Management of Cytomegalovirus Seroconversion during Pregnancy in France

Abstract

Introduction: Guidelines for the management of cytomegalovirus (CMV) infection of the fetus are rare. Our main objective was to evaluate how health care practitioners in France manage cases of CMV seroconversion during pregnancy. Material and Methods: A questionnaire was e-mailed to health care practitioners potentially concerned by CMV seroconversion during pregnancy. They were asked if they would recommend amniocentesis, fetal cerebral MRI examination and fetal blood analysis (FBA), depending on the ultrasound results. They then had to indicate whether they would accept termination of pregnancy (TOP), depending on the results of these examinations. Results: A total of 380 health care practitioners responded, mainly obstetricians (73.9%) and midwives (20.2%). Overall, 57% of respondents recommended amniocentesis in the case of CMV seroconversion during the first trimester of pregnancy, ultrasound findings being normal. In cases of positive amniocentesis and a major ultrasound abnormality, 84.5% of respondents would perform cerebral MRI, and 44.4% would perform FBA. In this case, the rate of acceptance of TOP was not significantly different whether the examinations were normal (337/372, 90.6%) or not performed (339/374, 93.3%; p = 0.17). Discussion: Amniocentesis is too infrequently used and should be encouraged. The results of MRI and FBA are often not taken into account in the final decision concerning TOP. Guidelines are needed to clarify the management of CMV seroconversion during pregnancy.

Current practices of management of maternal and congenital Cytomegalovirus infection during pregnancy after a maternal primary infection occurring in first trimester of pregnancy: Systematic review

“…Our results are globally comparable with previously published studies about management process of pregnant women with CMV, including practice surveys [56] and literature reviews [57][58][59][60]. While amniocentesis and US examination are widely performed, approaches to FBS, MRI, and therapies are more diverse.…”

“…One common limitation in systematic review is the potential presence of publication bias which could in our case overestimate these interventions compared to real life practices. In 2016, Carrara et al [56] published management practices after CMV PI in pregnant women in France, from a survey of gynecologists' practices. Amniocentesis was performed in only 57% to 62% of cases after a PI in the first trimester of pregnancy without US abnormalities, compared to 91% in our study.…”

“…This high proportion of TOP without abnormal imaging is of ethical concern. According to Carrara et al [56], TOP was unacceptable for 94% of practitioners in case of normal US and unacceptable for 78% in case of minor US abnormalities. However, TOP was acceptable for 90% of them in case of major US abnormalities and normal MRI.…”

Perinatal Outcomes of Non-Primary Maternal Cytomegalovirus Infection: A 15-Year Experience

“…Moreover, based on our experience, routine screening can lead to unnecessary intervention, including unnecessary abortions [14]. On the contrary, in case of abnormal ultrasound suggestive of CMV, we believe that it could be useful to investigate the serological status of the mother, as recently proposed for primary infection in a review about the management of CMV seroconversion during pregnancy in France [25]. Non-primary maternal CMV infection can in fact be diagnosed during pregnancy, as detailed above.…”

Hygiene promotion might be better than serological screening to deal with Cytomegalovirus infection during pregnancy: a methodological appraisal and decision analysis

“…In the absence of a vaccine against cytomegalovirus [6,14], some authors have suggested that screening during pregnancy or at birth could be good options to decrease the frequency of poor outcomes [15][16][17], but the possible benefits of screening has been debated [6,15,[18][19][20][21][22][23][24][25][26][27][28][29]. Diagnosis of a primary infection relies on the appearance of IgG, or a significant increase in IgG or presence of IgM; a test of IgG avidity can confirm the date of infection, with an uncertainty of 3 months [30][31][32][33].…”