Cytomegalovirus-Specific Hyperimmune Immunoglobulin Administration for Secondary Prevention after First-Trimester Maternal Primary Infection: A 13-Year Single-Center Cohort Study
Emmanouil Karofylakis,
Konstantinos Thomas,
Dimitra Kavatha,
Lamprini Galani,
Sotirios Tsiodras,
Helen Giamarellou,
Vassiliki Papaevangelou,
Anastasia Antoniadou
Affiliations
Emmanouil Karofylakis
Fourth Department of Internal Medicine, University General Hospital Attikon, National and Kapodistrian University of Athens, 12462 Athens, Greece
Konstantinos Thomas
Fourth Department of Internal Medicine, University General Hospital Attikon, National and Kapodistrian University of Athens, 12462 Athens, Greece
Dimitra Kavatha
Fourth Department of Internal Medicine, University General Hospital Attikon, National and Kapodistrian University of Athens, 12462 Athens, Greece
Lamprini Galani
1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, 4 Erythrou Stavrou & Kifisias, Marousi, 15123 Athens, Greece
Sotirios Tsiodras
Fourth Department of Internal Medicine, University General Hospital Attikon, National and Kapodistrian University of Athens, 12462 Athens, Greece
Helen Giamarellou
1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, 4 Erythrou Stavrou & Kifisias, Marousi, 15123 Athens, Greece
Vassiliki Papaevangelou
Third Department of Pediatrics, University General Hospital Attikon, National and Kapodistrian University of Athens, 12462 Athens, Greece
Anastasia Antoniadou
Fourth Department of Internal Medicine, University General Hospital Attikon, National and Kapodistrian University of Athens, 12462 Athens, Greece
Primary cytomegalovirus infection during pregnancy has a high risk of vertical transmission, with severe fetal sequelae mainly associated with first-trimester infections. We conducted a retrospective analysis of 200 IU/kg cytomegalovirus-specific hyperimmune globulin (HIG), used in first-trimester maternal primary infections for congenital infection prevention. The primary outcome was vertical transmission, defined as neonatal viruria or positive amniocentesis if pregnancy was discontinued. HIG, initially administered monthly and since 2019 biweekly, was discontinued in negative amniocentesis cases. Women declining amniocentesis and positive amniocentesis cases with normal sonography were offered monthly HIG until delivery as a treatment strategy. The total transmission rate was 29.9% (32/107; 10 pregnancy terminations with positive amniocentesis, 18 completed pregnancies with positive amniocentesis and 4 declining amniocentesis). Maternal viremia was the only factor associated with fetal transmission (OR 4.62, 95% CI 1.55–13.74). The transmission rate was not significantly different whether HIG was started during the first or second trimester (28.2% vs. 33.3%; p = 0.58), or between monthly and biweekly subgroups (25.7% vs. 37.8%, p = 0.193). Pre-treatment maternal viremia could inform decisions as a predictor of congenital infection.
