Does hygiene counseling have an impact on the rate of CMV primary infection during pregnancy?: Results of a 3-year prospective study in a French hospital
Section snippets
Background
Cytomegalovirus (CMV) is the most frequent cause of congenital viral infection, with an incidence of 0.5–1.0% of all live births in developed countries, and is the leading infectious cause of hearing loss and developmental delay.1, 2 It is estimated that 5–10% of infected newborns are symptomatic at birth, and that among asymptomatic newborns 10–15% will eventually show some developmental disorder(s), mainly sensorineural hearing loss.1 Although primary maternal infection seems to carry a
Objectives
Vaccines are currently under development, and antiviral treatment (using valaciclovir) or passive immunization (using CMV hyperimmune globulin) for pregnant women with primary CMV infection are about to be evaluated in randomized trials.16, 17, 18 However, the modes of CMV transmission to pregnant women are well known, and preventing transmission through behavioral changes could be, at the moment, the most effective and inexpensive way to decrease the risk of CMV infection during pregnancy.
Study design
In our obstetric department, the medical staff are accustomed to informing patients about CMV infection, and screening has been offered for many years. The analysis of this epidemiological cohort was undertaken in order to evaluate the impact of our counseling program. Medical data were stored anonymously and protected according to the recommendations of the CNIL (Commission Nationale Informatique et Liberté, authorization numbers 1181076 and 444971).
We retrospectively analyzed the data of all
Results
Among the 5312 women followed in our obstetric department who had an unknown immune status, or were known to be seronegative when they had their first visit to our center for their current pregnancy, 5173 (97.4%) agreed to undergo screening (Fig. 1). Out of the 5173 women tested, 2590 were CMV-G positive (50.1%) and 2583 CMV-G negative (49.9%). We did not observe any major adverse effect of the screening/counseling program, such as alarm or early termination of pregnancy, for any of these women.
Discussion
All the pregnant women in our cohort were informed about CMV infection and given hygiene information. A randomized trial would not have been ethically acceptable, as current evidence already points towards the probability that behavioral intervention has a benefit, and also considering French recommendations.10, 19, 20, 21 During the first 12 WG, before the first visit to our obstetric department, and before hygiene counseling, confirmed primary infection had occurred in 11 women. During the
Conflict of interest
The authors declare no conflicts of interest.
Acknowledgments
The authors acknowledge Dr. Richard Keros for the revision of the English.
Ethical approval: The study was approved by the ethics committee (Comité de Protection des Personnes, Ile de France; International Review Board Approval CEROG-2008-011).
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These authors contributed equally to this work.