Infection
Fetal Status
MRI Findings
Results
Congenital CMV Risk Stratifier
Timing · Long-term sequelae · Autism spectrum disorder · Fetal MRI interpretation
This tool stratifies the risk of long-term sequelae — including sensorineural hearing loss, neurodevelopmental impairment, and autism spectrum disorder (ASD) — based on the timing of primary maternal CMV infection and fetal MRI findings. It is built from the 2026 Leruez-Ville et al. prospective cohort study (Am J Obstet Gynecol, N=642, 23 years of follow-up, Necker-Enfants Malades Hospital, Paris).

Key findings this tool applies: all long-term CMV-related sequelae occurred exclusively after first-trimester maternal primary infection; ASD was diagnosed at a prevalence 4-fold higher than the general population (OR 4.25, 95% CI 1.63–21.33); and the absence of temporal lobe white matter abnormalities on fetal MRI carries a 100% negative predictive value for ASD. Every number displayed traces to a specific published source. View all references →
Maternal Infection Profile
Classify and date the maternal CMV infection — timing is the single most important prognostic variable
Type of Maternal Infection
Neonatal Clinical Status
Symptomatic vs. asymptomatic status at birth is a key independent prognostic variable
Neonatal Presentation at Birth
All 11 children diagnosed with ASD in this cohort were symptomatic at birth. No ASD was diagnosed among asymptomatic neonates (p<0.001). ASD rate: 5.1% in symptomatic vs 0% in asymptomatic neonates.
Source: Leruez-Ville et al. AJOG 2026, Table 4 (N=642)
Fetal / Postnatal MRI Findings
Temporal lobe white matter abnormalities are the neuroimaging signature linked to ASD risk
Three temporal lobe patterns to recognize (Figure 2, Leruez-Ville et al.): (1) T2 WM hyperintensity of temporal pole, (2) Temporal pole swelling/swollen appearance, (3) Temporal ventricular horn ectasia. Patterns 1 and 2 are associated with later ASD. Isolated ectasia was not associated with ASD in this cohort.
MRI Availability
Risk Profile & Clinical Guidance
Evidence-based assessment · Leruez-Ville et al. AJOG 2026 · N=642 · 23-year prospective cohort
Cohort Data Full Outcome Table by Infection Trimester
Outcome1st Trimester N=2882nd Trimester N=1443rd Trimester N=72OR (1st vs 2nd+3rd)p
Any Long-term CMV Sequelae76 (26.4%)00155.88 (21.63–1123.45)*<0.0001
Sensorineural Hearing Loss46 (15.9%)0083.04 (11.46–601.84)*<0.0001
Severe Imaging Findings16 (5.6%)0026.20 (3.50–196.16)*<0.0001
Autism Spectrum Disorder5 (1.7%)008.39 (0.46–152.48)*0.07
ADHD6 (2.1%)1 (0.7%)00.22 (0.05–1.86)0.25
Language Impairment (no SNHL)2 (0.7%)1 (0.7%)00.67 (0.01–12.9)1.0
* Haldane-Anscombe correction. Source: Leruez-Ville M et al. AJOG 2026, Table 1.
Diagnostic Performance Temporal Lobe MRI → ASD Prediction
MeasureFetal MRI (N=204, ASD n=5)Postnatal MRI (N=194, ASD n=11)
Sensitivity — WM Hyperintensity100% (95% CI 47.8–100)100% (95% CI 71.5–100)
Specificity — WM Hyperintensity91.9% (95% CI 87.3–95.3)77.6% (95% CI 70.8–83.4)
PPV — WM Hyperintensity23.8% (95% CI 16.3–33.3)21.1% (95% CI 17.0–26.0)
NPV — WM Hyperintensity100% (95% CI 98.0–100)100% (95% CI 97.4–100)
Sensitivity — WM + Swelling80.0% (95% CI 28.7–99.5)27.3% (95% CI 6.0–60.9)
Specificity — WM + Swelling97.5% (95% CI 94.2–99.2)97.8% (95% CI 94.5–99.4)
PPV — WM + Swelling44.4% (95% CI 23.6–67.9)42.8% (95% CI 16.0–74.6)
Source: Leruez-Ville M et al. AJOG 2026, Table 3.
References & Evidence Base
All numbers in this tool trace to these publications. Vancouver format.
1
Primary Study
Leruez-Ville M, Grevent D, Bourgon N, Chatzakis C, Parodi M, Fourgeaud J, Veyrenche N, Bahi-Buisson N, Pichon C, Magny J-F, Boddaert N, Ville Y. Maternal cytomegalovirus infection in the first trimester of pregnancy: timing, fetal brain injury, and long-term neurodevelopmental outcomes including autism spectrum disorder. Am J Obstet Gynecol. 2026. doi:10.1016/j.ajog.2026.04.040
N=642, 23-year prospective cohort (2001–2024), Necker-Enfants Malades, Paris. Source of all risk estimates, OR data, and MRI diagnostic performance metrics in this tool.
2
Meta-Analysis
Chatzakis C, Ville Y, Makrydimas G, Dinas K, Zavlanos A, Sotiriadis A. Timing of primary maternal cytomegalovirus infection and rates of vertical transmission and fetal consequences. Am J Obstet Gynecol. 2020;223(6):870-883.e11.
Meta-analysis of 17 studies (1986–2019): 22.8% SNHL or NDI after first-trimester infection vs. 0.1% and 0% for second/third trimester.
3
Guideline — ECCI 2024
Leruez-Ville M, Chatzakis C, Lilleri D, et al. Consensus recommendation for prenatal, neonatal and postnatal management of congenital cytomegalovirus infection from the European Congenital Infection Initiative (ECCI). Lancet Reg Health Eur. 2024;40:100892.
European consensus: valacyclovir 2g×4/day, amniocentesis at 17–18 weeks, fetal MRI at 30–32 weeks, structured postnatal follow-up.
4
RCT — Valacyclovir
Shahar-Nissan K, Pardo J, Peled O, et al. Valaciclovir to prevent vertical transmission of cytomegalovirus after maternal primary infection during pregnancy. Lancet. 2020;396(10253):779-85.
RCT supporting valacyclovir for secondary prevention of vertical CMV transmission after confirmed primary maternal infection.
5
IPD Meta-Analysis
Chatzakis C, Shahar-Nissan K, Faure-Bardon V, et al. The effect of valacyclovir on secondary prevention of congenital cytomegalovirus infection, following primary maternal infection in the first trimester. Am J Obstet Gynecol. 2023;S0002-9378(23)00470-2.
IPD meta-analysis confirming valacyclovir efficacy for periconceptional or first-trimester primary infections.
6
RCT — Valganciclovir
Kimberlin DW, Jester PM, Sánchez PJ, et al. Valganciclovir for symptomatic congenital cytomegalovirus disease. N Engl J Med. 2015;372(10):933-43.
RCT: valganciclovir for symptomatic congenital CMV improves audiological and neurodevelopmental outcomes. Supports neonatal antiviral treatment.
7
Population Study — ASD
Pesch MH, Leung J, Lanzieri TM, et al. Autism Spectrum Disorder Diagnoses and Congenital Cytomegalovirus. Pediatrics. 2024;153(6):e2023064081.
Large US Medicaid population-based study identifying association between congenital CMV and subsequent ASD diagnosis.
8
ASD Prevalence — France
Delobel-Ayoub M, Saemundsen E, Gissler M, et al. Prevalence of Autism Spectrum Disorder in 7-9-Year-Old Children in Denmark, Finland, France and Iceland. J Autism Dev Disord. 2020;50(3):949-59.
Source of French general population ASD prevalence estimate (0.392%) used in the Monte Carlo comparison yielding OR 4.25 (95% CI 1.63–21.33).
Evidence integrity statement: Every number displayed in this tool traces to one of the publications listed above. No data has been fabricated, estimated, or extrapolated beyond published findings.

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