Abstract
Objective
There is no consensus on the use of cytomegalovirus (CMV)–specific hyperimmunoglobulins
(CSHIGs) for suspected congenital CMV infections during pregnancy, but this therapy
is currently used in some countries. The objectives of this study were to describe
tolerability and pregnancy outcome following treatment with monthly intravenous CSHIG
and compare rates of positive PCR and postnatal symptoms according to whether CSHIGs
were given or not.
Methods
This retrospective cohort study included all pregnant women who were diagnosed with
primary CMV infection or congenital CMV infection at the Centre Hospitalier Universitaire
Sainte-Justine (Montreal, QC) between 2005 and 2016. CSHIG was discussed with pregnant
women who received positive CMV PCR results from amniotic fluid or if ultrasound anomalies
suggested congenital infection and there was serologic evidence of maternal primary
infection (therapeutic group). CSHIG was also offered as prophylaxis in pregnant women
without fetal ultrasound anomalies but with evidence of maternal primary infection,
when amniocentesis either had negative results or was not performed (prophylactic
group). A matched analysis was performed to control for timing of maternal infection,
amniocentesis, and type and timing of ultrasound anomaly.
Results
Sixteen women received CSHIG, and 55 had no CMV-specific treatment. CSHIG treatment
was well-tolerated. In bivariate analyses, the risk of congenital CMV infection and
postnatal symptoms did not significantly decrease with CSHIG treatment, in both the
therapeutic and the prophylactic groups. After matching, there was still no difference
in outcomes between CSHIG-treated and untreated women.
Conclusion
The effectiveness of CSHIG in preventing congenital CMV infection and its clinical
manifestations could not be demonstrated.
Résumé
Objectif
Bien qu’aucun consensus n’ait été établi quant à l’administration d’immunoglobulines
hyperimmunes spécifiques anti-cytomégalovirus (CMV) durant la grossesse lorsqu’on
soupçonne une infection congénitale à CMV, cette thérapie est actuellement employée
dans quelques pays. Les objectifs de cette étude étaient de décrire la tolérabilité
et les issues de la grossesse associées à l’administration par voie intraveineuse
d’immunoglobulines hyperimmunes spécifiques anti-CMV une fois par mois. L’étude visait
aussi à comparer les taux de résultats de PCR positifs et les symptômes postnataux
avec ou sans administration du traitement.
Méthodologie
Cette étude de cohorte rétrospective portait sur toutes les femmes enceintes ayant
reçu un diagnostic d’infection primaire ou d’infection congénitale à CMV au Centre
hospitalier universitaire Sainte-Justine (Montréal, Québec) entre 2005 et 2016. Les
femmes enceintes ayant reçu un résultat positif pour la détection du CMV par PCR dans
le liquide amniotique et les femmes enceintes présentant des signes sérologiques d’infection
maternelle primaire chez qui des anomalies indicatives d’une infection congénitale
avaient été observées à l’échographie (groupe de traitement) ont discuté de l’administration
possible d’immunoglobulines hyperimmunes spécifiques anti-CMV. Les immunoglobulines
étaient aussi proposées en prophylaxie aux femmes enceintes chez qui aucune anomalie
fœtale n’avait été observée lors de l’échographie, mais qui présentaient des signes
d’infection primaire, et dont l’amniocentèse était négative ou n’avait pas été effectuée
(groupe prophylactique). Pour l’analyse, les patientes ont été appariées en fonction
du moment de l’infection chez la mère et de l’amniocentèse, ainsi qu’en fonction du
type d’anomalies observées à l’échographie et du moment où elles ont été observées.
Résultats
Parmi l’échantillon, 16 femmes ont reçu des immunoglobulines hyperimmunes spécifiques
anti-CMV et 55 n’en ont pas reçu. Les immunoglobulines ont été bien tolérées. Des
analyses bivariées n’ont révélé aucune diminution significative du risque d’infection
congénitale à CMV et des symptômes postnataux, tant dans le groupe de traitement que
dans le groupe de la prophylaxie. Après l’appariement, il n’y avait toujours pas de
différence quant aux issues des femmes qui avaient reçu le traitement aux immunoglobulines
hyperimmunes spécifiques anti-CMV et celles qui ne l’avaient pas reçu.
Conclusion
L’efficacité des immunoglobulines hyperimmunes spécifiques anti-CMV pour prévenir
les infections congénitales à CMV et les manifestations cliniques qui y sont associées
n’a pas été démontrée.
Key Words
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Article info
Publication history
Published online: June 21, 2018
Received:
November 22,
2017
Footnotes
Competing interests: The authors declare that they have no competing interests.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
