Relation of Maternal CMV Viremia and Antibody Response to the Rate of Congenital Infection and Intrauterine Growth Retardation

Pregnancy outcome after maternal primary CMV infection initiated at different times during gestation was investigated by using the inbred Strain-2 guinea pig model of congenital CMV infection. The highest vertical transmission rates occurred in pups from dams that were initially viremic in late gestation presumably because delivery occurred prior to detectable maternal CMV-specific immune response. In contrast, conceptus loss was highest with maternal CMV infection initiated at conception. Intrauterine resorptions, intrauterine growth retardation, and disseminated neonatal CMV infection with CNS involvement were more frequent in pups born to mothers that were initially viremic prior to rather than after midgestation. Maternal viremia was prolonged and antibody responses were delayed after CMV inoculation in early gestation compared to late gestation. Prolonged maternal viremia plus early gestational virus exposure/infection of the fetus appeared to be associated with the most severe outcome. These findings suggest that the timing of initial maternal viremia and immune responses, the stage of fetal development, and the length of in utero exposure to CMV are important factors in subsequent disease expression and rates of congenital infection.