Maternal immunity and prevention of congenital cytomegalovirus infection.

Maternal immunity and prevention of congenital cytomegalovirus infection.
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DOI：
10.1097/01.ogx.0000089033.63347.04
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发表时间：
2003-10
期刊：
JAMA
影响因子：
--
通讯作者：
K. Fowler;S. Stagno;R. Pass
K. Fowler;S. Stagno;R. Pass
中科院分区：
其他
文献类型：
--
作者：
K. Fowler;S. Stagno;R. Pass

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背景 由于母体免疫力是否能保护胎儿的不确定性，预防先天性巨细胞病毒 (CMV) 感染的疫苗开发受到阻碍。目的 确定母体巨细胞病毒抗体的存在是否能显着降低未来妊娠先天性巨细胞病毒感染的风险。设计、背景和参与者 队列研究涉及来自先天性 CMV 感染率高的人群的 3461 名经产妇女，她们在 1993 年至 1998 年间分娩的新生儿接受了先天性 CMV 感染筛查，并且可以检索其先前分娩的脐带血清样本并检测其 CMV 抗体。主要观察指标 根据孕产妇免疫状况、年龄、种族、产次和社会经济状况确定先天性 CMV 感染情况。结果 最初血清阴性母亲所生的 604 名新生儿中，18 名（3.0%）发生先天性 CMV 感染。相比之下，在免疫母亲所生的 2857 名新生儿中，先天性 CMV 感染发生在 29 种（1.0%）中。孕前母亲免疫（调整后的风险比，0.31；95% 置信区间，0.17-0.58）和母亲年龄为 25 岁或以上（调整后的风险比，0.19；95% 置信区间，0.07-0.49）这两个因素对 CMV 具有高度保护作用。先天性巨细胞病毒感染。没有其他因素与先天性巨细胞病毒感染风险降低相关。结论 自然获得的免疫力可使未来怀孕时先天性 CMV 感染的风险降低 69%。
CONTEXT Vaccine development to prevent congenital cytomegalovirus (CMV) infection has been impeded by the uncertainty over whether maternal immunity protects the fetus. OBJECTIVE To determine whether the presence of maternal antibodies to CMV significantly reduces the risk of congenital CMV infection in future pregnancies. DESIGN, SETTING, AND PARTICIPANTS Cohort study of 3461 multiparous women from a population with a high rate of congenital CMV infection who delivered newborns screened for congenital CMV infection between 1993 and 1998, and whose cord serum specimen from a previous delivery could be retrieved and tested for antibody to CMV. MAIN OUTCOME MEASURE Congenital CMV infection according to maternal immune status, age, race, parity, and socioeconomic status. RESULTS Of 604 newborns born to initially seronegative mothers, congenital CMV infection occurred in 18 (3.0%). In contrast, of 2857 newborns born to immune mothers, congenital CMV infection occurred in 29 (1.0%) Two factors, preconception maternal immunity (adjusted risk ratio, 0.31; 95% confidence interval, 0.17-0.58) and maternal age of 25 years or older (adjusted risk ratio, 0.19; 95% confidence interval, 0.07-0.49), were highly protective against congenital CMV infection. No other factors were associated with a reduction in the risk of congenital CMV infection. CONCLUSION Naturally acquired immunity results in a 69% reduction in the risk of congenital CMV infection in future pregnancies.