Hyperimmunoglobulin therapy for the prevention and treatment of congenital cytomegalovirus: a systematic review and meta-analysis

ABSTRACT

Objective: To examine the safety and efficacy of hyeprimmunoglobulin therapy on vertical transmission of congenital cytomegalovirus (CCMV).

Method: We searched nine databases for studies investigating the effect of Hyperimmunoglobulin among pregnant women with CMV.

Results: Of total eight studies, the pooled prevalence of CCMV was 36.5% (95% confidence intervals (CI): 26–49%). There was no evidence that hyperimmunoglobulin is effective against CCMV [odds ratio (OR) (95% (CI)) = 0.53 (0.20–1.42)]. However, analyzing only studies of pregnant women with confirmed primary infection, a significant reduction in the congenital CCMV rates was observed [OR (95% CI) = 0.33 (0.18–0.59)]. Based on the purpose, CCMV prevention was successful with a reduction of the CCMV rates [OR (95% CI) = 0.33 (0.16–0.68)[, while treatment was not]OR (95% CI) = 0.80 (0.04–15.01)]. The most common adverse pregnancy outcome was prematurity, followed by intrauterine growth retardation (IUGR) and termination of pregnancy (TOP), with no significant impact of antenatal hyperimmunoglobulin usage.

Conclusion: Our results showed a promising efficacy of hyperimmunoglobulin therapy among pregnant women with confirmed primary infection, which fades away on including secondary infection. This effectiveness was limited to the prevention, not the treatment, of CCMV. More randomized controlled trials are needed to provide concrete evidence.

KEYWORDS:

• Hyperimmunoglobulin
• congenital
• cytomegalovirus
• CMV
• prevention
• treatment

Article highlights

• Congenital CMV constitutes one of the leading causes of infant disability.

• Hypermmunoglobulin therapy is effective in the prevention of congenital CMV of primary infectious origin.

• Hypermmunoglobulin therapy is not significantly associated with side effects.

• Larger randomized controlled trials are needed to ensure the safety and efficacy of antenatal hyperimmunoglobulins.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

AEE, SG, ASA, and NEK were responsible for the idea and study design. All authors screened articles and extracted the data. SG analyzed the data and interpreted it. AEE, SG, ES, and MD wrote the manuscript. All authors revised and approved the final version. SG and NEK have supervised and checked all the steps.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.