Primary prevention of cytomegalovirus in pregnancy: addressing the gaps

Ten children are born every day with congenital cytomegalovirus (CMV) infection.

CMV is the most common congenital infection in the UK and the leading non-genetic cause of sensorineural hearing loss and a common cause of neurodisability.

Acquisition of CMV infection in the first trimester of pregnancy is associated with the highest risk of adverse outcomes for the infant.

However, the risk of acquiring CMV in pregnancy can be reduced by making simple adaptions to behaviours to avoid direct contact with saliva and urine of young children - who are the most common transmitters of CMV infection to pregnant women.

There are currently no national policies that recommend CMV risk reduction measures in pregnancy and most women are not routinely told about CMV as part of routine antenatal care.

Our NIHR-funded study – Reducing acquisition of CMV in pregnancy (RACE-FIT) – has shown that pregnant women are highly motivated and willing to engage in CMV risk reduction measures and express disappointment and anger that they are not told about CMV in pregnancy. We have developed an educational film to inform and empower women to make in behavioural adaptions.

We are currently testing this educational film in a feasibility study. Preliminary feedback indicates it is highly acceptable to women and increases engagement with CMV.

Now is the time to work with policy makers and other key stakeholders to identify gaps which need to be addressed in future trials, and actions that need to be taken, in order to update antenatal policies to integrate CMV risk reduction measures into routine antenatal care.

The aim of the project is to establish and build effective partnerships with policy makers and stakeholders to identify policy priorities and gather evidence needed to inform policies to reduce the risk of CMV infection in pregnancy.

We will do this by engaging with policy makers and key stakeholders in a Policy Roundtable meeting, with a subsequent Delphi consensus process, to agree on gaps and actions that need to be taken to ensure our future research is optimally designed to address the policy gaps identified. We will carry out a CMV serosurvey using stored antenatal serum from pregnant women across England.

This will enable us to determine the proportion of women who are seronegative, as this is the group that will be enrolled in future intervention studies (both educational and also vaccine studies). This information is required to accurately inform the power calculation for large efficacy studies.

This will also allow us to determine the proportion of women who acquire CMV in the first trimester of pregnancy – thus demonstrating the consequences of policy inaction.

Our third workstream is to evaluate the ways of implementing, sustaining or enhancing CMV educational intervention in real-world routine antenatal care settings and to explore the feasibility of conducting a future large implementation study.

Now is the time to engage with policy makers to ensure that women have the advice they need to protect them and their unborn children from CMV infection.