Cytomegalovirus (CMV) infection during pregnancy is a significant concern due to its potential to cause congenital CMV, which can lead to serious neonatal complications such as hearing loss, visual impairment, intellectual disability, and developmental delays. CMV is a common herpesvirus with a high prevalence worldwide, and primary infection during pregnancy poses a high risk of vertical transmission to the new born and severe fetal outcomes. The risk of transmission increases with gestational age, but earlier infections tend to result in more severe fetal disease. Currently, there is no universally approved vaccine for CMV, and diagnosis relies on serologic testing and PCR detection of cytomegalovirus DNA in maternal blood, amniotic fluid, or urine. Pregnant women with suspected primary CMV infection should undergo detailed counseling, and efforts should be made to prevent infection through strict hygiene practices, especially during contact with young children, as they are common reservoirs. In cases where maternal primary infection is confirmed, fetal ultrasound and amniocentesis for PCR testing can help assess fetal involvement. Although there is no specific antiviral treatment approved for fetal CMV infection, some studies suggest that antiviral agents like valganciclovir or ganciclovir may reduce disease severity when used in pregnant women with symptomatic primary infection, especially in the later stages of pregnancy. Prenatal counseling about potential outcomes, close fetal monitoring, and multidisciplinary management are essential to optimize neonatal health. Ultimately, prevention—through education, hygiene measures, and possibly future vaccination—is the best strategy to reduce the burden of congenital CMV.
A recent study published in The American Journal of Obstetrics and Gynecology examined the cost-effectiveness of a universal screening approach for maternal cytomegalovirus in the first trimester of pregnancy followed by valacyclovir treatment in positive cases for prevention of the sequelae of congenital cytomegalovirus.
A decision-analytic model was constructed to compare outcomes of universal screening and subsequent valacyclovir treatment in a theoretical cohort of 2,869,141 individuals, the estimated number of pregnant people in the United States who receive prenatal care by the first trimester. Individuals found to be immunoglobulin G positive, immunoglobulin M positive, and to have low immunoglobulin G avidity were considered to have primary cytomegalovirus infection and received valacyclovir. Outcomes included cases of vertical cytomegalovirus transmission to the newborn, abortions, stillbirths, neonatal deaths, cases of hearing loss, cases of neurodevelopmental disabilities, costs, and quality-adjusted life years.
In This study, universal screening in the first trimester for primary cytomegalovirus and subsequent treatment with valacyclovir in positive cases decreased adverse outcomes by preventing 2,898 vertical transmissions to the child, 94 abortions, 19 stillbirths, 11 neonatal deaths, 460 cases of hearing loss, and 263 cases of neurodevelopmental disability. Universal screening and subsequent treatment, was the dominant strategy as it saved $242.2 million dollars and led to 3,437 additional quality-adjusted life years.
Conclusion
These results demonstrate that screening for first trimester primary cytomegalovirus may be a cost-saving intervention, as identification of cases allows for the provision of treatment, which in turn reduces vertical cytomegalovirus transmission to the child and costly sequelae.
Source
https://www.ajog.org/article/S0002-9378(25)00089-4/fulltextBottom of Form
