We published a systematic review on this topic before the meeting, which informed the consensus discussions at the April 2015 conference. Additionally, before this conference, additional relevant scientific literature was identified through searches of MEDLINE, Embase and ClinicalTrials.gov for articles published from Jan 1, 1968 to Feb 28, 2015, and updated after the meeting to Oct 31, 2016. Search terms included “congenital cytomegalovirus” and “treatment”, “screening”, “therapeutic”,
ReviewCongenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy
Introduction
Many adverse fetal and neonatal outcomes have been prevented since the introduction of maternal screening for infectious diseases during pregnancy, and since the institution of routine rubella vaccination of women of reproductive age. In stark contrast, congenital cytomegalovirus infection remains largely unrecognised in the developed and developing world.1 This is despite congenital cytomegalovirus now being the major infectious cause of sensorineural hearing loss and neurodevelopmental abnormalities in infants born in developed countries,2 and second only to cerebral palsy in all causes of serious malformation in many parts of the world. The prevalence of congenital cytomegalovirus has been reported as 0·2% to 2·0% (average of 0·64%) of pregnancies.3 Many factors contribute to congenital cytomegalovirus mortality and morbidity, including the limited awareness of clinicians and parents about infection during pregnancy, low levels of routine testing of neonates at risk, the absence of maternal or neonatal screening programmes, the limited efficacy and toxicity of current treatments, and the absence of licensed vaccines. In part, because of these limitations, congenital cytomegalovirus and preventive measures for acquiring cytomegalovirus during pregnancy are not routinely or consistently discussed with pregnant women or women attempting conception. However, with evidence for efficacy of preventive actions,4 efficacy of early intervention for children with sensorineural hearing loss,5 evolving antiviral treatments, and recent availability of candidate vaccines for pregnant women and neonates,6 there is an emerging consensus that more attention must be directed to this infection by clinicians3, 7 researchers, and communities. In some states of the USA, legislation requires cytomegalovirus education as part of routine antenatal care.8, 9, 10
To assist with clinical care, an informal International Congenital Cytomegalovirus Recommendations Group was convened as part of the 5th International Congenital Cytomegalovirus conference on April 19, 2015, to review and grade available evidence, and to draft recommendations that could be used to guide congenital cytomegalovirus diagnosis, prevention, and therapy. The International Congenital Cytomegalovirus Recommendations Group addressed whether pregnant women should be screened to aid diagnosis of maternal cytomegalovirus infection, and also addressed methods for diagnosis of maternal or fetal cytomegalovirus infection. Suggestions about who should be educated about congenital cytomegalovirus infections, and preventive measures for maternal cytomegalovirus infection, were considered. Whether cytomegalovirus hyperimmunoglobulin or antiviral therapy could be used routinely to prevent or treat congenital cytomegalovirus infection during pregnancy was discussed. Neonatal screening and the important questions of whether to treat infected neonates, and what form this therapy should consist of, were also addressed.
Section snippets
Methods to provide global recommendations on cytomegalovirus prevention, diagnosis, and treatment
Expert clinicians, opinion leaders for congenital cytomegalovirus, researchers with expertise in congenital cytomegalovirus infection, and representatives of the congenital cytomegalovirus community from Europe, the USA, and Australia were identified and invited to a workshop, organised as part of the 5th International Congenital Cytomegalovirus Conference in Brisbane, Australia (April 19, 2015). Identification of relevant participants was on the basis of publication track records about
Screening for maternal cytomegalovirus infection
Universal cytomegalovirus screening of pregnant women is not recommended by national public health bodies in any country. However, selective testing of pregnant women is done as part of population-based studies, and by some clinicians independently of formal screening programmes in parts of Europe, Israel, Australia, and the USA.15, 16, 17
One proposed approach to reducing the incidence of congenital cytomegalovirus infection is universal cytomegalovirus screening of pregnant women to assist
Conclusions
This Review summarises current data on the efficacy of prevention, the significant improvements in diagnostic capacity globally (particularly in molecular detection and characterisation of infection), and data showing utility of antiviral therapy in some infected neonates. These, and other published data, can now be used to inform jurisdictional policy, and practice, in reducing the global impact of congenital cytomegalovirus.
Search strategy and selection criteria
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