46: Immunoglobulin therapy of fetal cytomegalovirus infection occurring in the first half of pregnancy a case-control study of the outcome in children


      To evaluate the efficacy of immunoglobulin therapy in pregnant women with a primary CMV infection in the first half of gestation.

      Study Design

      We retrospectively performed a case-control study. Cases were 32 congenitally infected children between ages 1 and 5 years of age who had either hearing deficit (22 children) and/or psychomotor retardation (26 children) and whose mothers had a primary CMV infection during pregnancy at <20 weeks gestation. Controls were 32 congenitally infected children who were normal but whose mothers also had a primary infection at <20 weeks gestation. Case and controls were matched 1:1 stepwise by the estimated weeks of maternal gestation (+ one week) at the time of the mother's primary infection and by the child's age (+ one year) at final evaluation. The main outcome measure was whether a child was normal or abnormal at the time of the final evaluation.


      For the cases and controls the average age was 3.0 years with a standard deviation of + 1.3 years. The mean weeks gestation at maternal infection was 11 weeks with a standard deviation of + 5 weeks. An analysis of the 32 matched case-control pairs revealed that the only independent risk factor for an affected child was the mother not receiving therapeutic immunoglobulin (P = 0.001). Of the 32 cases only four mothers received CMV immunoglobulin during pregnancy compared to 27 of the 32 mothers of control infants (adjusted odds ratio, 14, 95% confidence interval 1.7, 110). The beneficial effect of immunoglobulin extended to both psychomotor retardation and hearing deficit. Of 31 mothers who received immunoglobulins, 2 of their infants developed only hearing deficit, one hearing deficit and cerebral palsy, and one psychomotor retardation.


      These results support the efficacy of immunoglobulin therapy for decreasing both the rate and severity of the disabilities caused by fetal CMV infection after a primary maternal infection during the first half of pregnancy.