Interpretation
Ascendant transmission from genital tract appears to be an important transmission route1. According to Rocha and colleagues (2012), after detection CMV in cervical samples of asymptomatic women at reproductive age, this could be a great method of pregnant women accompaniment that may reactivate the infection or have primo-infection under asymptomatic way27. Thus, it could be suggested that this might be the transmission pathway, once in the present study the placenta is apparently involved only in a single case. One-third of parturients with intrauterine infected newborns did not have a fixed partner, and besides the viral reactivation hypothesis due to a concomitant infection24, it might have happened reinfection by other CMV subtypes during the gestation period caused by sexual intercourse exposure.
Women at risk of transmitting CMV to the fetus should perform noninvasive tests, such as ultrasonographic monitoring of the fetus (that is able to detect malformations and signs of fetal infection) and even invasive tests such as cordocentesis and amniocentesis2,16. Among those neonates presenting the virus in cord blood only one presented ears malformation and micrognatia, besides prematurity and low weight at birth. Concerning this specific case, as observed in at least three more cases, mother realized no accompaniment examns during gestation period. Therefore, it is not possible to affirm for sure that the virus prevalence and this characteristic are correlated, once the mother was carrying other conditions that might have caused the proper scenario for this closure. However, this possibility should be strongly considered.
Relevant socio-economic factors such as malnutrition, inappropriate health care services and bad hygiene contribute to maternal-fetal infection increase in developing coutries17. Concerning the present study, the sociodemographic factors such as skin color and schooling have demonstrated a tendency in mother infection by CMV. Besides, the exposure time to the virus might be important, principally in reactivation cases. Women’s early onset of sexual intercourse, before 15 years old, was a risk factor to the virus presence in the umbilical cord blood. Therefore, the exposure certainly occurs and women carrying CMV can probably go under reactivation and transmit the virus to fetus. Simultaneously to the income factor, which was statistically significant, these data indicate that the lack of knowledge concerning the disease and preventive measures, as well as lack of sanitary conditions, commonly observed in poor populations, are strongly connected in this scenario.