Prevention of Primary Cytomegalovirus Infection in Pregnancy

Abstract

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.

Primary Human Cytomegalovirus (HCMV) Infection in Pregnancy

“…The value of HCMV screening as part of the prenatal program has become a subject of worldwide discussion (e20 Especially HCMV-IgG-negative pregnant women benefit from hygiene counseling on how to prevent HCMV-transmission (Box 2); a significant preventative effect of hygiene counseling aimed at HCMV exposure prophylaxis was demonstrated (21,22). In a French hospital, the rate of seroconversion during pregnancy was reduced by half from 0.4% to 0.2% (21).…”

“…The risk of primary infection is particularly high in mothers with HCMV shedding asymptomatic children (seroconversion rate of up to 24% per year [23]). In a current controlled HCMV prevention study conducted in Italy, evaluating hygiene counseling in pregnant women caring for at least one infant/toddler, the French outcomes were exceeded with a seroconversion rate reduction from 7.6% to 1.2% (22). After the introduction of the rubella vaccine for active immunization against the disease, a tremendous reduction in the incidence of congenital rubella syndrome (CRS) was observed (e22).…”

“…The AWMF guidelines recommend that at the time a pregnancy is confirmed the HCMV IgG serostatus should be tested (e11) to enable individual risk assessment and prevention. Counseling of HCMV IgGseronegative pregnant women with regard to preventive hygiene measures makes the most significant contribution to the prevention of mother-to-fetus HCMV transmission (21,22), without the risks associated with drug therapy. Only when a maternal primary HCMV infection is confirmed in the first trimester, a passive off-label immunization with HCMV HIG to prevent HCMV transmission should be taken into consideration in the context of a study.…”

Knowledge of Human Cytomegalovirus Infection and Prevention in Pregnant Women: A Baseline, Operational Survey

“…Indeed, a recent randomized study demonstrated that the aforementioned measures significantly prevented maternal infections and negative consequences for the newborns [6]. …”

Effect of Breastfeeding and Additional Household Children on Cytomegalovirus Seroprevalence among U.S. Children 1 to 5 Years of Age

“…Susceptible pregnant women who have contact with young children are at risk of acquiring a primary CMV infection (8). Strategies that reduce child-to-child CMV transmission, including CMV vaccines, may reduce child-to-mother transmission and thus reduce the burden of congenital CMV infection (9,10).…”