Prevention of transmission of cytomegalovirus from mother to fetus during pregnancy

There is insufficient evidence from randomised controlled trials to recommend use of any particular intervention to prevent the transmission of cytomegalovirus (CMV) from mother to fetus during pregnancy (congenital CMV infection). CMV is a herpesvirus and is the most common cause of congenital infection in developed countries. Some 40% of women who acquire the infection during pregnancy transmit the virus to their fetus. The fetus can have serious health problems as a result of this infection, including  growth restriction and the risk of late miscarriage. While 90% of infants with congenital CMV infection display no manifestations at birth, the remaining 10% do have signs and are at risk of life-long neurological consequences, including cognitive and motor deficits, hearing and visual impairments. Maternal education and behavioural modification are used to limit women acquiring CMV in pregnancy (for example by improved hand hygiene). Drug interventions include antiviral treatment, immunoglobulin therapy (for example CMV hyperimmune globulin) and the possibility of anti-CMV vaccination. There is currently no licensed vaccine against CMV. Antiviral therapy, such as ganciclovir, can be given to the newborn infant to prevent or reduce any consequences of congenital infection. Interventions differ in their efficacy, risks to the baby, possible side effects (such as nephrotoxicity, bone marrow suppression, and emergence of resistant CMV strains) and acceptability of use.

The review authors were unable to identify any trials that were eligible for inclusion in the review. There are insufficient data to assess whether any interventions for pregnant women with confirmed primary CMV infection make a difference in the prevention of congenital CMV infection and its sequelae or the occurrence of adverse events as a result of an intervention.


Authors' conclusions: 

To date, no RCTs are available that examine antenatal interventions for preventing the transmission of CMV from the infected mother to fetus during pregnancy and adverse outcomes in the congenitally infected infant. Further research is needed to assess the efficacy of interventions aimed at preventing the transmission of CMV from the mother to fetus during pregnancy including a long-term follow-up of exposed infants and a cost effective analysis.

Read the full abstract...
Background: 

Cytomegalovirus (CMV) is a herpesvirus and the most common cause of congenital infection in developed countries. Congenital CMV infection can have devastating consequences to the fetus. The high incidence and the serious morbidity associated with congenital CMV infection emphasise the need for effective interventions to prevent the antenatal transmission of CMV infection.

Objectives: 

The aim of this review was to assess the benefits and harms of interventions used during pregnancy to prevent mother to fetus transmission of CMV infection.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010).

Selection criteria: 

All randomised controlled trials (RCTs) and quasi RCTs investigating antenatal interventions for preventing the transmission of CMV from the mother to fetus during pregnancy and adverse outcomes in the congenitally infected infant.

Data collection and analysis: 

Two review authors independently assessed studies for inclusion.

Main results: 

We identified six studies from the search. None of these studies met the pre-defined criteria for inclusion in this review.

Share/Save