title: Antepartum Screening for Maternal Infection and Immune Status: Is it Time to Broaden Our Routine?
abstract: Maternal infections with PVB19, HCV, CMV, and HIV during the antepartum period are important health problems for which the technological capacities for screening and diagnosis during the antepartum period are available. Each of these viruses requires individual consideration for inclusion in screening and for the method of screening during the antepartum period. The availability of efficacious treatments for HCV and CMV, with demonstrable benefits to the mother or fetus, is required before antepartum screening for these infections can be justified. Screening for parvovirus B19 presents a greater concern because it meets most of the features of a screening test (Wilson’s criteria) endorsed by the WHO. There is insufficient evidence to argue strongly for implementation of antepartum PVB19 screening, but the available evidence indicates a need for large studies of potential effectiveness and costs of routine PVB19 screening, either for all pregnant woman or for those at high risk of exposure to PVB19. While the technology to screen for HCV, PVB19, and CMV certainly exists, there must be careful consideration of the downstream implications of routine screening at the level of the individual patient, the general population, and other health care resources, including laboratory infrastructure, before recommending that these infections be screened for routinely in the antepartum period. A strategy for national adoption of an opt-out screening strategy for HIV should be considered.
authors.affiliation: Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg MB.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Poliquin
authors.affiliation: Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto ON; Department of Obstetrics and Gynecology, University of Toronto, Toronto ON.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Yudin
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto ON; Department of Obstetrics and Gynecology, Mt. Sinai Hospital, Toronto ON.
authors.forename: Kellie E
authors.initials: KE
authors.lastname: Murphy
authors.affiliation: Department of Obstetrics and Gynecology, Mt. Sinai Hospital, Toronto ON.
authors.forename: Nan
authors.initials: N
authors.lastname: Okun
mesh_terms: D002170:Canada; D005260:Female; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011296:Prenatal Diagnosis
keywords: antepartum; cytomegalovirus; hepatitis C virus; human immune deficiency virus; parvovirus; screening