(577) Association Between Placental Syndrome and 2-year Neurodevelopmental Outcome in Patients with Primary Maternal CMV Infection

Objective: To evaluate whether there is an association between placental syndrome (PS) disorders in primary CMV and child outcomes at 2 years of age.

Study Design: Secondary analysis of a multicenter randomized placebo-controlled trial of CMV hyperimmune globulin to prevent congenital CMV infection, which did not show treatment benefit. Participants with primary CMV infection identified by positive IgM antibody and low positive avidity ( < 50%) IgG antibody before 24 weeks, or by IgG seroconversion before 28 weeks, and a singleton gestation without ultrasound findings suspicious for congenital CMV infection were included. PS was defined as having one or more of the following: preeclampsia, gestational hypertension, small for gestational age, placental abruption, or preterm delivery. Primary outcome was a composite of adverse neurodevelopmental outcome at 2 years of age, which included: death, sensorineural hearing loss, chorioretinitis, seizure disorder, or developmental delay (cognitive score < 70 or motor score < 70 on the Bayley III).

Results: Of the 399 participants randomized, 344 (86%) infants discharged alive underwent the 2-year follow up. Of these, 80 were exposed to PS (34 hypertensive disorders, 44 SGA, 23 PTB, and 3 placental abruption, with 19 having more than one). The primary composite outcome occurred more often in the PS group (15.6% vs. 4.1%; OR 4.3; 95% CI 1.6, 11.1; p=0.003). Developmental delay was greater in the PS group (cognitive score < 70: 7.3% vs. 0.8% p= 0.007, motor score < 70: 8.7% vs 0% p< 0.001). Results were consistent in a multivariate analysis after adjusting for treatment group, marital status, government insurance/self-pay, and smoking, as well as in the subgroup that delivered at term.

Conclusion: Placental syndrome in pregnant people with primary CMV is associated with adverse neurodevelopmental outcome in the children. This unique prospectively collected data on long-term impact of placental syndrome disorders helps to identify children that may benefit from early evaluation and intervention.