Original Article
Prevention of child-to-mother transmission of cytomegalovirus among pregnant women

https://doi.org/10.1016/j.jpeds.2004.05.041Get rights and content

Objective

To determine if protective behavior prevents child-to-mother transmission of cytomegalovirus (CMV) during pregnancy.

Study design

We studied 166 seronegative mothers (94% white women; mean age, 33 years) with a child <36 months of age attending a day care facility. Mothers, either pregnant or attempting pregnancy, were randomly assigned by day care center to either a control or intervention group. Mothers in the intervention group received instructions for hand washing, glove use, and for avoiding types of intimate contact with their child. The control group received no instructions or information about their serologic status or whether their child was shedding CMV.

Results

In the intervention group, 7.8% of women (9 of 115) seroconverted, as did 7.8% of women (4 of 51) in the control group. Two independent predictors of maternal infection were (1) a child shedding and (2) a mother attempting pregnancy at enrollment. For 41 women attempting pregnancy at enrollment with a child shedding CMV, 10 of 24 became infected compared with only 1 of 17 women who were already pregnant at enrollment (P = .008).

Conclusions

For seronegative women who already know they are pregnant, intervention may be highly effective for preventing CMV acquisition.

Section snippets

Subjects

Subjects were mothers who were either pregnant or not pregnant but attempting conception (using no contraception) who had a child younger than 36 months of age enrolled in 1 of 124 childcare centers in Central, Northern, and Eastern Virginia from 1999 through 2001. Informed consent was obtained from all subjects. The human experimentation guidelines of the US Department of Health and Human Services and those of Virginia Commonwealth University/Medical College of Virginia were followed in the

Results

During the study, 234 eligible women were enrolled. Excluded from the data analysis were 42 women in the control group who at enrollment were CMV-seropositive and 26 initially seronegative women who failed to provide follow-up specimens. One hundred sixty-six women who were initially seronegative completed the study.

At the end of 1999, an interim data analysis showed that half of the children who shed CMV at any time during maternal participation were not shedding when their mothers were

Discussion

CMV-seronegative women with frequent contact with young children in group day care have between a 5- and 25-fold increased risk for acquiring CMV from these children compared with seronegative women not in contact with young children.3., 4., 5., 14., 15., 16. The consequences of CMV acquisition during pregnancy may be severe for the developing fetus.2 Whether CMV transmission occurs through contact with contaminated environmental surfaces (fomites), saliva, urine, or respiratory droplets is

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      Citation Excerpt :

      Similar findings resulted from a cluster randomised trial where seronegative women with children less than 36 months old were randomly assigned to a day care that included information on hand hygiene and glove use versus one that did not. In the subgroup of women currently pregnant, the seroconversion rate was significantly lower in the intervention group compared with routine day-care: 5.9 % versus 41.7 % (P = .008) [77]. A study assessing the feasibility of educational intervention to reduce the risk of congenital CMV (Reducing Acquisition of CMV through antenatal Education; RACE-FIT) is currently underway in the UK. (

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    Supported by a grant from the National Institutes of Health.

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