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Abstract：
Background: Numerous studies have aimed to predict prenatal and neonatal outcomes for pregnancies complicated by congenital cytomegalovirus (CMV). Presently, assessing CMV severity prenatally relies largely on fetal imaging. A controversy exists regarding CMV viral load (VL) and its association with fetal and neonatal sequelae. Objective: To perform a systematic review and meta-analysis investigating the association between CMV DNA VL in amniotic fluid and fetal and neonatal outcomes in pregnancies with congenital CMV. Results: All cohort, case-control and observational studies that compared outcomes of fetuses with congenital CMV and provided information on individual patient CMV VL quantified in copies per milliliter (c/mL) from inception to January 2023 were included, with no geographical or language restrictions. A total of 1251 citations were reviewed with eight studies meeting inclusion criteria and included in meta-analysis. Affected pregnancies had a higher VL in the amniotic fluid compared to those unaffected with a mean difference of 2.2e+7 (range 1.5e+7 to 2.8e+7). In subgroup analysis, the VL was significantly higher in the fetuses, with imaging findings related to CMV compared to asymptomatic fetuses with a mean difference of 4.1e+7 (95% CI 2.8e+7-5.4e+7). However, among babies with congenital CMV, the VL was not significantly different between symptomatic and asymptomatic babies. Conclusions: Amniotic fluid CMV VL is associated with fetal sequalae in congenital CMV, with a higher VL conferring a greater risk for prenatal injury.
摘要：
背景：许多研究旨在预测先天性巨细胞病毒（CMV）并发妊娠的产前和新生儿结局。目前,产前评估CMV严重程度主要依赖于胎儿影像学检查.关于CMV病毒载量（VL）及其与胎儿和新生儿后遗症的关系存在争议。目的：进行系统评价和荟萃分析，探讨羊水中CMVDNAVL与先天性CMV妊娠胎儿和新生儿结局的关系。结果：所有队列，纳入病例对照和观察性研究,这些研究比较了先天性CMV胎儿的结局,并提供了从开始至2023年1月以每毫升拷贝(c/mL)量化的个体患者CMVVL的信息,没有地理或语言限制。共审查了1251篇引用，其中8项研究符合纳入标准，并纳入荟萃分析。与未受影响的孕妇相比，受影响的孕妇的羊水VL较高，平均差异为2.2e7（范围为1.5e7至2.8e7）。在亚组分析中，胎儿的VL明显更高，与无症状胎儿相比，与CMV相关的影像学检查结果平均差异为4.1e+7(95%CI2.8e+7-5.4e+7)。然而,在患有先天性CMV的婴儿中，有症状和无症状婴儿的VL无显著差异.结论:羊水CMVVL与先天性CMV胎儿后遗症有关,较高的VL赋予更大的产前损伤风险。
