CYTOMEGALOVIRUS screening and antenatal valacyclovir therapy elevated considerably in France following publication of a pivotal 2020 randomised managed trial, in line with a nationwide retrospective examine assessing maternal cytomegalovirus an infection throughout being pregnant.
The shift in apply was not accompanied by an increase in termination of being pregnant charges, addressing one of many longstanding issues round broader screening insurance policies.
Cytomegalovirus (CMV) is the main infectious reason for congenital neurosensory impairment. In France, roughly 0.4% of newborns are affected by congenital CMV an infection, which might result in psychomotor delay or sensorineural listening to loss, notably after first-trimester maternal an infection.
Maternal Cytomegalovirus Screening Elevated Nationwide
Utilizing knowledge from the French Nationwide Reference Heart for Herpesviruses database collected between 2017 and 2023, investigators examined 451 pregnancies with documented maternal CMV an infection and identified neonatal an infection standing at delivery, together with 220 pregnancies involving main an infection in the course of the periconceptional interval or first trimester.
The researchers discovered that systematic CMV screening elevated from 22.0% between 2017 and 2020 to 40.0% between 2021 and 2023. Maternal requests for testing additionally rose from 0% to 4.2% throughout the identical intervals.
The rise adopted the publication of a 2020 trial exhibiting that valacyclovir decreased vertical transmission by two-thirds when given throughout first-trimester main an infection. European skilled teams subsequently really helpful valacyclovir for girls contaminated in the course of the periconceptional interval or early being pregnant.
Use of antiviral remedy, predominantly valacyclovir, climbed from 27.7% earlier than 2021 to 59.8% afterwards.
Maternal-fetal transmission occurred in79.3% of pregnancies with early main an infection, though the authors famous that this determine was possible inflated by preferential reporting of extreme or confirmed instances.
Imaging Findings Formed Being pregnant Choices
Amniocentesis was carried out in most pregnancies with first-trimester or periconceptional an infection, whereas fetal mind MRI was reported in 56 instances. MRI abnormalities have been recognized in 41.9% of instances between 2017 and 2020 and in 48.0% between 2021 and 2023, with no important distinction between intervals.
All recorded terminations of being pregnant concerned fetuses with ultrasound or MRI abnormalities. Reported cerebral findings included ventriculomegaly, calcifications, cerebellar hypoplasia, irregular gyration, corpus callosum abnormalities and microcephaly.
The general termination of being pregnant charge in early maternal CMV an infection was 20.7%, however fell considerably after 2020, declining from 25.9% to 13.0%. Girls who didn’t obtain valacyclovir have been extra prone to bear termination than those that acquired therapy.
Questions Stay Round Nationwide Coverage
France didn’t introduce nationwide suggestions for systematic maternal CMV screening till Could 2025, and screening methods proceed to fluctuate throughout Europe. Considerations stay relating to maternal anxiousness, antagonistic results linked to excessive dose valacyclovir, and potential over-intervention.
The findings recommend rising acceptance of CMV serological testing and preventive therapy in routine being pregnant care as therapeutic choices turn into extra evidence-based.
Reference
Coste-Mazeau P et al. Altering traits in prenatal screening and therapy of cytomegalovirus an infection in France: 7-year nationwide cohort examine (2017–2023).
Ultrasound Obstet Gynecol. 2026;DOI:10.1002/uog.70223.
Featured picture: Sergey Novikov on Adobe inventory
