devleesschauwer, B.; Griffiths, P. Estimation of the worldwide seroprevalence of cytomegalovirus: A systematic review and meta-analysis. Rev. Med. Virol. 2019, 29, e2034. [Google Scholar] [CrossRef]
- Choi, R.; Lee, S.; Lee, S.G.; Lee, E.H. Seroprevalence of CMV IgG and IgM in Korean women of childbearing age. J. Clin. Lab. Anal. 2021, 35, e23716. [Google Scholar] [CrossRef] [PubMed]
- Fowler, K.B.; Boppana, S.B. Congenital cytomegalovirus infection. Semin. Perinatol. 2018, 42, 149–154. [Google Scholar] [CrossRef] [PubMed]
- Pekintürk, N. Doğurganlık Yaş Grubundaki Kadınlarda Rubella ve Sitomegalovirüs Seroprevalansı. J. Clin. Anal. Med. 2015, 6, 69–71. [Google Scholar]
- Pass, R.F.; Arav-Boger, R. Maternal and fetal cytomegalovirus infection: Diagnosis, management, and prevention. F1000Res. 2018, 7, 255. [Google Scholar] [CrossRef] [PubMed]
- Saldan, A.; Forner, G.; Mengoli, C.; Gussetti, N.; Palù, G.; Abate, D. Testing for Cytomegalovirus in Pregnancy. J. Clin. Microbiol. 2017, 55, 693–702. [Google Scholar] [CrossRef] [PubMed]
- Nigro, G.; Adler, S.P.; La Torre, R.; Best, A.M.; Congenital Cytomegalovirus Collaborating Group. Passive immunization during pregnancy for congenital cytomegalovirus infection. N. Engl. J. Med. 2005, 353, 1350–1362. [Google Scholar] [CrossRef] [PubMed]
- Nigro, G.; La Torre, R.; Pentimalli, H.; Taverna, P.; Lituania, M.; de Tejada, B.M.; Adler, S.P. Regression of fetal cerebral abnormalities by primary cytomegalovirus infection following hyperimmunoglobulin therapy. Prenat. Diagn. 2008, 28, 512–517. [Google Scholar] [CrossRef] [PubMed]
- Maidji, E.; Nigro, G.; Tabata, T.; McDonagh, S.; Nozawa, N.; Shiboski, S.; Muci, S.; Anceschi, M.M.; Aziz, N.; Adler, S.P.; et al. Antibody treatment promotes compensation for human cytomegalovirus-induced pathogenesis and a hypoxia-like condition in placentas with congenital infection. Am. J. Pathol. 2010, 177, 1298–1310. [Google Scholar] [CrossRef] [PubMed]
- Nigro, G.; Adler, S.P.; Congenital Cytomegalic Disease Collaborating Group. High-Dose Cytomegalovirus (CMV) Hyperimmune Globulin and Maternal CMV DNAemia Independently Predict Infant Outcome in Pregnant Women With a Primary CMV Infection. Clin. Infect. Dis. 2020, 71, 1491–1498. [Google Scholar] [CrossRef] [PubMed]
- Nigro, G.; Muselli, M.; On Behalf Of The Congenital Cytomegalic Disease Collaborating Group. Prevention of Congenital Cytomegalovirus Infection: Review and Case Series of Valaciclovir versus Hyperimmune Globulin Therapy. Viruses 2023, 15, 1376. [Google Scholar] [CrossRef] [PubMed]
- Choodinatha, H.K.; Jeon, M.R.; Choi, B.Y.; Lee, K.N.; Kim, H.J.; Park, J.Y. Cytomegalovirus infection during pregnancy. Obstet. Gynecol. Sci. 2023, 66, 463–476. [Google Scholar] [CrossRef] [PubMed]
- Diogo, M.C.; Glatter, S.; Binder, J.; Kiss, H.; Prayer, D. The MRI spectrum of congenital cytomegalovirus infection. Prenat. Diagn. 2020, 40, 110–124. [Google Scholar] [CrossRef]
- Linh, L.T.; Duc, N.M.; Nhung, N.H.; My, T.T.; Luu, D.T.; Lenh, B.V. Detecting Fetal Central Nervous System Anomalies Using Magnetic Resonance Imaging and Ultrasound. Med. Arch. 2021, 75, 45–49. [Google Scholar] [CrossRef] [PubMed]
Table 1.
Distribution of positivity of CMV IgM, CMV IgG, and the CMV IgG avidity tests in maternal blood samples and CMV DNA PCR tests in amniotic fluid samples by age group.
Table 1.
Distribution of positivity of CMV IgM, CMV IgG, and the CMV IgG avidity tests in maternal blood samples and CMV DNA PCR tests in amniotic fluid samples by age group.
Age Groups | CMV IgM Positivity | CMV IgG Positivity | CMV IgG Avidity | CMV DNA | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Negative | Positive | |||||||||
n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | |
19–25 (n:26—18.44%) |
– | 0 | 26 | 100 | – | 0 | 25 | 96.1 | 1 | 3.9 |
26–30 (n:33—23.40%) |
1 (suspected positive) | 3 | 33 | 100 | 1 (low avidity) | 3 | 26 | 78.7 | 7 | 21.3 |
31–36 (n:50—35.46%) |
1 (suspected positive) | 2 | 50 | 100 | 1 (low avidity) | 2 | 44 | 88 | 6 | 12 |
37–40 (n:19—13.48%) |
– | 0 | 19 | 100 | – | 0 | 18 | 94.7 | 1 | 5.3 |
41–46 (n:13—9.22%) |
– | 0 | 13 | 100 | – | 0 | 11 | 84.6 | 2 | 15.4 |
Total (n:141) | 2 | 1.41 | 141 | 100 | 2 | 1.41 | 124 | 87.9 | 17 | 12.05 |
Table 2.
Distribution of CMV DNA, CMV IgG, CMV IgM, and CMV avidity.
Table 2.
Distribution of CMV DNA, CMV IgG, CMV IgM, and CMV avidity.
No | Age | CMV DNA Conc—Amniotic Fluid Samples (Copies/mL) | CMV DNA Conc—Infant Urine Samples (Copies/mL) | CMV IgG (U./mL) | CMV IgM (U./mL) | CMV Avidity Index |
---|---|---|---|---|---|---|
1 | 29 | 94 | 191,486 | Positive (200) | Negative | |
2 | 27 | 54 * | 285,587 | Positive (200) | Negative | |
3 | 34 | 43 * | 342,674 | Positive (200) | Negative | |
4 | 41 | 21 * | ND | Positive (200) | Negative | |
5 | 33 | 3,381,865 | 1,134,547 | Positive (200) | Negative | |
6 | 30 | 3,441,374 | ND | Positive (200) | Negative | |
7 | 36 | 5 * | ND | Positive (24.7) | Negative | |
8 | 27 | 58,249,030 | 1,752,586 | Positive (188) | Negative | |
9 | 37 | 7 * | ND | Positive (200) | Negative | |
10 | 36 | 9 * | ND | Positive (200) | Negative | |
11 | 20 | 14 * | 248,125 | Positive (200) | Negative | |
12 | 33 | 18 * | ND | Positive (200) | Negative | |
13 | 29 | 4766 | 201,148 | Positive (200) | Negative | |
14 | 31 | 9 * | ND | Positive (127) | Negative | |
15 | 45 | 82 | ND | Positive (200) | Negative | |
16 | 27 | 115 | ND | Positive (200) | Suspicious (9.72) | Low avidity (0.15) |
17 | 30 | 3,992,043 | 1,158,153 | Positive (200) | Negative | |
18 | 35 | Negative | Negative | Positive (200) | Suspicious (9.97) | Low avidity (0.19) |
Table 3.
Prenatal and perinatal characteristics of CMV PCR-positive cases (n = 17) in amniocentesis (AC).
Table 3.
Prenatal and perinatal characteristics of CMV PCR-positive cases (n = 17) in amniocentesis (AC).
Prenatal and Perinatal Characteristics | Median (Min–Max) | |
---|---|---|
Gestational week at prenatal diagnosis | 23 (22–29) | |
Gestational week at amniocentesis (AC) | 25 (22–32) | |
n | % | |
Prenatal ultrasonographic features | ||
Central nervous system | 14 | 82 |
Ventriculomegaly | 8 | 47 |
Mega cisterna magna | 3 | 17 |
Corpus callosum abnormality | 4 | 23 |
Intraventricular synechia | 2 | 12 |
Microcephalia | 1 | 6 |
Periventricular echogenicity | 2 | 12 |
Hyperechogenic intestine | 4 | 23 |
Intrauterine growth restriction (IUGR) | 5 | 29 |
Ascites | 1 | 6 |
Polyhydramniosis | 3 | 17 |
Perinatal outcome | ||
Intrauterine demise | 2 | 12 |
Termination of pregnancy | 7 | 41 |
Livebirth | 8 | 47 |
Neonatal exitus * | 1 | 12 |
Deafness ¶ | 1 | 12 |
Table 4.
Distribution of CMV IgG, IgM seroprevalence, and the CMV IgG avidity data in some recent studies on pregnant women in different cities in Turkey.
Table 4.
Distribution of CMV IgG, IgM seroprevalence, and the CMV IgG avidity data in some recent studies on pregnant women in different cities in Turkey.
Reference, City | CMV IgM Positivity (%) |
CMV IgG Positivity (%) |
CMV IgG Avidity Results |
---|---|---|---|
Bursal et al., 2021, Aydın [27] | 2.6 | 98 | N/A |
Çubuk et al., 2020, Sivas [28] | 0.7 | 99 | N/A |
Gülseren et al., 2019, Konya [30] | 0.2 | 100 | N/A |
Obut et al., 2019, Diyarbakır [31] | 0.7 | 99.2 | N/A |
Demir et al., 2019, İstanbul [32] | 3.2 | 94 | N/A |
Altunal et al., 2018, İstanbul [33] | 0.2 (Turkish citizens) | 99.5 (Turkish citizens) | N/A |
0 (Syrian immigrants) | 100 (Syrian immigrants) | N/A | |
Şirin et al., 2017, İzmir [34] | 1.5 | 98.9 | in IgM-positive 9 cases: Low avidity: 0 Intermediate: 1 High avidity: 8 (88.9%) |
Şahiner et al., 2015, Ankara [35] | 0.97 | 98.1 | High avidity in all |
Parlak et al., 2015, Van [36] | 2.6 | 100 | High avidity in all |
Bakacak et al., 2014, Kahramanmaraş [37] |
3.2 | 99.3 | N/A |
İnci et al., 2014, Artvin [38] | 1.6 | 98.6 | N/A |
This study, 2022, Istanbul | 1.41 | 100 | Low avidity |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |