Am J Obstet Gynecol. 2025 Nov 18:S0002-9378(25)00854-3. doi: 10.1016/j.ajog.2025.11.018. Online ahead of print.
ABSTRACT
BACKGROUND: The long interval between serological diagnosis of maternal primary infection (MPI) at first trimester and prenatal diagnosis of fetal infection by amniocentesis from 17 weeks’ may cause anxiety and distress. CMV-PCR in chorionic villi (CV) sampled by CVS at 14 weeks’ can diagnose trophoblastic infection.
OBJECTIVE: To assess the diagnosis and prognostic value of CMV-PCR in CV in pregnant women with CMV-MPI for predicting vetical transmission (VT) and related symptoms at birth.
STUDY DESIGN: This single-center retrospective cohort study enrolled pregnant women referred for CMV-MPI in early pregnancy identified by serological screening before 14 weeks’ between October 2019 and December 2024. Secondary prevention by valaciclovir was offered. The primary outcome was VT, defined by a positive CMV-PCR in CV, amniotic fluid (AF) obtained by amniocentesis from 17 weeks, and neonatal saliva/urine at birth (or positive in situ hybridization in terminated pregnancies). Secondary outcomes were symptomatic congenital infection in live-born infants, defined according to ECCI criteria, and sensorineural hearing loss (SNHL).
RESULTS: 422 women were diagnosed with MPI and 330 had both CVS and amniocentesis. CMV-PCR was positive in the trophoblast in 19/330 women (5.7%) and associated with maternal-fetal transmission during the course of pregnancy in 89.4%, mostly before 17 weeks (73.7%). No fetal infection occured in “triple negative CMV-PCR” in trophoblast, maternal blood and urine in the first trimester. Overall, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of CMV-PCR in trophoblast to predict congenital infection were 48.28%, 98.34%, 73.68% and 95.18%. Among the 16 infected newborns who were symptomatic at birth, two had bilateral severe-to-profound SNHL (all with positive CMV-PCR in CV), and five had unilateral SNHL. Specificity and NPV of CMV-PCR on trophoblast to predict symptoms at birth was 97.12% and 97.74% respectively; 96.26% and 99.68% for SNHL at birth, and 96.55% and 99.35% for long-term symptoms.
CONCLUSION: CMV-PCR on CV showed high specificity and negative predictive value for fetal infection and related symptoms at birth.
PMID:41265737 | DOI:10.1016/j.ajog.2025.11.018
