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Screening for cytomegalovirus infection in pregnancy

BMJ 2019; 367 doi: (Published 19 November 2019) Cite this as: BMJ 2019;367:l6507
  1. Mark D Kilby, professor1,
  2. Yves Ville, professor2,
  3. Ganesh Acharya, professor3
  1. 1Fetal Medicine Centre, Birmingham Women’s and Children’s Foundation Trust, University of Birmingham, Birmingham, UK
  2. 2Department of Obstetrics Fetal Imaging and Fetal Medicine, Necker-Enfants-Malades Hospital, University of Paris, Paris, France
  3. 3Division of Obstetrics and Gynaecology, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to: G Acharya ganesh.acharya{at}

In the absence of a vaccine, detecting maternal primary infection is key

Cytomegalovirus (CMV) is the most common cause of congenital infection, affecting 0.5-2% of all live births. Congenital CMV is the main non-genetic cause of congenital neurosensory hearing loss and potentially serious lifelong neurological disability.1 Knowledge, prevention, and treatment of the disease are evolving rapidly, and it may be time to revisit antenatal screening and management.

In Europe, some women acquire CMV for the first time during pregnancy or become reinfected with a different strain. Transplacental transmission occurs in 30% of cases after primary infection and in 2% after non-primary infection. However, the prospective risk of infectionin seronegative pregnant women is four times that of immune women.2 The risk of harm is mainly during the first trimester, when up to one third of neonates will develop sequelae after maternal primary infection.3

Maternal primary infection

Maternal infection is asymptomatic or presents with non-specific, flu-like symptoms, which makes timely diagnosis difficult.1 Serological testing is recommended in symptomatic women or if ultrasonography shows echogenic bowel effusions, cerebral anomalies, or that the fetus is …

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