title: Cytomegalovirus in pregnancy: to screen or not to screen.
abstract: BACKGROUND
  Cytomegalovirus (CMV) infection is now the commonest congenital form of infective neurological handicap, recognized by the Institute of Medicine as the leading priority for the developed world in congenital infection. In the absence of an effective vaccine, universal screening for CMV in pregnancy has been proposed, in order that primary infection could be diagnosed and- potentially- the burden of disability due to congenital CMV prevented.
  
  
  CONCLUSIONS
  Universal screening for CMV to identify seronegative women at the beginning of pregnancy could potentially reduce the burden of congenital CMV in one of three ways. The risk of acquiring the infection during pregnancy has been shown to be reduced by institution of simple hygiene measures (primary prevention). Among women who seroconvert during pregnancy, CMV hyperimmune globulin (CMV HIG) shows promise in reducing the risk of perinatal transmission (secondary prevention), and CMV HIG and/ or antivirals may be effective in reducing the risk of clinical sequelae among those known to be infected (tertiary prevention). The reports from these studies have re-ignited interest in universal screening for CMV, but against the potential benefit of these exciting therapies needs to be weighed the challenges associated with the implementation of any universal screening in pregnancy. These include; the optimal test, and timing of screening, to maximize detection; an approach to the management of equivocal results, and the cost effectiveness of the proposed screening program. In this article, we provide an overview of current knowledge and ongoing trials in the prevention, diagnosis and management of congenital CMV. Recognising that CMV screening is already being offered to many patients on an ad hoc basis, we also provide a management algorithm to guide clinicians and assist in counseling patients.
  
  
  CONCLUSIONS
  We suggest that- on the basis of current data- the criteria necessary to recommend universal screening for CMV are not yet met, but this position is likely to change if trials currently underway confirm that CMV HIG and/ or antivirals are effective in reducing the burden of congenital CMV disease.
authors.affiliation: Department of Perinatal Medicine, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC 3084, Australia. spwalker@unimelb.edu.au
authors.forename: Susan P
authors.initials: SP
authors.lastname: Walker
authors.forename: Ricardo
authors.initials: R
authors.lastname: Palma-Dias
authors.forename: Erica M
authors.initials: EM
authors.lastname: Wood
authors.forename: Paul
authors.initials: P
authors.lastname: Shekleton
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Giles
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000635:transmission*; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008403:Mass Screening; D009422:Nervous System Diseases / Q000151:congenital / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000821:virology; D011296:Prenatal Diagnosis; D011322:Primary Prevention; D055502:Secondary Prevention; D055512:Tertiary Prevention
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins