Comments regarding "Current evidence gaps to support systematic cytomegalovirus screening in pregnancy".

Current evidence gaps to support systematic cytomegalovirus screening in pregnancy

Authors' reply: comments regarding "Current evidence gaps to support systematic cytomegalovirus screening in pregnancy".

To determine the risk of congenital toxoplasmosis (CT) and provide early (pre- or postnatal) identification of cases of CT in the absence of systematic screening in pregnancy.In the presented cross-sectional study, serological criteria were used to date Toxoplasma gondii infection versus conception in 80 pregnant women with fetal abnormalities or referred to as suspected of acute infection, and in 16 women after delivery of symptomatic neonates. A combination of serological, molecular (qPCR), and biological (bioassay) methods was used for prenatal and/or postnatal diagnosis of CT.Most (77.5%) pregnant women were examined in advanced pregnancy. Of all the examined seropositive women (n = 90), infection could not be ruled out to have occurred during pregnancy in 93.3%, of which the majority (69%) was dated to the periconceptual period. CT was diagnosed in 25 cases, of which 17 prenatally and 8 postnatally. Molecular diagnosis proved superior, but the diagnosis of CT based on bioassay in 7 instances and by Western blot in 2 neonates shows that other methods remain indispensable.In the absence of systematic screening in pregnancy, maternal infection is often diagnosed late, or even only when fetal/neonatal infection is suspected. In such situations, use of a complex algorithm involving a combination of serological, biological, and molecular methods allows for prenatal and/or early postnatal diagnosis of CT, but lacks the preventive capacity provided by early maternal treatment.

Ultrasound screening and perinatal mortality: Controlled trial of systematic one-stage screening in pregnancy

Background C hlamydia trachomatis (CT) is the commonest STI in the UK with high prevalence in pregnancy. CT testing is not routinely recommended for pregnant women in the UK despite adverse effects on pregnancy, neonate and mother. Countries with recommended CT screening in pregnancy have good results despite suboptimal uptake. Aim(s) To determine the prevalence of CT and treatment uptake in pregnant and non-pregnant women who have attended a large, busy urban integrated sexual health service. Methods Retrospective observational cohort study of all patient encounters with women of child bearing age (15 to 49) between 2012 and 2015 who were tested for CT. Women with a positive pregnancy and STI testing 2 weeks prior and 9 months post STI test were included (n = 837). Women with terminations were excluded. Socio-demographic factors and clinical factors were compared to 20,629 women who had a CT test but no pregnancy. Results Pregnant women were on average younger (25 vs 28) and had higher CT prevalence across all age groups (12 vs 5%), peaking between 15 and 25 years (21 vs 10%). Being pregnant doubled the odds of having CT after controlling for age (adjusted OR 1.96; CI 1.64–2.30). Discussion The national opportunistic screening programme is deemed to cover CT detection in an age group where both STIs and pregnancy rates are high. However, the results of our study support additional targeted CT screening during pregnancy, particularly in the youngest age group.

Congenital cytomegalovirus (cCMV) is the most common congenital infection worldwide. cCMV can lead to severe long-term sequelae, including neurological impairment and developmental delay. We performed a systematic review of clinical practice guidelines containing recommendations concerning serological screening for CMV during pregnancy. We performed a search of MEDLINE, Turning Research into Practice (TRIP) database and the grey literature for clinical practice guidelines or consensus statements published in the English language from Jan 2010 to June 2022. The quality of the included guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Textual synthesis was used to summarise and compare the recommendations on CMV serological screening in pregnancy. Eleven guidelines and two consensus statements were included. None recommended universal serological screening for CMV in pregnant women; five recommended screening for high-risk women (those with frequent contact with young children). The overall quality of the guidelines varied; most were medium or low. Although clinical practice guidelines do not actively recommend routine serological screening in pregnancy, most did not meet standard processes for development and predated the emerging data on valaciclovir as a potential intervention. Existing recommendations are underpinned by limited, low-level evidence, exposing the lack of robust data in this area of practice. Further high-level evidence and methodologically robust guidelines are needed to guide clinical practice in this rapidly changing field.

Is it time to adopt routine cytomegalovirus screening in pregnancy? No!

Ultrasound screening and perinatal mortality: controlled trial of systematic one-stage screening in pregnancy

IMPLICATIONS OF PRENATAL ULTRASOUND SCREENING IN THE INCIDENCE OF MAJOR GENITOURINARY MALFORMATIONS

BackgroundWhile the US Preventive Services Task Force recommends prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum, the Canadian pediatric society no longer recommends its use. Systematic...

To evaluate the performance of different commercial assays for the detection of recent cytomegalovirus (CMV) in pregnancy, the sensitivity and specificity of assays for CMV-specific IgM antibodies were compared. Routine specimens from pregnant women were screened for CMV IgM using the Abbott AxSYM assay. Sera that were reactive according to AxSYM were further tested for IgM by other commercial assays. In selected IgM positive samples a CMV IgG avidity assay (Radim) and virus isolation from urine (shell vial) were also performed. The positivity rate for IgM anti-CMV by AxSYM was relatively high (140 out of 492, combining reactive and grayzone results). Only 26 of the 140 samples were positive for IgM according to Radim. The IgG avidity was low in 16 of the 43 samples tested, and the Radim and DiaSorin IgM assays were negative in 5 of them; 2 of the latter cases were also positive for viral isolation according to a shell vial method. There are differences in the sensitivity of the commercially available tests for CMV antibodies. CMV screening in pregnancy is performed as a first step by immunoassays and the choice of highly sensitive IgM test associated with further serological and virological methods could help to identify early primary infections.

BackgroundCytomegalovirus (CMV) infection is now the commonest congenital form of infective neurological handicap, recognized by the Institute of Medicine as the leading priority for the developed world in congenital infection. In the absence of an effective vaccine, universal screening for CMV in pregnancy has been proposed, in order that primary infection could be diagnosed and- potentially- the burden of disability due to congenital CMV prevented.DiscussionUniversal screening for CMV to identify seronegative women at the beginning of pregnancy could potentially reduce the burden of congenital CMV in one of three ways. The risk of acquiring the infection during pregnancy has been shown to be reduced by institution of simple hygiene measures (primary prevention). Among women who seroconvert during pregnancy, CMV hyperimmune globulin (CMV HIG) shows promise in reducing the risk of perinatal transmission (secondary prevention), and CMV HIG and/ or antivirals may be effective in reducing the risk of clinical sequelae among those known to be infected (tertiary prevention). The reports from these studies have re-ignited interest in universal screening for CMV, but against the potential benefit of these exciting therapies needs to be weighed the challenges associated with the implementation of any universal screening in pregnancy. These include; the optimal test, and timing of screening, to maximize detection; an approach to the management of equivocal results, and the cost effectiveness of the proposed screening program. In this article, we provide an overview of current knowledge and ongoing trials in the prevention, diagnosis and management of congenital CMV. Recognising that CMV screening is already being offered to many patients on an ad hoc basis, we also provide a management algorithm to guide clinicians and assist in counseling patients.SummaryWe suggest that- on the basis of current data- the criteria necessary to recommend universal screening for CMV are not yet met, but this position is likely to change if trials currently underway confirm that CMV HIG and/ or antivirals are effective in reducing the burden of congenital CMV disease.

To evaluate the clinical and economic impact of universal screening for cytomegalovirus (CMV) in pregnant women in Italy, with valacyclovir (VCV) therapy in the case of maternal primary CMV infection, compared with no screening. We developed a decision-analytic model using a deterministic decision tree and compared the no-screening strategy (Scenario 1) with universal screening until 13 + 6 weeks' gestation (Scenario 2), and universal screening until 23 + 6 weeks' gestation (Scenario 3) as recommended by the Italian National Health Service. The model was applied in a hypothetical population of 400 000 pregnant women, representative of the annual number of women giving birth in Italy. Only women susceptible to primary CMV infection were considered, in whom CMV screening by serological testing (IgG/IgM testing ± IgG avidity), followed by VCV treatment (8 g/day) in the case of primary CMV infection, is recommended. Outcomes included the numbers of primary maternal CMV infections diagnosed, fetal congenital CMV (cCMV) infections, terminations of pregnancy (TOPs) and symptomatic and asymptomatic neonatal cCMV infections, and the cost per symptomatic cCMV caseavoided (in Euros (€)) from the perspective of the Italian National Health Service. Universal screening until 13 + 6 weeks' gestation would identify 910 maternal primary CMV infections. Compared with no screening, it would prevent 92% of symptomatic cCMV infections (183 vs 15 cases) and prevent 70% of TOPs (33 vs 10 cases). Extending the universal screening period to 23 + 6 weeks' gestation would result in 280 additional diagnoses of maternal primary CMV infection and a further 2% and 9% reduction in symptomatic cCMV infections and TOPs, respectively. Both screening strategies would increase costs by approximately €7 million compared with Scenario 1, with a cost per symptomatic cCMV case avoided of ~ €45 500 for Scenario 2 and ~ €44 400 for Scenario 3. Universal serological CMV screening in pregnancy until 24 weeks' gestation, with VCV treatment in the case of maternal primary infection, substantially reduces the burden of cCMV-related disabilities and appears economically justifiable in the Italian healthcare context. These findings may inform policy decisions in countries with a similar CMV seroprevalence and National Health Service. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Cytomegalovirus (CMV) is the most common cause of viral intrauterine infection, affecting 0.5–1.5% of all neonates in different parts of the world. The birth prevalence of neonatal infection correlates with maternal seroprevalence, ranging from 0.4 to 1% in countries with lower and higher seroprevalence, respectively. The risk of congenital CMV disease at birth is mainly associated with maternal primary infection, but the presence of maternal antibodies before conception does not prevent transmission in all cases, even if it is protective in most cases. Nonprimary or recurrent infections can occur with immunosuppression and during pregnancy. Recurrent infections during pregnancy are most often asymptomatic and primarily caused by the reactivation of the endogenous virus, but can also be caused by a low-grade chronic infection or reinfection by a different strain of CMV. CMV screening in pregnancy is not routinely recommended in many countries, even in women who are seronegative, mainly given the lack of proven intervention if seroconversion is detected.

To determine threshold cytomegalovirus (CMV) infectious rates and treatment effectiveness to make universal prenatal CMV screening cost-effective. Decision analysis comparing cost-effectiveness of two strategies for the prevention and treatment of congenital CMV: universal prenatal serum screening and routine, risk-based screening. The base case assumptions were a probability of primary CMV of 1% in seronegative women, hyperimmune globulin (HIG) effectiveness of 0%, and behavioral intervention effectiveness of 85%. Screen-positive women received monthly HIG and screen-negative women received behavioral counseling to decrease CMV seroconversion. The primary outcome was the cost per maternal quality-adjusted life year (QALY) gained with a willingness to pay of $100,000 per QALY. In the base case, universal screening is cost-effective, costing $84,773 per maternal QALY gained. In sensitivity analyses, universal screening is cost-effective only at a primary CMV incidence of more than 0.89% and behavioral intervention effectiveness of more than 75%. If HIG is 30% effective, primary CMV incidence can be 0.82% for universal screening to be cost-effective. The cost-effectiveness of universal maternal screening for CMV is highly dependent on the incidence of primary CMV in pregnancy. If efficacious, HIG and behavioral counseling allow universal screening to be cost-effective at lower primary CMV rates.