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Context  Vaccine development to prevent congenital cytomegalovirus (CMV) infection has been impeded by the uncertainty over whether maternal immunity protects the fetus.

Objective  To determine whether the presence of maternal antibodies to CMV significantly reduces the risk of congenital CMV infection in future pregnancies.

Design, Setting, and Participants  Cohort study of 3461 multiparous women from a population with a high rate of congenital CMV infection who delivered newborns screened for congenital CMV infection between 1993 and 1998, and whose cord serum specimen from a previous delivery could be retrieved and tested for antibody to CMV.

Main Outcome Measure  Congenital CMV infection according to maternal immune status, age, race, parity, and socioeconomic status.

Results  Of 604 newborns born to initially seronegative mothers, congenital CMV infection occurred in 18 (3.0%). In contrast, of 2857 newborns born to immune mothers, congenital CMV infection occurred in 29 (1.0%) Two factors, preconception maternal immunity (adjusted risk ratio, 0.31; 95% confidence interval, 0.17-0.58) and maternal age of 25 years or older (adjusted risk ratio, 0.19; 95% confidence interval, 0.07-0.49), were highly protective against congenital CMV infection. No other factors were associated with a reduction in the risk of congenital CMV infection.

Conclusion  Naturally acquired immunity results in a 69% reduction in the risk of congenital CMV infection in future pregnancies.

JAMA. 2003;289:1008-1011

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Author/Article Information

 
 
Author Affiliations: Departments of Pediatrics (Drs Fowler, Stagno, and Pass), Epidemiology (Dr Fowler), Maternal and Child Health (Dr Fowler), and Microbiology (Drs Stagno and Pass), University of Alabama, Birmingham.
 
Corresponding Author and Reprints: Karen B. Fowler, DrPH, Department of Pediatrics, 1600 Seventh Ave S, CHB 306, Birmingham, AL 35233 (e-mail: kfowler@uab.edu).

Author Contributions: Study concept and design: Fowler, Pass.

Acquisition of data: Fowler, Stagno, Pass.

Analysis and interpretation of data: Fowler, Stagno, Pass.

Drafting of the manuscript: Fowler, Pass.

Critical revision of the manuscript for important intellectual content: Fowler, Stagno, Pass.

Statistical expertise: Fowler.

Obtained funding: Fowler, Stagno, Pass.

Administrative, technical, or material support: Fowler, Stagno, Pass.

Study supervision: Fowler, Pass.

Funding/Support: This study was supported in part by grant P01 HD 10699 from the National Institutes of Health and the National Institute of Child Health and Human Development; grant P01 AI43681 from the National Institute of Allergy and Infectious Diseases; grant R01 DC02139 from the National Institute on Deafness and Other Communication Disorders; and grant M01 R00032 from the General Clinical Research Center.