Secondary prevention of congenital cytomegalovirus infection with valacyclovir following maternal primary infection in early pregnancy.
Adult
Amniocentesis
Antiviral Agents
/ therapeutic use
Case-Control Studies
Cytomegalovirus
Cytomegalovirus Infections
/ drug therapy
Female
Fetal Diseases
/ prevention & control
Gestational Age
Humans
Infectious Disease Transmission, Vertical
/ prevention & control
Logistic Models
Longitudinal Studies
Maternal Serum Screening Tests
Odds Ratio
Pregnancy
Pregnancy Complications, Infectious
/ virology
Pregnancy Trimester, First
Propensity Score
Secondary Prevention
Treatment Outcome
Valacyclovir
/ therapeutic use
CMV
congenital infection
cytomegalovirus
fetus
pregnancy
prevention
valacyclovir
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
revised:
05
05
2021
received:
01
03
2021
accepted:
06
05
2021
pubmed:
18
5
2021
medline:
15
12
2021
entrez:
17
5
2021
Statut:
ppublish
Résumé
Cytomegalovirus (CMV) maternal primary infection (MPI) in early pregnancy is the main risk factor for congenital CMV (cCMV) infection with long-term sequelae. Our aim was to evaluate, in a single center offering CMV serology screening at 11-14 gestational weeks, secondary prevention of cCMV by administration of high-dosage maternal oral valacyclovir (VACV) in the first trimester of pregnancy. This was a case-control study in a longitudinal cohort of pregnancies with CMV-MPI diagnosed prior to 14 weeks of gestation by serology screening (immunoglobulin (Ig) M and IgG measurement and IgG avidity) between 2009 and 2020. From October 2019 onwards, all women presenting at our center with MPI before 14 weeks' gestation were offered treatment with high-dosage oral VACV (8 g/day, 4 g twice/day). We used propensity score matching to compare fetal infection rates in cases treated with maternal oral VACV (8 g/day) with those in untreated controls. Fetal infection was assessed following amniocentesis at 17-22 weeks of gestation, by polymerase chain reaction (PCR) analysis of amniotic fluid for viral DNA. Of 310 cases of CMV-MPI identified, 269 underwent amniocentesis for PCR. Of these, 66 were offered, and 65 accepted, treatment with VACV. From the remaining untreated cases, we selected 65 controls, matched for proportion of periconceptional infections and gestational age at amniocentesis. VACV was initiated at a median gestational age of 12.71 (interquartile range (IQR), 10.00-13.86) weeks and the median duration of treatment was 35 (IQR, 26-54) days. On multivariate logistic regression, fetal infection was lower in the treated group (odds ratio, 0.318 (95% CI, 0.120-0.841); P = 0.021). One treated patient developed acute renal failure 4 weeks after initiation of VACV therapy, but this resolved within 5 days after treatment was stopped. This study confirms the acceptability, tolerance and benefit of secondary prevention by VACV of cCMV infection in a clinical setting with a well-established routine maternal serum screening policy in the first trimester of pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Substances chimiques
Antiviral Agents
0
Valacyclovir
MZ1IW7Q79D
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
576-581Informations de copyright
© 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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