Prevention of Acquisition of Cytomegalovirus Infection in Pregnancy Through Hygiene-based Behavioral Interventions: A Systematic Review and Gap Analysis

Abstract

BackgroundCongenital cytomegalovirus (cCMV) infection is the most common non-genetic cause of sensorineural hearing loss in childhood and an important cause of neuro-disability.There is no licensed CMV vaccine and no antenatal treatment for congenital CMV that is routinely recommended in clinical practice in the UK. ObjectivesTo review the published literature for studies that evaluated preventative hygienebased interventions in pregnancy for their impact on knowledge about CMV prevention, the uptake of preventative behaviors or the acquisition of CMV in pregnancy. Search StrategySearches were carried out in OVID Medline database and CINAHL. Selection CriteriaAll human studies, limited to women of childbearing age were included. Data Collection and AnalysisTwo reviewers independently assessed the quality of the methods and results of included articles. Extracted data were classified using Cochrane guidelines. Main ResultsSeven studies met the inclusion criteria. These show that preventative measures are acceptable to pregnant women, can impact their behavior, and have the potential to reduce CMV in pregnancy. They are limited by several factors; sample size, nonrandomized trial design and interventions that are beyond routine clinical practice. ConclusionsAn effective intervention that changes behavior in pregnancy and reduces the risk of CMV acquisition is needed as part of routine care. There is currently insufficient evidence about the form that this intervention should take.

Cytomegalovirus Infection in Pregnancy: Prevention, Presentation, Management and Neonatal Outcomes

“…Like most infectious diseases for which there are not yet vaccines, behavioral modifications do not completely eliminate the risk of cCMV. However, there is increasing evidence that antenatal education about cCMV and risk reduction strategies may significantly lower rates of antepartum seroconversion 6 …”

“…A recent expert review published in the American Journal of Obstetrics and Gynecology highlighted cCMV prevention behaviors, specifically that “both parents avoid contact with body fluids from infected individuals, especially toddlers, from before conception until 14 weeks (gestation).” 8 Prenatal cCMV education has been found to be viewed favorably by women 17,18 and has been associated with increased engagement in recommended hygiene practices 19 . Observational controlled studies have found that hygiene counseling of CMV‐seronegative pregnant women significantly decreased risk of both seroconversion and congenital infection 6,17 . Some practitioners may not want to worry their patients by discussing the risks of cCMV, but these risks deserve consideration by expectant individuals.…”

“…Empowerment with knowledge about CMV risk reduction strategies is the only way (short of a vaccine) to mitigate risk. A recent qualitative study of parents of children with cCMV found frequent “frustration about not knowing about CMV infection during their pregnancies and therefore not having the opportunity to take measures to reduce their risk of acquiring CMV while pregnant.” 20 Leading experts in infectious diseases in obstetrics have lent their support to prenatal CMV prevention education, 8,15,21 although further research about the ideal format of such interventions is needed 6 …”

“…This is not only because of its association with hearing loss but also because it is underemphasized in health care education across disciplines and thus is underdiagnosed and undertreated 2 . Evidence supporting the effectiveness of antenatal counseling about behavior changes to reduce the risk of cCMV in pregnancy is mounting 6 . Yet, at present, antenatal education about cCMV risks is not common practice for most United States obstetrician‐gynecologists or midwives 7 .…”

Changing knowledge, attitudes and behaviours towards cytomegalovirus in pregnancy through film-based antenatal education: a feasibility randomised controlled trial of a digital educational intervention

“…Antenatal education about CMV risk reduction may provide a significant opportunity to reduce CMV infection in pregnancy and consequently reduce the incidence of cCMV. In a recent systematic review, seven studies were identified which investigated preventative hygiene-based interventions in pregnancy or in women of child-bearing age [ 9 ]. This concluded that hygiene-based interventions in pregnancy could play a useful role in primary prevention of CMV infection in pregnancy, however the studies were too heterogeneous in terms of study population, intervention and outcome to form firm conclusions on the relative impact of such interventions.…”