Seroprevalence and impact of Cytomegalovirus infection on pregnancy and neonatal outcomes: A cross-sectional study in Kirkuk, Iraq

Background: Congenital cytomegalovirus (CMV) infection, the most prevalent intrauterine infection, is a leading cause of sensorineural and developmental disabilities, including hearing loss, visual impairment, and neurological abnormalities. This cross-sectional study evaluated the association between recent CMV infection, confirmed via detection of human CMV-specific immunoglobulin M (HCMV-IgM) antibodies using enzyme-linked immunosorbent assay (ELISA), and adverse pregnancy and neonatal outcomes. Methods: Between September 2023 and June 2024, 368 pregnant women aged 18–40 years in Kirkuk, Iraq, were enrolled. Blood samples were analyzed for HCMV-IgM seropositivity and inflammatory markers. The study compared HCMV-IgM-positive and HCMV-IgM-negative groups for differences in maternal sociodemographic factors, pregnancy outcomes (preterm labor, abortion, stillbirth, placental insufficiency), and neonatal outcomes (intrauterine growth restriction (IUGR), low birth weight, congenital CMV infection, hearing loss, neurological impairment, neonatal intensive care unit (NICU) admission, and neonatal death). Results: Among 368 women, 24.18% (89) tested HCMV-IgM positive, indicating recent CMV infection. They exhibited higher mean white blood cells (WBC) (9.5 ± 1.2 vs. 8.8 ± 1.0 ×10³/µL), lymphocytes (3.2 ± 0.8 vs. 2.8 ± 0.7 ×10³/µL), and CRP (12.5 ± 2.1 vs. 9.7 ± 1.9 mg/L). HCMV-IgM+ women had increased preterm labor (39.33% vs. 17.92%, p=0.01), abortion (22.47% vs. 10.75%, p=0.02), stillbirth (11.24% vs. 5.38%, p=0.04), IUGR (16.85% vs. 7.17%, p=0.03), low birth weight (20.22% vs. 8.96%, p=0.02), and congenital CMV infection (5.62% vs. 0.72%, p=0.01). Conclusion: HCMV-IgM seropositivity is strongly linked to adverse maternal and neonatal outcomes, underscoring the necessity for routine screening and targeted interventions to mitigate CMV-related morbidity and mortality.