Prevention of maternal-fetal transmission of cytomegalovirus after primary maternal infection in the first trimester by biweekly hyperimmunoglobulin administration
Prevention of maternal-fetal transmission of cytomegalovirus after primary maternal infection in the first trimester by biweekly hyperimmunoglobulin administration
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DOI：
10.1002/uog.19164
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发表时间：
2019-03-01
影响因子：
7.1
通讯作者：
Hamprecht, K.
中科院分区：
文献类型：
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作者：
Kagan, K. O.;Enders, M.;Hamprecht, K.
目的探讨两周一次高免疫球蛋白（hyperimmunoglobulin，HIG）治疗早期巨细胞病毒（cytomegalovirus，CMV）感染对母婴传播的预防作用。所有女性均接受每两周一次的HIG治疗，直至妊娠20周，剂量为200 IU/kg母体体重。每例受试者在第20周左右首次就诊后至少6周接受腹膜穿刺术。主要结果是子宫穿刺时的母胎传播，次要结果是出生时先天性CMV感染的频率。结果进行了比较，与一个历史队列的妇女与孕早期CMV感染谁没有经过HIG治疗，谁在约20 weeks.Results的受试者是40名孕妇与原发性CMV感染，与中位孕龄在第一次介绍的9.6（范围，5.1-14.3）周。平均而言，HIG给药开始于11.1周，持续至16.6周。在此间隔内，每例患者给予HIG 2 - 6次。虽然CMV免疫球蛋白-G（IgG）监测显示在每两周一次的HIG给药周期内出现周期性波动，但高CMV-IgG亲合力指数在整个治疗期间保持稳定。40例病例中仅1例在穿刺前发生母胎传播（2.5%（95%CI，0-13.2%））。分娩时，发现另外两名受试者有妊娠晚期传播。考虑到所有三例母婴传播，我们的40例病例中的传播率为7.5%（95%CI，1.6-20.4%）。所有感染的新生儿出生时均无症状。匹配的历史对照组包括108例妊娠。38次传输（35.2%（95%CI，26.2-45.0%））发生在对照组，显著高于结论妊娠早期母体CMV感染后，以200 IU/kg的剂量每两周施用HIG可防止母胎传播，直至妊娠20周。版权所有（c）2018 ISUOG.由John Wiley & Sons有限公司出版
Objective To examine the efficacy of biweekly hyperimmunoglobulin (HIG) administration to prevent maternal-fetal transmission of cytomegalovirus (CMV) in women with primary first-trimester CMV infection.Methods This was a prospective observational study of women with confirmed primary CMV infection in the first trimester who had the first HIG administration at or before 14 weeks' gestation. All women had biweekly HIG treatment until 20 weeks' gestation at a dose of 200 IU/kg of maternal body weight. Each subject underwent amniocentesis at least 6 weeks after first presentation at about 20 weeks. Primary outcome was maternal-fetal transmission at the time of amniocentesis, and secondary outcome was the frequency of congenital CMV infection at birth. The results were compared with a historic cohort of women with first-trimester CMV infection who did not undergo HIG treatment and who had amniocentesis at about 20 weeks.Results Subjects were 40 pregnant women with a primary CMV infection, with a median gestational age at first presentation of 9.6 (range, 5.1-14.3) weeks. On average, HIG administration started at 11.1 weeks and continued until 16.6weeks. Within this interval, HIG was administered between two and six times in each patient. While CMV immunoglobulin-G (IgG) monitoring showed periodic fluctuations during biweekly HIG administration cycles, high CMV-IgG avidity indices remained stable over the whole treatment period. Maternal-fetal transmission before amniocentesis occurred in only one of the 40 cases (2.5% (95% CI, 0-13.2%)). At delivery, two additional subjects were found to have had late-gestation transmission. Considering all three cases with maternal-fetal transmission, the transmission rate was 7.5% (95% CI, 1.6-20.4%) in our 40 cases. All infected neonates were asymptomatic at birth. The matched historical control group consisted of 108 pregnancies. Thirty-eight transmissions (35.2% (95% CI, 26.2-45.0%)) occurred in the control group, which was significantly higher (P < 0.0001) than the transmission rate in the HIG treatment group.Conclusion After a primary maternal CMV infection in the first trimester, biweekly HIG administration at a dose of 200 IU/kg prevents maternal-fetal transmission up to 20 weeks' gestation. Copyright (c) 2018 ISUOG. Published by John Wiley & Sons Ltd.