Trisko Erin, Gosnell Kayla, Douglas Taneesha, Wu Katrina
Department of Nursing, Social Work, and Community Health, Bethel University, Saint Paul, Minnesota.
J Midwifery Womens Health. 2025 Jul-Aug;70(4):576-592. doi: 10.1111/jmwh.13749. Epub 2025 Mar 28.
Cytomegalovirus (CMV) infection immediately before or during pregnancy can infect a fetus transplacentally, causing congenital CMV (cCMV). cCMV can cause miscarriage, stillbirth, growth restriction, neurodevelopmental delay, hearing, and vision impairment. This integrative review examined original research to better inform health care providers on methods for reducing cCMV infections.
Database searching to identify original research pertaining to cCMV prevention in CINAHL, PubMed, and Nursing and Allied Health in January 2024 produced an initial 417 initial studies. Final extraction included 34 studies that met inclusion criteria for analysis.
Three relevant themes emerged: education, screening, and treatment. Messaging and education focused on risk reduction as most effective for behavioral changes. Maternal screening did not predict cCMV in low-risk women; however, it did diagnose early-stage maternal infections. Initiation of treatment closer to infection diagnosis demonstrated better outcomes. The 2 main treatment options for maternal infection were valacyclovir 8 g daily orally and CMV-hyperimmunoglobulin (HIG) 100 or 200 units per kilogram via intravenous (IV) infusion at varying frequency. Research on the efficacy of valacyclovir showed reductions in the incidence of cCMV without adverse maternal effects. Reduction in neonatal transmission and adverse sequelae were more likely with the 200 units per kilogram dosing of IV administration of HIG-CMV compared with the lower dose of 100 units per kilogram.
cCMV is often overlooked and untreated. Education in a variety of formats is effective at increasing provider knowledge and reducing infection rates by influencing maternal behavior. Screening recommendations are inconsistent but can be used as a tool to identify those pregnant individuals at highest risk, which could facilitate early diagnosis and prompt treatment. Maternal administration of medications such as valacyclovir and HIG-CMV have been shown to reduce the incidence of cCMV. Treatment options for CMV infection in pregnancy and resources for patient education are available and can reduce transmission to the neonate.
孕期前或孕期感染巨细胞病毒（CMV）可经胎盘感染胎儿，导致先天性CMV（cCMV）感染。cCMV可导致流产、死产、生长受限、神经发育迟缓、听力和视力损害。本综合综述对原始研究进行了审查，以便为医疗保健提供者提供更多关于降低cCMV感染方法的信息。
2024年1月在CINAHL、PubMed以及护理与联合健康数据库中进行检索，以识别与cCMV预防相关的原始研究，初步检索到417项研究。最终纳入分析的有34项符合纳入标准的研究。
出现了三个相关主题：教育、筛查和治疗。信息传递和教育侧重于降低风险，这对行为改变最为有效。母体筛查无法预测低风险女性的cCMV感染情况；然而，它确实能诊断出母体早期感染。在更接近感染诊断时开始治疗，效果更佳。母体感染的两种主要治疗选择是每天口服8克伐昔洛韦，以及通过静脉输注以不同频率给予每千克体重100或200单位的CMV高免疫球蛋白（HIG）。关于伐昔洛韦疗效的研究表明，其可降低cCMV的发病率，且对母体无不良影响。与每千克体重100单位的较低剂量相比，每千克体重200单位静脉注射HIG-CMV更有可能降低新生儿传播率和不良后遗症。
cCMV感染常常被忽视且未得到治疗。通过多种形式的教育可以有效提高医疗服务提供者的认知，并通过影响母体行为降低感染率。筛查建议并不一致，但可作为识别高危孕妇的工具，这有助于早期诊断和及时治疗。已证明母体服用伐昔洛韦和HIG-CMV等药物可降低cCMV的发病率。孕期CMV感染的治疗选择和患者教育资源是可用的，并且可以减少向新生儿的传播。
