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

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Abstract

Background

Cytomegalovirus (CMV) is the most frequent cause of congenital viral infection in developed countries.

Objectives

The objective of this study was to evaluate the impact of our prenatal CMV infection screening and counseling policy.

Study design

Since 2005, all pregnant women in our obstetric center have been informed about CMV infection, and if they agree, given a serological test at around 12 weeks of gestation (WG). If this first test is negative, the women and their partners are given hygiene counseling on how to prevent CMV infection, and a second test is performed at around 36 WG.

Results

Among the 5312 women 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, 97.4% agreed to CMV screening. Primary infection was detected in 11 women between 0 and 12 WG (0.42%), and seroconversion was diagnosed in five women between 12 and 36 WG (0.19%).

Conclusions

These results suggest that if clear information is given on CMV infection during pregnancy, the rate of seroconversion is lower following counseling than before counseling.

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).

References (30)

  • B. Gratacap-Cavallier et al.

    Cytomegalovirus seroprevalence in French pregnant women: parity and place of birth as major predictive factors

    Eur J Epidemiol

    (1998)
  • Évaluation de l’intérêt du dépistage de l’infection à cytomégalovirus chez la femme enceinte en France. Saint-Denis La...
  • J. Jeon et al.

    Knowledge and awareness of congenital cytomegalovirus among women

    Infect Dis Obstet Gynecol

    (2006)
  • D.S. Ross et al.

    Women's knowledge of congenital cytomegalovirus: results from the 2005 HealthStyles survey

    J Womens Health

    (2008)
  • Knowledge and practices of obstetricians and gynecologists regarding cytomegalovirus infection during pregnancy—United...
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    These authors contributed equally to this work.

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