Clinical characteristics, pregnancy outcomes, and neonatal effects of cytomegalovirus infection in pregnant women in Liuzhou city, North central Guangxi of Southern China: a retrospective study from 2018 to 2024.

OBJECTIVE: To evaluate the clinical characteristics, pregnancy and neonatal outcomes of cytomegalovirus (CMV) infection in pregnant women. METHODS: This retrospective study included 22,673 pregnant women from Liuzhou, Guangxi, China, between 2018 and 2024. Amniotic fluid samples collected during mid-to-late pregnancy were tested for CMV DNA. Clinical data among CMV-infected pregnant women were collected, including prenatal diagnosis indicators, early-pregnancy CMV antibodies, pregnancy and neonatal outcomes, and offspring follow-up outcomes. RESULTS: Among 22,673 pregnant women, 36 (1.59‰) were tested positive for CMV DNA in amniotic fluid, among which 14 (38.9%) with adverse pregnancy outcomes, including 7(19.4%) termination of pregnancy, 3(8.3%) stillbirth and 4 (11.1%) preterm delivery. Prenatal imaging modalities detected fetal abnormalities 21 (58.3%) in the CMV-infected pregnant women, mainly were ventriculomegaly, fetal growth restriction (FGR), pericardial effusion, ascites, cardiomegaly, placentomegaly, enlarged cisterna magna and hyperechogenic bowel. Notably, Fetuses of 2 pregnant women with primary CMV infection developed severe edema. Four newborns failed with initial hearing screening during postnatal evaluation. Among them, two (50%) were diagnosed with severe sensorineural hearing loss (SNHL) and one child was diagnosed with cerebral palsy in subsequent clinical assessments. CONCLUSION: Diagnosis of primary CMV infection during pregnancy is of critical importance. Current guidelines recommend implementing CMV serological screening during the first trimester, with subsequent CMV IgG avidity testing when CMV IgG antibodies are detected. Maternal CMV infection during the second and third trimesters may lead to fetal complications, including ventriculomegaly, FGR and fetal hydrops. Congenital CMV (cCMV) infection predominantly manifests with sensorineural hearing loss (SNHL) and cerebral palsy. It is essential to screen all neonates from CMV-infected pregnant women for CMV DNA and provide mandatory 5-year follow-up for symptomatic cCMV children.