Hygiene Promotion Might Be Better Than Serological Screening to Deal with Cytomegalovirus Infection During Pregnancy: a Methodological Appraisal and Decision Analysis

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2020 Jun 18

PMID 32546244

Citations 7

Authors

Agathe Billette de Villemeur

Pierre Tattevin

Louis-Rachid Salmi

Affiliations

Soon will be listed here.

Abstract

Background: Cytomegalovirus 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.

Methods: Screening 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.

Results: Relevant 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).

Conclusions: Prevention of cytomegalovirus infection during pregnancy should promote hygiene; serological screening should not be recommended.

Citing Articles

Current evidence gaps to support systematic cytomegalovirus screening in pregnancy.

Billette de Villemeur A, Hoen B, Billaud E, Deruelle P, Goueslard K, Halley des Fontaines V EClinicalMedicine. 2024; 78:102941.

PMID: 39640941 PMC: 11617987. DOI: 10.1016/j.eclinm.2024.102941.

Exploring the implementation of an educational film within antenatal care to reduce the risk of cytomegalovirus infection in pregnancy: A qualitative study.

Vandrevala T, Montague A, Boulton R, Coxon K, Jones C BMC Pregnancy Childbirth. 2024; 24(1):524.

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Cytomegalovirus infection during pregnancy: cross-sectional survey of knowledge and prevention practices of healthcare professionals in French-speaking Switzerland.

Sartori P, Baud D, Martinez de Tejada B, Farin A, Rossier M, Rieder W Virol J. 2024; 21(1):45.

PMID: 38383491 PMC: 10882847. DOI: 10.1186/s12985-024-02318-w.

Primary, Secondary, and Tertiary Prevention of Congenital Cytomegalovirus Infection.

Sartori P, Egloff C, Hcini N, Vauloup Fellous C, Perillaud-Dubois C, Picone O Viruses. 2023; 15(4).

PMID: 37112800 PMC: 10146889. DOI: 10.3390/v15040819.

A systematic literature review of the global seroprevalence of cytomegalovirus: possible implications for treatment, screening, and vaccine development.

Fowler K, Mucha J, Neumann M, Lewandowski W, Kaczanowska M, Grys M BMC Public Health. 2022; 22(1):1659.

PMID: 36050659 PMC: 9435408. DOI: 10.1186/s12889-022-13971-7.

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