Comparison of two serological screening strategies for cytomegalovirus primary infection in the first trimester of pregnancy

Introduction: CMV serology screening in the first trimester pregnancy is based on IgG and IgM testing followed by IgG avidity in cases with positive IgM. However, the sensitivity of this strategy to diagnose maternal primary infection has been questioned. The objective of the study was to compare this strategy 1 with a strategy 2 consisting of running avidity test on all samples with positive IgG (ignoring IgM results) using fully automated current generation CMV IgG, IgM and IgG avidity assays.Population and methods: 1516 consecutive pregnant women between 12 and 14 weeks were screened in one maternity. Strategy 1 was done prospectively with LIAISON (R) CMV IgG II and LIAISON (R) CMV IgM II, followed by LIAISON (R) CMV IgG Avidity II and VIDAS (R) CMV IgG avidity II testing in cases with positive or equivocal IgM. Strategy 2 was done retrospectively on the same population and consisted of running avidity with the LIAISON (R) CMV IgG Avidity II in all samples with positive IgG.Results: The sensitivity to diagnose a confirmed or a possible maternal primary infection in the first trimester was 91.6 % and 83 % for strategy 1 and 2 respectively (p > 0.99). Strategy 1 missed one possible primary infection and strategy 2 missed 2 confirmed primary infection. Inconclusive results happened in 0 and 0.7 % of samples with strategy 1 and 2 respectively.Conclusion: This study suggests that strategy 1 has better sensitivity and practicability than strategy 2. However, to achieve a good performance with strategy 1, using highly sensitive IgM assay is mandatory.

Automated summary

The study suggests that strategy 1 has better sensitivity and practicability than strategy 2 for diagnosing maternal primary CMV infection in the first trimester of pregnancy. However, achieving good performance with strategy 1 requires the use of a highly sensitive IgM assay.