Maternal CMV seroprevalence rate in early gestation and congenital cytomegalovirus infection in a Chinese population

Yue Huang, Tingdong Li, Huan Yu, Jiabao Tang, Qiaoqiao Song, Xiaoyi Guo, Han Wang, Caihong Li, Jiangding Wang, Caihong Liang, Xingmei Yao, Lingxian Qiu, Chunlan Zhuang, Zhaofeng Bi, Yingying Su, Ting Wu, Shengxiang Ge, Jun Zhang, Yue Huang, Tingdong Li, Huan Yu, Jiabao Tang, Qiaoqiao Song, Xiaoyi Guo, Han Wang, Caihong Li, Jiangding Wang, Caihong Liang, Xingmei Yao, Lingxian Qiu, Chunlan Zhuang, Zhaofeng Bi, Yingying Su, Ting Wu, Shengxiang Ge, Jun Zhang

Abstract

Background Congenital human cytomegalovirus (CMV) infection remains largely unrecognized and underemphasized in medical practice. This study aimed to describe the maternal CMV seroprevalence rate in early gestation and congenital CMV infection in a Chinese population. Methods This prospective cohort study was conducted in three hospitals in China from 2015 through 2018. Pregnant women were enrolled in early gestation and followed up in middle and late gestation with serological testing. CMV serostatus was determined by IgG testing in serum during early gestation. Their newborns were screened for cCMV infection by PCR testing in both saliva and urine at two time points. The cCMV prevalence, maternal seroprevalence and associated factors were analyzed. Results In China, the CMV seroprevalence was 98.11% (6602/6729, 95% CI: 97.76%-98.41%), and the cCMV prevalence was 1.32% (84/6350, 95% CI: 1.07%-1.64%). Over 98% of cCMV-positive newborns were from pregnant women who were seropositive in early gestation in China. The prevalence of cCMV infection in newborns from seropositive and seronegative pregnant women was similar (crude prevalence: 1.33% vs 0.82%, P = 1.00; estimated prevalence: 1.27% vs 1.05%, P = 0.32). Pregnant women who were under 25 years old or primiparous had a lower seroprevalence. Newborns from pregnant women under 25 years old or from twin pregnancies had a higher prevalence of cCMV infection. Conclusion in China, the cCMV prevalence was high, and the rates were similar in newborns from pregnant women who were seropositive and seronegative in early gestation. The vast majority of cCMV newborns were from seropositive mothers.Trial registration: ClinicalTrials.gov identifier: NCT02645396..

Keywords: Cytomegalovirus; congenital infection; pregnant women; prevalence; seroprevalence.

Conflict of interest statement

Jun Zhang received a grant from Merck Sharp & Dohme Corp. and a grant from the National Natural Science Foundation of China during the conducting of the study. All other authors declare no competing interests.

Figures

Figure 1.
Figure 1.
Estimation of the prevalence of cCMV. Note: Nu is the number of newborns not followed up after showing a positive result on screening, and Ru is the rate of cCMV infection in newborns without follow-up. N≤21 is the number of newborns who tested positive on confirmatory testing within 21 days of birth, and R≤21 is the rate of cCMV cases in newborns who underwent confirmatory testing within 21 days of birth. N>21 is the number of newborns who tested positive on confirmatory testing beyond 21 days of birth, and R>21 is the rate of cCMV cases in newborns who underwent confirmatory testing beyond 21 days of birth. Rt is the rate of true cCMV cases in newborns who tested positive beyond 21 days of birth on confirmatory testing.
Figure 1.
Figure 1.
Estimation of the prevalence of cCMV. Note: Nu is the number of newborns not followed up after showing a positive result on screening, and Ru is the rate of cCMV infection in newborns without follow-up. N≤21 is the number of newborns who tested positive on confirmatory testing within 21 days of birth, and R≤21 is the rate of cCMV cases in newborns who underwent confirmatory testing within 21 days of birth. N>21 is the number of newborns who tested positive on confirmatory testing beyond 21 days of birth, and R>21 is the rate of cCMV cases in newborns who underwent confirmatory testing beyond 21 days of birth. Rt is the rate of true cCMV cases in newborns who tested positive beyond 21 days of birth on confirmatory testing.
Figure 2.
Figure 2.
Flow diagram of enrolment and cCMV screening.
Figure 2.
Figure 2.
Flow diagram of enrolment and cCMV screening.

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