First-Trimester Universal One-Time Serology Screening for Cytomegalovirus: A Pilot Study at Two Tertiary Referral Centers in Barcelona (Catalunya, Spain).

IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY
Karen P Castillo, Laura Guirado, Alex Cahuana, María Angeles Marcos, Imma Mercadé, Elena Casals Font, Qiqi Liu, Clara Medina, Marta López, María Dolores Gómez-Roig, Francesc Figueras, Anna Goncé
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引用次数: 0

Abstract

Introduction: Congenital cytomegalovirus (cCMV) is the main infectious cause of sensorineural hearing loss and neurodevelopmental disability. First-trimester and periconceptional period are the most vulnerable times for fetal injury. Universal serological cytomegalovirus (CMV) screening in pregnant women is not currently recommended. After a recent randomized controlled clinical trial that demonstrated a 70% reduction of vertical transmission with high-dose valacyclovir (VCV), a pilot first-trimester screening program was launched at our setting.

Methods: This epidemiological surveillance study was conducted at two tertiary hospitals in Barcelona. The primary outcome was to evaluate the results of the first 2 years of implementation of a universal first-trimester CMV screening program. The secondary outcome was to assess maternal seroprevalence, and the burden of primary infection during the fetal risk period in this population. IgG and IgM antibodies were determined in first-trimester pregnant women at the time of the combined test for aneuploidy. In those with positive IgG and IgM, IgG avidity was performed through a fast alert system. Low or intermediate avidity was considered as primary infection in the first-trimester or periconceptional period, and women were offered VCV up to the time of amniocentesis. Infected fetuses were followed-up according to our clinical protocol.

Results: From February 2021 to August 2023, 2,777 first-trimester pregnant women between 8+0 and 13+6 gestational weeks were screened. Maternal IgG seroprevalence was 70.6%. Among these, 22 (0.8%) had IgM antibodies, four with low or intermediate avidity, suggesting a recent primary infection, and they received oral VCV 2 g/6 h. Vertical transmission occurred in one with a delayed start of VCV treatment and the family opted for termination of pregnancy.

Conclusions: Universal first-trimester CMV screening is feasible. A high seroprevalence was observed in our population. Larger studies will confirm whether screening is cost-effective in our setting.

妊娠早期巨细胞病毒一次性血清学筛查在巴塞罗那(西班牙加泰罗尼亚)的两个三级转诊中心进行试点研究。
先天性巨细胞病毒(cCMV)是引起感音神经性听力损失和神经发育障碍的主要感染原因。妊娠早期和围孕期是胎儿最易受伤害的时期。目前不建议孕妇进行巨细胞病毒(CMV)血清学筛查。最近的一项随机对照临床试验表明,高剂量valacyclovir (VCV)可减少70%的垂直传播,在我们的机构启动了一项试点妊娠早期筛查计划。方法对巴塞罗那市两所三级医院进行流行病学监测。主要结果是评估前两年实施普遍的妊娠早期巨细胞病毒筛查计划的结果。次要结果是评估母体血清阳性率,以及该人群在胎儿危险期的原发性感染负担。IgG和IgM抗体在妊娠早期进行非整倍体联合检测。在IgG和IgM阳性的患者中,IgG贪婪通过快速警报系统进行。低度或中度妊娠被认为是妊娠早期或围孕期的原发性感染,妇女被提供VCV直到羊膜穿刺术。根据我们的临床方案对感染的胎儿进行随访。结果2021年2月至2023年8月共筛查8+0 ~ 13+6孕周的早孕期孕妇2777例。母体IgG血清阳性率为70.6%。其中22例(0.8%)有IgM抗体,4例为低或中等水平,提示近期原发感染,接受口服VCV 2g/6h。垂直传播发生在VCV治疗开始延迟且家庭选择终止妊娠的患者中。结论妊娠早期CMV筛查是可行的。在我们的人群中观察到高血清阳性率。更大规模的研究将证实筛查在我们的环境中是否具有成本效益。
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来源期刊
Fetal Diagnosis and Therapy
Fetal Diagnosis and Therapy 医学-妇产科学
CiteScore
4.70
自引率
9.10%
发文量
48
审稿时长
6-12 weeks
期刊介绍: The first journal to focus on the fetus as a patient, ''Fetal Diagnosis and Therapy'' provides a wide range of biomedical specialists with a single source of reports encompassing the common discipline of fetal medicine.
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