Cytomegalovirus Infection in Pregnancy: Neonatal Implications

A 31-year-old gravida 7 para 2-2-2-3 woman was referred to Maternal-Fetal Medicine at 12 weeks’ gestation due to 2 prior preterm births. A cerclage had recently been placed. She was otherwise healthy without medical issues.At 30 weeks’ gestation, a third-trimester ultrasonography revealed early-onset fetal growth restriction; no structural abnormalities were appreciated. An evaluation included cytomegalovirus (CMV) serologies. Maternal serologies demonstrated immunoglobulin (Ig) M and IgG positivity with high IgG avidity. The patient had no history of CMV; therefore, infection in pregnancy could not be confirmed or excluded by these serologies. After counseling, she elected to undergo amniocentesis at 31 weeks’ gestation to evaluate for infectious and genetic etiologies. The chromosomal microarray was normal; CMV was detected in the amniotic fluid on qualitative analysis.The patient was counseled on CMV infection in pregnancy, neonatal implications of CMV infection, and expectations regarding ongoing monitoring, delivery, and postnatal evaluation.The patient underwent continued surveillance with serial growth ultrasonographies, umbilical artery Dopplers, and antenatal testing with biophysical profiles. Fetal testing was reassuring. Her final growth ultrasonography at 37 weeks and 4 days’ gestation was notable for an estimated fetal weight of 2725 grams (16th percentile) with an abdominal circumference at the third percentile and head measurements within the normal range. Imaging demonstrated the absence of echogenic bowel, intracranial calcifications, or ventriculomegaly. At 37 weeks and 6 days’ gestation, she went into spontaneous labor.The patient had an uncomplicated vaginal birth and postpartum course. She opted to breastfeed her infant.A vigorous female neonate was delivered and had a birthweight of 2550 g (