Journal of Maternal-Fetal and Neonatal Medicine 2020;: 1 - 5

Maternal high-dose valacyclovir and its correlation with newborn blood viral load and outcome in congenital cytomegalovirus infection.

Goncé A, Hawkins-Villarreal A, Salazar L, Guirado L, Marcos MÁ, Pascual Mancho J, Prats P, López M, Eixarch E, Salvia MD, Fortuny C, Figueras F
03.11.2020

BACKGROUND/OBJECTIVE

Currently, there is no validated treatment for fetal cytomegalovirus (CMV). Two studies suggest that high-dose maternal valacyclovir decreases fetal viral load and improves outcomes in moderately-symptomatic fetuses. We offered valacyclovir in cases of fetal infection lacking ultrasound abnormalities or with non-severe infection. Maternal tolerability, fetal outcome and newborn blood viral load were evaluated in pregnancies of mothers receiving valacyclovir.

STUDY DESIGN

"We performed a case series including 8 pregnancies with fetal CMV classified as unaffected/mildly-moderately affected. Mothers received valacyclovir (8\xE2\x80\x89g/24h) from fetal infection diagnosis to delivery. Standard newborn evaluation was performed, and viremia was determined in the first 48\xE2\x80\x89h of life and compared according to length of maternal treatment and presence/absence of prenatal anomalies."

RESULTS

i: - p - p content: - "Valacyclovir was administered at a median gestational age of 26.5\xE2\x80\x89weeks (23.8-33.1) in 3 cases without fetal abnormalities, and 5 with mild/moderate abnormalities. Three were 3 first trimester primary infections, one non-primary infection, and in 4 the type of infection was unknown. Valacyclovir was well-tolerated. Fetal features did not progress. Three newborns were asymptomatic, and one was severely affected (bilateral chorioretinitis). The median newborn viral load (IQR) was 502\xE2\x80\x89IU/mL (231-191781) with lower levels when maternal treatment was administered \xE2\x89\xA510\xE2\x80\x89weeks, and in cases without fetal abnormalities [median 234\xE2\x80\x89IU/mL (228-711) vs. 4061 (292-510500) " - "\xE2\x80\x89=\xE2\x80\x89.18; and 234\xE2\x80\x89IU/mL (228-379500) vs. 711\xE2\x80\x89IU/mL (292-4061) " - "\xE2\x80\x89=\xE2\x80\x89.65, respectively], these differences being non-significant."

CONCLUSIONS

Fetal CMV lesions remained stable with high-dose maternal valacyclovir. Newborn viral load was unchanged despite treatment duration and fetal/neonatal abnormalities.

SUMMARY

Fetal cytomegalovirus lesions remained stable with high-dose maternal valacyclovir. Newborn viral load was unchanged despite treatment duration and fetal/newborn abnormalities.
DOI
10.1080/14767058.2020.1843016