法国产前巨细胞病毒筛查与治疗趋势：7年全国队列研究（2017—2023）

原文

OBJECTIVES: Cytomegalovirus (CMV) is the leading cause of congenital infectious neurosensory impairment. We aimed to present national epidemiological data on maternal CMV infection during pregnancy in France, focusing in particular on primary infection in the periconceptional period or first trimester, and to assess the impact of changes in screening practices and clinical management of affected pregnant women and their newborns. METHODS: In this retrospective, multicenter study, we retrieved data from the electronic database of the French National Reference Center for Herpesviruses from cases of maternal CMV infection diagnosed during pregnancy between January 2017 and December 2023, with known neonatal infection status (infected or non-infected) at birth. Maternal, fetal and neonatal data in cases with maternal primary infection during the periconceptional period or first trimester were compared between the periods before and after publication of a pivotal randomized controlled trial (RCT) in September 2020 that demonstrated that valacyclovir reduced vertical transmission by two-thirds when administered to women with first-trimester primary CMV infection. RESULTS: Among 451 documented cases of maternal CMV infection during pregnancy with known fetal/newborn CMV status, there were 220 pregnancies (222 fetuses) with periconceptional or first-trimester primary maternal infection (PI), among which maternal-fetal transmission occurred in 176 (79.3%). Compared with the period from 2017 to 2020, in the period from 2021 to 2023 there was a significant increase in both systematic CMV screening (from 22.0% to 40.0%; P = 0.001) and maternal requests for testing (from 0% to 4.2%; P = 0.02). Among cases of maternal infection during the periconceptional period or in the first trimester, antiviral therapy (generally valacyclovir) was administered more frequently in the period from 2021 to 2023 (27.7% vs 59.8%; P < 0.0001). The overall rate of termination of pregnancy (TOP) for early maternal CMV-PI was 20.7% (40/193 with known pregnancy outcome), with significantly fewer TOPs being performed in the period from 2021 to 2023 (25.9% vs 13.0%; P = 0.03). Notably, women who did not receive valacyclovir treatment had higher rates of TOP overall compared with women who had received valacyclovir (22.1% vs 8.1%; P = 0.01). CONCLUSIONS: Congenital CMV infection is a major public health problem. Despite the lack of national guidelines for systematic maternal CMV screening until mid-2025, the uptake of maternal CMV screening and preventive treatment increased significantly in France after publication of the pivotal RCT in 2020, apparently without an associated rise in the rate of TOP. These findings support the safety and potential benefits of offering CMV serological testing during pregnancy, particularly in the context of evidence-based therapeutic options. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.