Is it time for routine prenatal serological screening for congenital cytomegalovirus?

Abstract

Congenital CMV infection (cCMV) is the most prevalent congenital infection, main non-genetic cause of sensorineural hearing loss (SNHL) and major cause of neurological disability. Despite the burden of cCMV, no Public Health body recommends universal serology screening in pregnancy. This was explained by gaps in knowledge of epidemiology, diagnosis, prognosis and the absence of any validated treatment. Over 10 years, progress has been made in our understanding of cCMV following primary maternal infection. Risk factors have been identified and quantified, notably it is now well recognized that among maternal primary infections only those occurring in the first trimester may lead to long-term sequelae. Algorithms combining IgG, IgM, and IgG avidity detection with serological assays adapted on high throughput platforms have demonstrated high sensitivity and specificity to diagnose maternal primary infection. The prognostic value of prenatal imaging combining ultrasound and MRI has been validated by many studies. Finally, recent data from a randomized controlled study demonstrated the efficacy of early antiviral therapy to prevent vertical transmission. Whether CMV serology screening in the first trimester of pregnancy meets the WHO's criteria for a screening program will therefore be reviewed.