Preconception Screening for Cytomegalovirus: An Effective Preventive Approach

Reichman, Orna; Miskin, Ian; Sharoni, Limor; Eldar‐Geva, Talia; Goldberg, D.A.; Tsafrir, Avi; Gal, M.

doi:10.1155/2014/135416

Cited by 12 publications

(8 citation statements)

References 17 publications

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“…Should these women become pregnant again, it is less likely they will be inadvertently exposed to CMV. Indeed, in a population of women receiving fertility treatment, preconception screening and counseling seemed to have the potential to reduce CMV exposure in pregnancy ( Reichman et al, 2014 ). Preconception testing would also reduce problems arising from the detection and interpretation of CMV-specific IgM antibody in an already pregnant woman ( Revello and Gerna, 2002; Guerra et al, 2007 ).…”

Section: Discussionmentioning

confidence: 99%

Prevention of Primary Cytomegalovirus Infection in Pregnancy

Revello¹,

Tibaldi²,

Masuelli³

et al. 2015

EBioMedicine

188

177

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BackgroundCytomegalovirus (CMV) is the leading infectious agent causing congenital sensorineural hearing loss and psychomotor retardation. CMV vaccine is currently unavailable and treatment options in pregnancy are limited. Susceptible pregnant women caring for children are at high risk for primary infection. CMV educational and hygienic measures have the potential to prevent primary maternal infection.MethodsA mixed interventional and observational controlled study was conducted to investigate the effectiveness of hygiene information among pregnant women at risk for primary CMV infection for personal/occupational reasons. In the intervention arm, CMV-seronegative women, identified at the time of maternal serum screening for fetal aneuploidy at 11–12 weeks of gestation, were given hygiene information and prospectively tested for CMV until delivery. The comparison arm consisted of women enrolled at delivery who were neither tested for nor informed about CMV during pregnancy, and who had a serum sample stored at the screening for fetal aneuploidy. By design, groups were homogeneous for age, parity, education, and exposure to at least one risk factor. The primary outcome was CMV seroconversion. Acceptance of hygiene recommendations was a secondary objective and was measured by a self-report.FindingsFour out of 331 (1.2%) women seroconverted in the intervention group compared to 24/315 (7.6%) in the comparison group (delta = 6.4%; 95% CI 3.2–9.6; P < 0.001). There were 3 newborns with congenital infection in the intervention group and 8 in the comparison group (1 with cerebral ultrasound abnormalities at birth). Ninety-three percent of women felt hygiene recommendations were worth suggesting to all pregnant women at risk for infection.InterpretationThis controlled study provides evidence that an intervention based on the identification and hygiene counseling of CMV-seronegative pregnant women significantly prevents maternal infection. While waiting for CMV vaccine to become available, the intervention described may represent a responsible and acceptable primary prevention strategy to reduce congenital CMV.

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Section: Discussionmentioning

confidence: 99%

Prevention of Primary Cytomegalovirus Infection in Pregnancy

Revello¹,

Tibaldi²,

Masuelli³

et al. 2015

EBioMedicine

188

177

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“…In the absence of a vaccine to prevent infection, a greater focus on education and prevention strategies for cCMV infection are needed for women intending to become pregnant, those already pregnant, and healthcare professionals alike. Preconception screening in those attending a fertility clinic, with resultant counseling to improve personal hygiene in those who were not immune to CMV, has shown that hygiene counseling (albeit in this highly selected cohort) is effective in reducing CMV exposure (79). In pregnant women, hygiene counseling of CMVseronegative pregnant women significantly prevents maternal infection (11).…”

Section: What Are the Gaps In Our Understanding?mentioning

confidence: 99%

Congenital Cytomegalovirus Infection: A Narrative Review of the Issues in Screening and Management From a Panel of European Experts

et al. 2020

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Maternal primary and non-primary cytomegalovirus (CMV) infection during pregnancy can result in in utero transmission to the developing fetus. Congenital CMV (cCMV) can result in significant morbidity, mortality or long-term sequelae, including sensorineural hearing loss, the most common sequela. As a leading cause of congenital infections worldwide, cCMV infection meets many of the criteria for screening. However, currently there are no universal programs that offer maternal or neonatal screening to identify infected mothers and infants, no vaccines to prevent infection, and no efficacious and safe therapies available for the treatment of maternal or fetal CMV infection. Data has shown that there are several maternal and neonatal screening strategies, and diagnostic methodologies, that allow the identification of those at risk of developing sequelae and adequately detect cCMV. Nevertheless, many questions remain unanswered in this field. Well-designed clinical trials to address several facets of CMV treatment (in pregnant women, CMV-infected fetuses and both symptomatic and asymptomatic neonates and children) are required. Prevention (vaccines), biology and transmission factors associated with non-primary CMV, and the cost-effectiveness of universal screening, all demand further exploration to fully realize the ultimate goal of preventing cCMV. In the meantime, prevention of primary infection during pregnancy should be championed to all by means of hygiene education.

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“…Ideally, all women should be tested for CMV antibody and informed before pregnancy. Indeed, in a population of women receiving fertility treatment, preconception screening and counseling, seems to have a risk reduced to CMV infection in pregnancy [46]. Moreover, preconception testing would also reduce problems arising from the detection and interpretation of CMV-speci c IgM antibody in pregnant woman [47,48].…”

Section: Discussionmentioning

confidence: 99%

Seroepidemiology Study of Cytomegalovirus and Rubella in Pregnant Women in Luanda, Angola: Geospatial Distribution and its Association with Socio-Demographic and Clinical-Obstetric Determinants

Vueba

Faria

Almendra

et al. 2021

Preprint

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Background: The main objective was to study the seroprevalence of anti-CMV and anti-Rubella antibodies in pregnant women of Luanda (Angola), identify the primary maternal infection during gestation and to evaluate the socio-demographic risk factors associated with CMV and Rubella virus infections. Methods: A prospective cross-sectional study was conducted from August 2016 to May 2017. Blood samples were collected and specific anti-CMV and anti-Rubella antibodies (IgG and IgM) were quantified by electrochemiluminescence (COBAS e411). Demographic and clinical data were collected by standardized questionnaire. Bivariate and multivariate logistic regression analysis was used to quantify the effect of clinical and obstetric risk factors on virus seroprevalence. The level of statistical significance was set as p<0.05, and Odds Ratio (OR) and 95% Confidence Intervals (95% CI) were computed. Results: The 396 pregnant women participated in the study aged from 15 to 47. Of the participants, 382 (96.5%) had anti-CMV IgG antibodies, 8 (2.0%) had anti-CMV IgG and IgM antibodies and 6 (1.5%) were seronegative. For Rubella virus, 347 (87.6%) were positive for anti-IgG, 4 (1.0%) positive for anti-IgG and IgM, and 45 (11.4%) were seronegative. The mean age of CMV positivity was 28.4 (SD ± 6.2) and for Rubella virus was 28.6 (SD ± 6.1). The multivariate logistic regression analysis has shown a significant association between Rubella virus infection and pregnant women without child (OR 2.673; CI: 1.026 - 7.007) and suffering spontaneous abortion (OR 3.232; CI: 1.192 - 7.952). In contrast, the level of schooling, residence, occupation, marital status, number of children in the household, basic sanitation, gestational age, history of miscarriages and hepatitis B were not significantly associated with the Rubella virus infection. Conclusions: Overall, this study showed that there is a high seroprevalence of anti-CMV and anti-Rubella antibodies in pregnant women in Luanda. Therefore, it is important a rapid and accurate diagnosis of CMV and Rubella infection in pregnant women to prevent congenital infections. Rubella vaccination should be offered to women non-immune to Rubella. Overall, it would be important to implement national screening for CMV, Rubella and other diseases linked to maternal and child health.

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Preconception Screening for Cytomegalovirus: An Effective Preventive Approach

Cited by 12 publications

References 17 publications

Prevention of Primary Cytomegalovirus Infection in Pregnancy

Prevention of Primary Cytomegalovirus Infection in Pregnancy

Congenital Cytomegalovirus Infection: A Narrative Review of the Issues in Screening and Management From a Panel of European Experts

Seroepidemiology Study of Cytomegalovirus and Rubella in Pregnant Women in Luanda, Angola: Geospatial Distribution and its Association with Socio-Demographic and Clinical-Obstetric Determinants

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