Abstract
BackgroundCytomegalovirus infection is the most frequent viral congenital infection, with possible consequences such as deafness, or psychomotor retardation. In 2016, the French High Council of Public Health was mandated to update recommendations regarding prevention of cytomegalovirus infection in pregnant women. We summarize a critical appraisal of knowledge and deterministic decision analysis comparing the current no-screening situation to serological screening during pregnancy, and to hygiene promotion.MethodsScreening was defined as systematic serological testing, during the first trimester, with repeated tests as needed, to all pregnant women. Outcomes were: 1) severe sequela: intellectual deficiency with IQ ≤ 50 or hearing impairment < 70 dB or sight impairment (≤ 3/10 at best eye); 2) moderate sequela: any level of intellectual, hearing or sight deficiency; and 3) death or termination of pregnancy. We simulated the one-year course of cytomegalovirus infection in a cohort of 800,000 pregnant women. We developed a deterministic decision model, using best and min-max estimates, extracted from systematic reviews or original studies.ResultsRelevant data were scarce or imprecise. We estimated that 4352 maternal primary infections would result in 1741 foetal infections, and an unknown number of maternal reinfections would result in 1699 foetal infections. There would be 788 cytomegalovirus-related consequences, including 316 foetal deaths or terminations of pregnancy, and 424 moderate and 48 severe sequelae. Screening would result in a 1.66-fold increase of poor outcomes, mostly related to a 2.93-fold increase in deaths and terminations of pregnancy, not compensated by the decrease in severe symptomatic newborns. The promotion of hygiene would result in a 0.75-fold decrease of poor outcomes, related to both a decrease in severe sequelae among symptomatic newborns (RR = 0.75; min-max: 1.00–0.68), and in deaths and terminations of pregnancy (RR = 0.75; min-max: 0.97–0.68).ConclusionsPrevention of cytomegalovirus infection during pregnancy should promote hygiene; serological screening should not be recommended.
Highlights
Cytomegalovirus infection is the most frequent viral congenital infection, with possible consequences such as deafness, or psychomotor retardation
Decision model The Population Intervention Comparisons Outcome (PICO) and decision models were formulated from a public health perspective, to assess whether screening during pregnancy or promotion of hygiene through information campaigns targeting the public and healthcare professionals would decrease the frequency of children infected by cytomegalovirus and having sequelae, decrease the frequency of infected foetuses resulting in termination of pregnancy, and decrease the number of deaths in newborns and toddlers, compared to care usually provided, which does not include screening
Main findings To our knowledge, this is the first attempt to compare promotion of hygiene and systematic serological screening as interventions to deal with cytomegalovirus infection during pregnancy
Summary
Cytomegalovirus infection is the most frequent viral congenital infection, with possible consequences such as deafness, or psychomotor retardation. With a prevalence in live births from 0.6 to 6.1% in lowincome countries [1] and 0.4 to 0.7% in industrialized countries [2], cytomegalovirus infection is the most frequent viral congenital infection worldwide [3]. In a population with 50% seroprevalence, the risk of transmission to the foetus and severity of consequences seem similar after reinfections or reactivations than after primary infections [37,38,39,40,41,42,43], but the frequency of reinfection remains unknown [6, 44,45,46,47]
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