Epidemiology of cytomegalovirus infection in pregnancy in Israel: Real‐world data from a large healthcare organization

• Published in: Journal of medical virology Vol. 94; no. 2; pp. 713 - 719
• Main Authors: Weil, Clara, Bilavsky, Efraim, Sinha, Anushua, Chodick, Gabriel, Goodman, Elizabeth, Wang, Wei (Vivian), Calhoun, Shawna R., Marks, Morgan A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2022
• Subjects: Adolescent; Adult; Age; Cohort analysis; cohort studies; Confidence intervals; Cytomegalovirus; cytomegalovirus infections; Cytomegalovirus Infections - epidemiology; Databases, Factual; Epidemiology; Female; Fetuses; Health care; Health services; Hearing loss; Humans; Infections; Israel - epidemiology; Logistic Models; Neonates; Pregnancy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Outcome; Regression analysis; Regression models; Retrospective Studies; Risk; Seroepidemiologic Studies; Serology; Statistical analysis; Virology; Young Adult; Israel; cohort studies; epidemiology; cytomegalovirus infections; pregnancy
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/jmv.27403

Congenital cytomegalovirus infection (cCMVi) is the leading cause of nonhereditary sensorineural hearing loss among newborns. Women newly acquiring cytomegalovirus infection (CMVi) during pregnancy have the highest risk of vertical transmission. This study aimed to describe the epidemiology of CMVi in pregnancy in a large healthcare database. A retrospective cohort study was performed using the Maccabi Healthcare Services database (Israel). Women aged 18–44 years old on July 1, 2013 with no record of pregnancy in the prior 6 months were followed through December 31, 2017 for first pregnancy occurrence. Pregnancy outcomes (live birth, spontaneous/therapeutic abortions, stillbirth, and uncertain outcomes) were captured. CMV test results were obtained to assess serostatus at the start of pregnancy (SoP) and primary CMV infection (CMVi) during pregnancy. Associations of demographic and reproductive factors with pCMVi were investigated (multivariable logistic regression). The study included 84 699 pregnant women (median age = 31 years; interquartile range = 28–35). Live birth, fetal loss, and uncertain pregnancy outcomes accounted for 76.8%, 18.2%, and 5.0%, respectively. The seroprevalence of CMV at the start of pregnancy in this cohort was 63.4% (95% confidence interval [CI]: 63.1–63.7). Among seronegative women with available test results (n = 10 657), CMVi incidence was 14.5 per 1000 (95% CI = 12.2–16.7). In multivariate logistic regression models adjusting for maternal age, CMVi was significantly associated with having one or more prior live births (odds ratio [OR]: 3.8 [95% CI: 2.6–5.4]) and having a child less than 6 years of age (OR: 4.3 [95%CI: 3.0–6.1]). One in three pregnant women in Israel is at risk for primary CMVi. This study demonstrates that real‐world electronic healthcare data can be leveraged to support clinical management and development of interventions for congenital CMV by identifying women at high risk for CMVi during pregnancy. Highlights In an analysis of real‐world data from 84,699 pregnant women from Israel, the seroprevalence of CMV at the start of pregnancy was 63.4%. Among women who were CMV seronegative at the start of pregnancy, the incidence of primary CMV infection was 14.5 per 1000. The incidence of primary CMV infection was higher among multi‐parous women and women with children under six years of age.