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9/26/2014  |   4:30 PM - 6:00 PM   |  

A Retrospective Review of the Clinical Utilization and Outcomes of Cytomegalovirus (CMV) IgG Avidity Testing in Pregnant Women in a Canadian Province

Background Cytomegalovirus (CMV) remains the most common infectious cause of congenital birth defects and accounts for 15-20% of bilateral, moderate to profound sensorineural hearing loss in childhood. Risk of congenital CMV infection (and fetal damage) is related to type of maternal infection: primary maternal infection during pregnancy poses a much higher risk of intra-uterine transmission and fetal adverse outcomes. CMV IgG avidity helps determine if primary CMV infection occurred during pregnancy and hence is crucial for counseling regarding further diagnostic (i.e. ammiocentesis) or therapeutic options (i.e. CMV-immunoglobulin), or termination of pregnancy. The Society of Obstetricians and Gynaecologists of Canada recommends CMV IgG avidity testing if maternal serum tests positive for both IgG and IgM in cases of symptomatic maternal disease consistent with primary CMV infection or following detection of sonographic findings suggestive of fetal CMV infection. However, only a minority (3/12) of Canadian provinces and territories offer CMV IgG avidity testing currently. Objective This study aims to review the clinical utilization of a CMV IgG avidity test on the management of possible recent, acute primary CMV infection during pregnancy, since its introduction in August 2013 in a Canadian province. Methods Information on reasons for testing, type of maternal infection, subsequent pregnancy progress, management and outcomes as related to CMV IgG avidity testing will be summarized anonymously and analyzed by the research team (awaiting ethics approval). Statistical analysis will be applied, where appropriate. Individual cases will be highlighted where they demonstrate an important decision/outcome point for or against the utilization of the CMV IgG avidity assay. Results and Discussion Based on this analysis a final recommendation for the continued use of the CMV IgG avidity test will be made for this population. Availability of this information can significantly impact the timely and appropriate management of these pregnancies particularly in the Canadian context.

Eliana Castillo (Primary Presenter,Author), ecastillo@me.com;
Dr. Eliana Castillo is Clinical Assistant Professor at the University of Calgary, where her medical and teaching practice focuses on medical disorders in pregnancy and maternal infections. She has been active in the area of immunization during pregnancy, congenital CMV infection and maternal mortality at a local and national level through her work with the Society of Obstetrics and Gyneacologists of Canada, Alberta Perinatal Health Program and National Advisory Committee for Immunization.

ASHA DISCLOSURE:

Financial - No relevant financial relationship exist.

Nonfinancial - No relevant nonfinancial relationship exist.

Julian Tang (Author), Julian Tang ;
Dr. Tang graduated from Christ’s College, University of Cambridge, UK in Medical and Natural Sciences (1989), then acquired his PhD in Zoology, involving applied fluid dynamics at the University of Aberdeen, UK (1993). He further went on achieve his medical degree at the University of Sheffield, UK (1996). He later became a Fellow of the Royal College of Pathologists in the UK as a clinical virologist at the University College London Hospital while he also worked as an academic research fellow. Dr. Tang then moved to Hong Kong for a Clinical Assistant Professor position at the Chinese University of Hong Kong in the Department of Microbiology (2005). Here, he mainly focused on clinical virology with special interests in phylogenetic/bioinformatics techniques and hospital acquired infection control measures. In 2012, Dr. Tang was recruited by the University of Alberta.

Sue Chandra (Author), Sue Chandra ;
Department of Obstetrics and Gyneacology, Director Division of Materno-Fetal Medicine, University of Alberta, Edmonton AB

Ryan Cooper (Author), Ryan Cooper ;
HIV Viral Hepatitis Inner-City Health Tuberculosis

Venu Jain (Author), Venu Jain ;
Associate Professor, Department of Obstetrics & Gynecology Program Director, Undergraduate Medical Education

Raymond Tellier (Author), Raymond Tellier ;
Associate Professor, Departments of Microbiology, Immunology & infectious Diseases and Pathology & Laboratory Medicine

Carmen Young (Author), Carmen Young ;
Maternal Fetal Medicine Specialist

Radha Chari (Author), Radha Chari ;
Dr. Radha Chari Department of Obstetrics & Gyneacology University of Alberta

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