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9/25/2018  |   2:30 PM - 3:00 PM   |  Emerald Ballroom I

Risk of Intrauterine Growth Restriction Among Infants With and Without Congenital Cytomegalovirus (CMV) Infection

Background: Although an increased risk of intrauterine growth restriction (IUGR) has been described in infants with symptomatic congenital cytomegalovirus (cCMV) infection, it has not been definitively demonstrated in infants from populations screened for cCMV. Many studies have not considered IUGR alone as symptomatic cCMV disease because a variety of maternal, placental, and fetal factors can lead to IUGR. We evaluated the association between cCMV and IUGR among >10,000 live births in the Brazilian CMV Hearing and Maternal Secondary Infection Study. Methods: CMV screening was performed using PCR of saliva samples collected within 15 days of life and cCMV was confirmed in infants with positive results by testing urine samples. IUGR was defined as birth weight below the 10th percentile for gestational age and severe IUGR as <2.5th percentile on the reference standard. Multiple births were excluded. Results: Among 11,784 singleton live-born infants, 65 (0.6%) were identified with cCMV. Overall, 20/65 (30.8%) CMV-positive infants had IUGR. The risk of IUGR was significantly greater among CMV-positive infants compared to uninfected infants (30.8% vs. 16.3%; RR: 1.89; 95%CI: 1.35-3.89). The association between cCMV and IUGR remained significant (RR: 1.82; 95%CI: 1.26-2.82) even after adjusting for maternal age, parity, marital status and education. IUGR was the only abnormal finding in 15/65 (23.1%) infants. The risk of severe IUGR was significantly greater among CMV-positive infants compared to uninfected infants (15.3% vs. 4.7%; RR: 3.36; 95%CI: 1.89-5.98). We estimated 1.29% (95%IC: 0.20-2.73%) of all severe IUGR cases were attributable to cCMV. Conclusions: IUGR was the only abnormal finding in almost one-fourth of CMV-infected infants and about a third of CMV-infected infants had IUGR. Infants with cCMV were at significantly increased risk for IUGR compared to uninfected infants. These results support consideration of CMV testing of infants with IUGR.

  • Describe the prevalence of intrauterine growth restriction (IUGR) among infants from population screened for congenital CMV infection (cCMV)
  • Evaluate the association between IUGR and cCMV
  • Describe the fraction of severe IUGR in the population that is attributable to cCMV

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Aparecida Y. Yamamoto (Primary Presenter,Author), yulie@fmrp.usp.br;
Dr Yamamoto is an investigator in the Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil. She is a co-PI for the BRaCHS Study and she has experience in the field of medicine, with emphasis on mother-to-child transmission infections, mainly on the following topics: congenital and perinatal infections, transmission, diagnosis and consequences in the child, with emphasis on congenital CMV infection.

      ASHA DISCLOSURE:

Financial - No relevant financial relationship exists.

Nonfinancial - No relevant nonfinancial relationship exists.


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.




Tatiana Lanzieri (Co-Author), uyk4@cdc.gov;
Tatiana Lanzieri is a medical epidemiologist in the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

      ASHA DISCLOSURE:

Financial - No relevant financial relationship exists.

Nonfinancial - No relevant nonfinancial relationship exists.


      AAA DISCLOSURE:

Financial -




Davi C. Aragon (Co-Author), dcaragon@fmrp.usp.br;
Statistician, Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil

      ASHA DISCLOSURE:

Financial -

Nonfinancial -


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.




Suresh Boppana (Co-Author), sboppana@peds.uab.edu;
Dr. Boppana is a Professor in the Division of Infectious Diseases in the Department of Pediatrics and was the PI of the NIDCD CHIMES Study.

      ASHA DISCLOSURE:

Financial -

Nonfinancial -


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.




Karen B. Fowler (Co-Author), kfowler@uab.edu;
Dr. Fowler is a Professor in the Division of Infectious Diseases in the Department of Pediatrics at the University of Alabama at Birmingham.

      ASHA DISCLOSURE:

Financial - Receives Consulting fee for Consulting from Merck.  

Nonfinancial - No relevant nonfinancial relationship exists.


      AAA DISCLOSURE:

Financial - Receives support from NIH, Merck.  




William Britt (Co-Author), WBritt@peds.uab.edu;
Dr. Britt is a Professor, Chair in the Division of Infectious Diseases in the Department of Pediatrics of University of Alabama

      ASHA DISCLOSURE:

Financial -

Nonfinancial -


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.




Marisa Mussi-Pinhata (Co-Author), mmmpinha@fmrp.usp.br;
Marisa M. Mussi-Pinhata, MD, has a broad background in Pediatrics and Clinical Research, with specific training and expertise in neonatology and maternal/infant infections. Since her postdoctoral research fellowship in HIV/AIDS in the US, she has been involved with research with focus on HIV, CMV, and hepatitis. She is a leader of a Clinical Research Site that is part of international research networks in Infectious Diseases. Currently she is a Full Professor of Pediatrics and occupies the function of chief of the Department of Pediatrics of Ribeirão Preto Medical School, University of São Paulo, Brazil. She has authored or co-authored 69 peer-reviewed publications and has received several research supports and awards for research works.

      ASHA DISCLOSURE:

Financial -

Nonfinancial -


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.