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    ACOG Guidelines at a Glance: Key points about 4 perinatal infections

    COMMITTEE ON PRACTICE BULLETINS—OBSTETRICS

    ACOG Practice Bulletin Number 151: Cytomegalovirus, Parvovirus B19, Varicella Zoster, and Toxoplasmosis in Pregnancy. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;125:1510-25. Full text of ACOG Practice Bulletins is available to ACOG members at www.acog.org/Resources-And-Publications/Practice-Bulletins/Committee-on-...

    Abstract:

    Cytomegalovirus, Parvovirus B19, Varicella Zoster, and Toxoplasmosis in Pregnancy

    Among the many physiologic changes that occur during pregnancy, the maternal immune system is altered to dampen the maternal inflammatory response and allow for fetal antigen tolerance (1, 2). Although such immunologic changes diminish the chance of fetal rejection, they potentially increase maternal and fetal vulnerability to certain infectious diseases. Common infections that cause mild-to-moderate disease in healthy adults and children can cause serious maternal and fetal complications if acquired during pregnancy. A unique concern with maternal infection is the potential for mother-to-child transmission or congenital infection. Cytomegalovirus (CMV), parvovirus B19, varicella zoster virus (VAV) and toxoplasmosis are common infections associated with moderate-to-severe fetal and infant complications when acquired congenitally. The purpose of this document is to update the current understanding of these infections, including their clinical presentations; their modes and risks of perinatal transmission; and their maternal, fetal, and infant effects, and to offer guidelines for preventing and managing these infections during pregnancy.

    Used with permission. Copyright the American College of Obstetricians and Gynecologists.

    Commentary

    Key points about 4 perinatal infections

     

     

    by Sarah J Kilpatrick, MD, PhD

    Dr Kilpatrick is Helping Hand Endowed Chair, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.

     

    This 2015 Practice Bulletin1 replaces one published in 2000. I will not review the basic facts about the 4 possible perinatal infections (type of virus or parasite, symptomatology, potential impact on the fetus, and methods of diagnosis in the mother and fetus); that information is in the full Practice Bulletin, which I recommend that you read. Listed here are what I consider the key diagnostic points about maternal and fetal infection, highlights of the few new findings, and information on the level A recommendations for each disease.

    Cytomegalovirus

    Diagnostic points

    Risk of transmission to the fetus with maternal primary infection is approximately 30% to 40% and 0.15% to 2% with recurrent infection. If you are suspicious, check maternal immunoglobulin M (IgM) and immunoglobulin G (IgG) with avidity testing.

    New points

    1. IgG avidity assay measures the maturity of the IgG antibody, which helps to identify a primary infection with greater accuracy than simple IgG and IgM titers. After an initial cytomegalovirus (CMV) infection, the IgG antibody produced has low avidity because it is not mature. After about 4 months, the antibodies mature, hence the high avidity. Therefore, if a woman has low-avidity IgG and positive IgM, she is likely to have a recent primary infection with CMV.

    2. Use of polymerase chain reaction (PCR) on amniotic fluid is now recommended for diagnosis of fetal CMV infection. Fetal blood sampling is no onger recommended to make this diagnosis. PCR on amniotic fluid for CMV is more sensitive after 21 weeks’ gestation.

    3. Remember that 75% of congenital CMV infections may be due to reactivation of old infection, or reinfection with a new strain of CMV, so evidence of old infection does not rule out the possibility of fetal CMV.

    Next: Parovirus >>

    Sarah J. Kilpatrick, MD, PhD
    Dr. Kilpatrick is the Helping Hand Endowed Chair in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los ...

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