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Cytomegalovirus infection (from the same family as cold sores or herpes) can be dramatic when it affects a pregnant woman and her baby. To avoid after-effects on the child, the National Academy of Medicine is now calling for systematic maternal serological screening.
Do you know about congenital cytomegalovirus (CMV) infection? This complicated name, however, represents a common infection, from the herpes cold sore family, and chickenpox, benign for adults but dramatic for the unborn baby.
Risky transmission from mother to baby
Congenital cytomegalovirus infection is thus a fetal infection whose consequences can cause serious after-effects for the future child, particularly if the mother has never been infected before (like 50% of the population of women aged 15 to 45). . If she is exposed to the virus just before or during her pregnancy and develops a primary infection (which is common when other young children make up the family) then the rate of transmission of the infection to the embryo is 30%.
Serious after-effects on the baby
The danger is not trivial. According to the National Academy of Medicine, approximately four newborns out of 1,000 in France (i.e. approximately 2,900 per year) are therefore infected with CMV during their intrauterine life and, among them, 18% (approximately 500 per year ) will develop medium and long term after-effects:
- Hearing loss and deafness;
- Balance disorders;
- Motor deficit;
- Mental retardation, constituting the leading cause of congenital neurosensory disabilities in our country, apart from genetic anomalies.
“These attacks, of varying degrees, potentially lead to lifelong disabilities, too often with serious consequences for the family. They induce significant costs for society which must take care of them,” worries the Academy.
Screening necessary to treat the infection as quickly as possible
However, CMV screening during pregnancy is the subject of much debate. However, it is a procedure requested today by the Academy of Medicine. “THE serological screening early maternal pregnancy allows the diagnosis of primary peri-conception CMV infection in previously HIV-negative mothers.
In case of positivity, the search for CMV in the amniotic fluid can make it possible to make the diagnosis of fetal infection and to quickly initiate antiviral treatment of the mother to reduce the fetal viral load and avoid damage to the fetal tissues by the CMV. Valaciclovir in particular would reduce the risk of viral transmission by 70%.
“Without this early maternal screening, on the other hand, the diagnosis of fetal CMV infection is made late during pregnancy, based on the presence of suggestive ultrasound signs (microcephalybrain damage) or symptoms at birth, the delay in diagnosis having given way to the replication of the virus inducing serious fetal damage.
The Academy of Medicine contradicts the High Council of Public Health
For the National Academy of Health, it is therefore time for France to take a position on this screening.
“In France, such screening could be organized, since commercial serological techniques, available and used routinely, are standardized, automated and accessible throughout the territory,” advances the institution. The networks of biologists and gyneco-obstetricians, and the CMV reference centers are able to organize themselves to expand and support the implementation of CMV screening, already partly in place in certain regions, notably the Island of France, she indicates, in opposition to a recent opinion from the High Council of Public Health, which ruled out systematic early detection of CMV infection at the start of pregnancy.
“Faced with the observation of serious congenital CMV infections, easily preventable with effective antiviral treatment well tolerated by the mother and fetus, the National Academy of Medicine renews its recommendations”or that:
- This public health problem is taken into account in all its dimensions, including ethical ones and that, in particular, all the costs induced by lifelong disabilities, borne by families and by Society, are included in the analysis of the benefit/risk ratio of screening;
- The means of CMV screening are put in place, including anti-CMV IgG and IgM screening in the first trimester and monitoring of seronegative women, on the basis of a decision-making algorithm, as recommended by the National College of Gynecologists and French obstetricians;
- Cohort and monitoring studies of the impact of the measure be developed, particularly based on the national health data system.
Slide: The different pregnancy examinations