Maternal transmission, neonatal outcomes, and predictors of adverse effects in congenital cytomegalovirus infection

Background: Congenital cytomegalovirus (cCMV) infection, caused by a DNA beta-herpesvirus, is the most common congenital infection globally, with significant neurodevelopmental and audiological sequelae. This study aimed to evaluate maternal-to-fetal transmission rates, neonatal outcomes, and the predictive value of clinical and virological markers for adverse outcomes. Methods: This prospective longitudinal study enrolled 43 neonates born to mothers with CMV infection during pregnancy (2019–2023). cCMV was diagnosed by CMV DNA detection in urine or saliva within the first two weeks of life. Neuroimaging, audiological evaluations, and neurodevelopmental assessments were conducted during follow-up. Statistical analyses examined associations between maternal infection type, neonatal findings, and clinical outcomes. Results: Among 43 neonates, 31 (72%) were diagnosed with cCMV. Primary maternal infection was significantly associated with higher transmission rates (p < 0.01). Twelve infected infants (38.7%) showed neurological symptoms, most commonly of speech and motor delay. SNHL was diagnosed in 2 patients (6.4%). High blood viral load was significantly associated with adverse audiological outcomes (p < 0.05), while intrauterine growth restriction (IUGR) predicted adverse neurological outcomes (p = 0.05). No statistically significant association was found between MRI abnormalities and neurological or audiological outcomes, although a trend toward correlation with adverse outcomes was observed. Conclusions: cCMV carries a high risk of neurodevelopmental and auditory sequelae. High blood viral load and IUGR may serve as early predictors of poor outcomes. Early diagnosis, parental counseling, and long-term follow-up remain essential. Larger multicenter studies are needed to validate these findings and refine predictive models.