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Cytomegalovirusinfektion in der Schwangerschaft

CMV infections during pregnancy

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Von den möglichen intrauterinen Infektionen in der Schwangerschaft ist die Cytomegalovirusinfektion (CMV) die mit Abstand bedeutendste. Bei etwa 0,6 % der Frauen kommt es im Verlauf zu einer CMV-Primärinfektion, die in 80 % der Fälle für die Patientin asymptomatisch verläuft. In Abhängigkeit vom Gestationsalter steigt die maternofetale Transmission von 30 auf 70 % an. Gleichzeitig nimmt aber die Schädigungsrate ab. Insofern tragen Patientinnen mit einer Infektion im ersten Trimenon das höchste Risiko. Die nachgeburtlichen Symptome einer kongenitalen CMV können Mikrozephalie, Hörstörungen und langfristige schwere Entwicklungsstörungen umfassen. Die derzeitigen Behandlungsansätze zielen auf die Prävention der Transmission ab, zum einen durch die Aufklärung über die Infektionswege und Hygieneberatung, zum anderen im Rahmen von Studien durch die Applikation von Hyperimmunglobulinen bei maternaler Infektion (HIG). Auch bei erfolgter Transmission wird die Applikation von HIG oder Valaciclovir diskutiert.

Abstract

Primary infection with cytomegalovirus (CMV) affects about 0.6 % of all pregnant women. In about 80 % of the cases, these women are asymptomatic. Depending on the gestational age, the maternal–fetal transmission rate raises from 30 to 70 %. At the same time, the rate of postnatal sequelae decreases with increasing gestational age. As a consequence, a CMV infection in the first trimester carries the highest risk for an adverse outcome. Among others, postnatal symptoms of a congenital CMV infection include microcephaly and sensorineural hearing loss and are generally associated with a long-term developmental disorder. Treatment focuses on prevention of transmission. This could be realized by detailed hygiene counseling about the common ways of infection. In case of maternal infection, hyperimmunglobulines (HIG) are often used off-label in Germany to avoid maternofetal transmission. If fetal infection is documented, treatment may also involve the application of HIG or alternatively valaciclovir.

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Author information

Authors and Affiliations

  1. Universitäts-Frauenklinik Tübingen, Tübingen, Deutschland

    Karl Oliver Kagan

  2. Abteilung für Neonatologie, Universitätsklinikum Tübingen, Tübingen, Deutschland

    Rangmar Goelz

  3. Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen (UKT), Elfriede-Aulhorn-Straße 6, 72076, Tübingen, Deutschland

    Klaus Hamprecht

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  1. Karl Oliver Kagan
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Correspondence to Klaus Hamprecht.

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Interessenkonflikt

K. Hamprecht ist Mitglied im Wissenschaftlichen Beirat der Initiative zur Prävention konnataler Zytomegalieinfektionen (ICON). Alle damit in Zusammenhang stehenden Honorare werden einem UKT-Drittmittelkonto des Institutes für Medizinische Virologie zur Unterstützung der Tübinger CMV-Kongenitalstudie zugeführt. K.O. Kagan und R. Goelz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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R. Kimmig, Essen

A. Köninger, Essen

I. Mylonas, München

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Kagan, K.O., Goelz, R. & Hamprecht, K. Cytomegalovirusinfektion in der Schwangerschaft. Gynäkologe 49, 582–591 (2016). https://doi.org/10.1007/s00129-016-3923-0

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