(Revello et al 2015) Cohort III-2 331 Aim: to investigate the effectiveness of hygiene information in reducing risk of CMV infection. Population: Pregnant women at risk of primary CMV infection for personal/occupational reasons. Methods: A mixed interventional and observational controlled study was conducted. In the intervention arm, CMV-seronegative women, identified at the time of maternal serum screening for fetal aneuploidy at 11-12 weeks of gestation, were given hygiene information and prospectively tested for CMV until birth. The comparison arm consisted of women enrolled at delivery who were neither tested for nor informed about CMV during pregnancy, and who had a serum sample stored at the screening for fetal aneuploidy. By design, groups were homogeneous for age, parity, education, and exposure to at least one risk factor. The primary outcome was CMV seroconversion. Acceptance of hygiene recommendations was a secondary objective and was measured by a self-report. Four out of 331 (1.2%) women seroconverted in the intervention group compared to 24/315 (7.6%) in the comparison group (delta=6.4%; 95%CI 3.2 to 9.6; P<0.001). There were three newborns with congenital infection in the intervention group and 8 in the comparison group (1 with cerebral ultrasound abnormalities at birth). Ninety-three percent of women felt hygiene recommendations were worth suggesting to all pregnant women at risk for infection. This controlled study provides evidence that an intervention based on the identification and hygiene counselling of CMV-seronegative pregnant women significantly prevents maternal infection.
(Pereboom et al 2013) IV 1,097 Aim: to assess knowledge and risk behaviour related to toxoplasmosis, listeriosis and CMV infection prevention in pregnant women. Population: Pregnant women. Methods: Women from twenty midwifery practices across the Netherlands participated in the DELIVER study, between October 2010 and December 2010. The questionnaire items covered respondents' knowledge of preventive practices in general, risk behaviour, and sources of received information. Among respondents (response 66.0%), 12.5% had heard, read or seen information about CMV. The majority reported having heard about these infections from their care providers or read about these in printed media or on the Internet. Respondents showed limited knowledge about preventive practices for CMV infection. Regarding CMV infections, risk behaviour was less prevalent among respondents who were in their third trimester of pregnancy. (Shand et al 2018) IV 774 Aim: To assess the knowledge, practice and attitudes of maternity clinicians regarding congenital cytomegalovirus (CMV). It is the most common congenital infection, and cause of neurodevelopmental disability and hearing loss. New consensus recommendations state all pregnant women and health-care providers should be educated about congenital CMV infection and preventive measures. Methods: An questionnaire was distributed in October 2015 to specialists (37.3%), general practitioners (17.3%), and trainees of the Royal Australian New Zealand College of Obstetricians and Gynaecologists (16.8%), and Victorian and New South Wales midwives (28.6%). Overall, 30.2% felt confident discussing CMV in pregnancy: less than 10% of midwives (7.4%) and less than half of specialists (47.1%, p < .0001). Only 8.8% of respondents routinely discussed CMV prevention with pregnant women. The majority (69.3%) responded that professional societies should make practice recommendations, and 88% thought more patient information was needed, preferably leaflets. Evidence table: Hyperimmunoglobulin Study ref Design LoE N Aim/population/methods Results Comments
(Rawlinson et al 2017) Consensus — — — Cytomegalovirus hyperimmunoglobulin should not be routinely administered to pregnant women with primary cytomegalovirus infection to prevent fetal cytomegalovirus infection. Cytomegalovirus hyperimmunoglobulin treatment should not be routinely administered for fetal cytomegalovirus infection. Consensus recommendation (Hamilton et al 2014) SLR IV 4 6 Aim: To identify evidence-based interventions for prevention of congenital CMV at the primary level (prevention of maternal infection), secondary level (risk reduction of fetal infection and disease) and tertiary level (risk reduction of infected neonates being affected by CMV). Treatment of maternal CMV infection with hyperimmune globulin (HIG) showed some evidence for efficacy in prevention of fetal infection and fetal/neonatal morbidity with a reasonable safety profile. However, more robust clinical evidence is required before HIG therapy can be routinely recommended. Included (Revello et al 2014) and (Nigro et al 2015) (Revello et al 2014) RCT II 123 Aim: To evaluate the efficacy of CMV-specific hyperimmune globulin in reducing intrauterine transmission. Population: Pregnant women with primary CMV infection at 5 to 26 weeks of gestation. Methods: Women were randomly assigned within 6 weeks after the presumed onset of infection to receive hyperimmune globulin or placebo every 4 weeks until 36 weeks of gestation or until detection of CMV in amniotic fluid. The primary endpoint was congenital infection diagnosed at birth or by means of amniocentesis. The rate of congenital infection was 30% in the hyperimmune globulin and 44% in the placebo group (a difference of 14 percentage points; 95%CI -3 to 31; P=0.13). The clinical outcome of congenital infection at birth was similar in the two groups. The number of obstetrical adverse events was higher in the hyperimmune globulin group than in the placebo group (13% vs. 2%).