Association between postnatal maternal serology and congenital cytomegalovirus infection in neonates with jaundice
##plugins.themes.bootstrap3.article.main##
Abstract
Congenital cytomegalovirus (CMV) infection is one of the most prevalent infections at birth and can lead to severe health complications in neonates. Timely detection is crucial. However, polymerase chain reaction (PCR) testing is often unavailable in numerous healthcare settings. In such cases, maternal CMV antibody testing may assist in identifying at-risk infants. In the development of diagnostic methods to date, there is no single method for detecting CMV infection in pregnant women at all stages of pregnancy. This study examined the relationship between maternal CMV serology after delivery and congenital CMV infection in newborns presenting with symptoms including jaundice, prematurity, or low birth weight. Urine samples from neonates within the first 21 days of life were analyzed for CMV DNA via PCR, while maternal IgG and IgM antibodies were assessed within three weeks after delivery. A total of 87 neonates were examined, with 28 (32.2%) testing positive for CMV DNA. Neonatal jaundice was significantly associated with CMV infection, whereas prematurity and low birth weight were not. Maternal CMV IgM positivity was significantly correlated with neonatal CMV PCR positivity, while maternal IgG did not exhibit a significant relationship. In conclusion, maternal CMV IgM positivity post-delivery may assist in identifying newborns requiring confirmatory PCR testing, particularly in healthcare environments with constrained diagnostic resources.
Downloads
##plugins.themes.bootstrap3.article.details##
Copyright (c) 2026 Puspa Wardhani, Joko Pamungkas, Dominicus Husada, Ernawati Ernawati, Nyilo Purnami, Munawaroh Fitriah

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
References
Salomè S, Corrado FR, Mazzarelli LL, Maruotti GM, Capasso L, Blazquez-Gamero D, Raimondi F. Congenital cytomegalovirus infection: The state of the art and future perspectives. Front Pediatr. 2023;11:1276912. https://doi.org/10.3389/fped.2023.1276912
Putri ND, Wiyatno A, Dhenni R, Sriyani IY, Dewantari AK, Handryastuti S, Iskandar ATP, Rahma MM, Jumiyanti N, Aprilia YY, Prayitno A, Karyanti MR, Satari HI, Hadinegoro SR, Myint KSA, Safari D. Birth prevalence and characteristics of congenital cytomegalovirus infection in an urban birth cohort, Jakarta, Indonesia. Int J Infect Dis. 2019;86:31–37. https://doi.org/10.1016/j.ijid.2019.06.009
Iijima S. Pitfalls in the serological evaluation of maternal cytomegalovirus infection as a potential cause of fetal and neonatal involvement: A narrative literature review. J Clin Med. 2022;11(17):5114. https://doi.org/10.3390/jcm11175114
Revello MG, Genini E, Gorini G, Klersy C, Piralla A, Gerna G. Comparative evaluation of eight commercial human cytomegalovirus IgG avidity assays. J Clin Virol. 2004;30(1):19–24. https://doi.org/10.1016/j.jcv.2003.09.006
Razonable RR, Inoue N, Pinninti SG, Boppana SB, Lazzarotto T, Gabrielli L, Simonazzi G, Pellett PE, Schmid DS. Clinical diagnostic testing for human cytomegalovirus infections. J Infect Dis. 2020;221(Suppl 1):S74–S85. https://doi.org/10.1093/infdis/jiz601
Ohyama S, Fujioka K, Fukushima S, Abe S, Ashina M, Ikuta T, Nishida K, Matsumoto H, Nakamachi Y, Tanimura K, Yamada H, Iijima K. Diagnostic value of cytomegalovirus IgM antibodies at birth in PCR-confirmed congenital cytomegalovirus infection. Int J Mol Sci. 2019;20(13):3239. https://doi.org/10.3390/ijms20133239
Huang Y, Wang H, Li T, Li C, Tang J, Yu H, Guo X, Song Q, Wei F, Wang J, Liang C, Zheng F, Li H, Li H, Wu H, Lu Z, Su Y, Wu T, Ge S, Fu TM, Zhang J, Xia N. Comparison of detection strategies for screening and confirming congenital cytomegalovirus infection in newborns in a highly seroprevalent population. Lancet Reg Health West Pac. 2021;12:100196. https://doi.org/10.1016/j.lanwpc.2021.100196
Leruez-Ville M, Chatzakis C, Lilleri D, Blazquez-Gamero D, Alarcon A, Bourgon N, Foulon I, Fourgeaud J, Gonce A, Jones CE, Klapper P, Krom A, Lazzarotto T, Lyall H, Paixao P, Papaevangelou V, Puchhammer E, Sourvinos G, Vallely P, Ville Y, Vossen A. Consensus recommendation for prenatal, neonatal and postnatal management of congenital cytomegalovirus infection. Lancet Reg Health Eur. 2024;40:100887. https://doi.org/10.1016/j.lanepe.2024.100887
Buonsenso D, Serranti D, Gargiullo L, Ceccarelli M, Ranno O, Valentini P. Screening for congenital cytomegalovirus infection: current strategies and future directions. Pediatr Infect Dis J. 2023;42(2):e41–e47. https://doi.org/10.1097/INF.0000000000003855
Nye MB, Leman AR, Meyer ME, Menegus MA, Rothberg PG. Sequence diversity in the glycoprotein B gene complicates real-time PCR assays for detection and quantification of cytomegalovirus. J Clin Microbiol. 2005;43(10):4968-4971. https://doi.org/10.1128/JCM.43.10.4968-4971.2005
Habbal W, Monem F, Gärtner BC. Comparative evaluation of published cytomegalovirus primers for rapid real-time PCR: which are the most sensitive?. J Med Microbiol. 2009;58(7):878-883. https://doi.org/10.1099/jmm.0.010587-0
Luck SE, Wieringa JW, Blázquez-Gamero D, Henneke P, Schuster K, Butler K, Capretti MG, Cilleruelo MJ, Curtis N, Garofoli F, Heath P, Iosifidis E, Klein N, Lombardi G, Lyall H, Nieminen T, Pajkrt D, Papaevangelou V, Posfay-Barbe K, Puhakka L, Roilides E, Rojo P, Saavedra-Lozano J, Shah T, Sharland M, Saxen H, Vossen ACTM; ESPID Congenital CMV Group Meeting, Leipzig 2015. Congenital cytomegalovirus: clinical manifestations and neonatal outcomes. Pediatr Infect Dis J. 2017;36 (12):1205–1213. https://doi.org/10.1097/inf.0000000000001763
Schleiss MR, Blázquez-Gamero D. Universal newborn screening for congenital cytomegalovirus infection. Lancet Child Adolesc Health. 2025;9(1):57–70. https://doi.org/10.1016/S2352-4642(24)00237-2
Tang J, Wei H, Dai Y, Luo Y, Hu Y, Zhou Y-H, Lin N, Liu A. Transplacental transmission of cytomegalovirus in pregnant women with positive anti-CMV IgG and negative anti-CMV IgM. Pathogens. 2025;14(9):929. https://doi.org/10.3390/pathogens14090929
Chan ES, Suchet I, Somerset D, de Koning L, Chadha R, Soliman N, Kuret V, Yu W, Lauzon J, Thomas MA, Poon E, Zhou HY. Maternal cytomegalovirus (CMV) serology: The diagnostic limitations of CMV IgM and IgG avidity in detecting congenital CMV infection. Pediatr Dev Pathol. 2024;27(6):530–544. https://doi.org/10.1177/10935266241253477
Moutsopoulou RA, Markou A, Lianou A, Leontari K, Iliodromiti Z, Boutsikou T, Kafalidis G, Paliatsiou S, Volaki P, Iacovidou N, Tsantes AG, Sokou R. Congenital cytomegalovirus infection: From silent threat to vaccine horizon. Vaccines. 2025;13(9):929. https://doi.org/10.3390/vaccines13090929
Khalil A, Heath PT, Jones CE, Soe A, Ville YG. Congenital cytomegalovirus infection: Update on screening, diagnosis and treatment. BJOG. 2025;132(2):e42–e52. https://doi.org/10.1111/1471-0528.17966
Akpan US, Pillarisetty LS. Congenital cytomegalovirus infection. StatPearls. 2023. https://doi.org/10.33029/2308-2402-2023-11-4-68-87
Al Beloushi M, Saleh H, Ahmed B, Konje JC. Congenital and perinatal viral infections: Consequences for the mother and fetus. Viruses. 2024;16(11):1789. https://doi.org/10.3390/v16111789
Boppana SB, Rivera LB, Fowler KB, Mach M, Britt WJ. Intrauterine transmission of cytomegalovirus to infants of women with preconceptional immunity. N Engl J Med. 2001;344(18):1366-71. https://doi.org/10.1056/nejm200105033441804
Hui L, Wood G. Perinatal outcome after maternal primary cytomegalovirus infection in the first trimester. Prenat Diagn. 2015;35(1):1–7. https://doi.org/10.1002/pd.4497
Modrzejewska M, Połubiński P, Zdanowska O. Ophthalmic complications, diagnosis, and treatment of congenital human cytomegalovirus infection. J Clin Med. 2024;13(12):3379. https://doi.org/10.3390/jcm13123379
Kohmer N, Nagel A, Berger A, Enders M, Hamprecht K, Korn K, Kortenbusch M, Überla K, Rabenau HF. Laboratory diagnosis of congenital CMV infection in newborns: Impact of pre-analytic factors. J Clin Virol. 2019;115:32–36. https://doi.org/10.1016/j.jcv.2019.03.014
Zuhair M, Smit GSA, Wallis G, Jabbar F, Smith C, Devleesschauwer B, Griffiths P. Estimation of the worldwide seroprevalence of cytomegalovirus. Rev Med Virol. 2019;29(3):e2034. https://doi.org/10.1002/rmv.2034
Novelli M, Caramuscio E, Natale F, Zitarelli C, Ferri R, Terrin G, Caravale B. One-year neurodevelopmental outcome in children with asymptomatic congenital CMV infection. Glob Pediatr. 2024;9:100192. https://doi.org/10.1016/j.gpedi.2024.100192
Liberati C, Sturniolo G, Brigadoi G, Cavinato S, Visentin S, Cosmi E, Donà D, Rampon O. Burden of congenital CMV infection: A narrative review. Viruses. 2024;16(8):1311. https://doi.org/10.3390/v16081311
Xie M, Tripathi T, Holmes NE, Hui L. Serological screening for cytomegalovirus during pregnancy. Prenat Diagn. 2023;43(7):959–967. https://doi.org/10.1002/pd.6397
Leber AL. Maternal and congenital human cytomegalovirus infection: Laboratory testing for detection and diagnosis. J Clin Microbiol. 2024;62(4):e00313-23. https://doi.org/10.1128/jcm.00313-23
Chiereghin A, Pavia C, Turello G, Borgatti EC, Baiesi Pillastrini F, Gabrielli L, Gibertoni D, Marsico C, De Paschale M, Manco MT, Ruscitto A, Pogliani L, Bellini M, Porta A, Parola L, Scarasciulli ML, Calvario A, Capozza M, Capretti MG, Laforgia N, Clerici P and Lazzarotto T. Universal newborn screening for congenital cytomegalovirus infection: A prospective multicenter study. Front Pediatr. 2022;10:909646. https://doi.org/10.3389/fped.2022.909646
Rawlinson WD, Boppana SB, Fowler KB, Kimberlin DW, Lazzarotto T, Alain S, Daly K, Doutré S, Gibson L, Giles ML, Greenlee J, Hamilton ST, Harrison GJ, Hui L, Jones CA, Palasanthiran P, Schleiss MR, Shand AW, van Zuylen WJ. Congenital cytomegalovirus infection in pregnancy and the neonate: Consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. 2017;17(6):e177–e188. https://doi.org/10.1016/S1473-3099(17)30143-3
Wang H, Oyenirah SJ. Diagnosis of congenital and maternal cytomegalovirus infection—an up-to-date review. Clin Microbiol Rev. 2023;45(9):69-76. https://doi.org/10.1128/cmr.00062-22
Puspa Wardhani
https://orcid.org/0000-0003-2202-8090