Cytomegalovirus Infection in Pregnancy: A Comparative Review of Guidelines.

IMPORTANCE

Cytomegalovirus (CMV) infection in pregnancy is the most common viral cause of congenital infection and is associated with serious sequelae.

OBJECTIVES

This study aimed to review and compare the recommendations from published guidelines on screening, diagnosis, and management prevention of CMV infection during pregnancy, as well as neonatal management.

EVIDENCE ACQUISITION: A descriptive review of guidelines from the Society for Maternal-Fetal Medicine, the Royal College of Obstetricians & Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, and the European Congenital Infection Initiative (ECCI) on CMV infection in pregnancy was conducted.

RESULTS

There is a consensus on the importance of prevention, whereas all guidelines underline that the severity of fetal infection results mainly from primary maternal infection occurring during the early periconceptional period or first trimester of pregnancy. Controversy exists regarding universal screening for CMV, with the Society for Maternal-Fetal Medicine, the Royal College of Obstetricians & Gynecologists, and the Royal Australian and New Zealand College of Obstetricians and Gynecologists stating against it, the Society of Obstetricians and Gynecologists of Canada recommending testing for CMV early for women at high-risk only in areas where avidity testing is available, and ECCI recommending routine screening up to 16 weeks of pregnancy. Moreover, there is relative consensus on the diagnosis of maternal infection, either with CMV immunoglobulin G seroconversion or with positive immunoglobulin M CMV in combination with low immunoglobulin G avidity, with ECCI recommending only the latter. Moreover, there is a disagreement among the reviewed guidelines on the antenatal management of maternal and fetal infection, whereas ECCI offers the most comprehensive recommendations in neonatal management compared with the other guidelines.

CONCLUSIONS

CMV infection in pregnancy is considered a major contributor to severe neurodevelopmental disability and hearing impairment in infants. Hence, consistent global guidelines should be issued to be integrated into everyday practice to achieve the optimal perinatal outcome.

TARGET AUDIENCE: Obstetricians and gynecologists, family physicians.

CME LEARNING

OBJECTIVES

After participating in this activity, the learner should be better able to discuss hygiene strategies for the prevention of maternal infection from CMV; describe diagnostic methods for maternal CMV infection; and explain the optimal management of pregnant women with CMV infection.