Citomegalovirus congénito

Conciencia y conocimiento sobre el citomegalovirus congénito entre los profesionales de la salud y las mujeres embarazadas: una acción de prevención

Introducción: El citomegalovirus (CMV) es una causa importante de discapacidades infantiles, y las recomendaciones consensuadas enfatizan la importancia de las medidas higiénicas para reducir la infección perinatal. Our study aimed to evaluate the level of awareness about CMV among health professionals and pregnant women. Methods: We submitted a 20-item online survey regarding CMV perinatal infection to all obstetricians and midwives in Catalonia (Spain) and a 7-item lay version of the questionnaire to 700 pregnant women. Levels of knowledge were compared among groups. Results: Of the 1,449 health professionals approached, 338 surveys were answered. 72% of professionals considered CMV a relevant problem. 47% of obstetricians and 28% of midwives (p ≤ 0.001) routinely informed pregnant women, and less than half knew the risk of fetal transmission. We observed significant differences in knowledge between obstetricians and midwives concerning the risks of recurrent infections, risk of transmission, and risk of severe infection (60.7% vs. 45.6%, p = 0.006 and 50.6% vs. 22.5%, p ≤ 0.001); and regarding maternal and neonatal symptoms and newborn sequelae (23% vs. 8.8%, p ≤ 0.001). Of the 700 women approached, we obtained a response rate of 72%. Only 23% had previously heard about CMV, 22% identified transmission routes, and 15% preventive measures. Compared to women without risk factors for CMV infection, women at greater risk had heard more about CMV (mothers of children < 0.001; occupational exposure: 43% vs. 20%, p ≤ 0.001) and had received more information (mothers of children

Introduction Congenital cytomegalovirus (CMV) is the leading cause of nongenetical sensorineural hearing loss and a major cause of neurodevelopmental disabilities, with 0.4– 1% infected newborns worldwide [1–3]. CMV is a complex virus since fetal infection may occur not only after primary maternal infection but also after reactivation or reinfection with a different strain [3, 4]. About 10% of infected newborns are symptomatic at birth and most present neurological and audiological sequelae. Among asymptomatic infants, however, around 10% will develop hearing loss [3, 5]. Nevertheless, this proportion depends on the time of maternal infection. A recent meta-analysis confirmed that fetal insult is around 25–30% when transmission occurs in the first trimester and periconceptional period, although fetal consequences are rare thereafter [4]. Since there is no available vaccine or effective therapy for infected fetuses, and while treatment to prevent fetal infection is under evaluation [6], universal screening of pregnant women is currently not recommended, and most cases of congenital CMV infection remain unnoticed [7]. Exposure to young children is the greatest risk factor for primary infection as toddlers shed the virus in urine and saliva over a considerable period of time. Hygienic measures to avoid maternal infection are recommended by most consensus statements and pregnancy guidelines [8, 9]. Measures to be applied during pregnancy, specifically in the first trimester and the preconceptional period include handwashing after contact with urine or saliva from children.

Materials and Methods This was a descriptive, cross-sectional study on knowledge, attitudes, and practices with respect to congenital CMV among health professionals involved in prenatal care and pregnant women carried out between December 2018 and December 2019. This study was approved by the Hospital Clinic Ethics Committee: Reg. HCB/2018/1084/ER-01. A 20-item survey was designed to evaluate knowledge about CMV infection among health professionals (online suppl. material 1; see www.karger.com/doi/10.1159/000525528 for all online suppl. material). All registered obstetricians (n = 850) (Catalan Society of Obstetrics and Gynecology) and midwives (n = 570) (Catalan Society of Midwifery) working in Catalonia were invited to anonymously answer the survey using an online platform. The questionnaire consisted of multiple-choice questions, with one or more valid answers. The answers were rated as correct when all the items of the questionnaire were answered accurately, partially correct when there was a failure or omission, and incorrect when al the items were erroneous or the question was not answered. Professionals not involved in prenatal care were excluded from completion of the questionnaire. A shorter lay-version survey comprising 7 questions (online suppl. material 2) was provided to 700 consecutive pregnant women who attended routine first-trimester scan between 11 and 13+6 weeks at the Fetal-Maternal Department, BCNatal-Hospital Clínic, Barcelona. To assess whether there were differences concerning the participants’ knowledge, pregnant women were classified according to epidemiological risk factors related to CMV infection: having children ≤3 years old and occupational exposure in childcare centers. Additionally, their level of education was also recorded. Patients under 18 years of age and those with a language barrier were excluded. Statistical Analysis The level of knowledge of both health care providers and pregnant women was analyzed using the χ2 , Pearson and Fisher’s exact test for categorical variables. Trends across categories of educational status were obtained with the two-sample test of proportions. Quantitative variables were assessed using the Shapiro-Wilk test for normality. Non-normally distributed variables were expressed as median and interquartile range (p25–75). A p value

Results Knowledge of the Health Care Professionals Among the health professionals approached, 23% (338/1,449) completed the survey (Fig. 1). The results are summarized in Table 1. Health care professionals were surveyed about their perception of the relevance of CMV infection in our setting, and 76.4% of doctors and 69% of midwives considered it to be a relevant problem. However, only 47% and 28% of obstetricians and midwives (odds ratio; Intervalo de confianza del 95%: 2,30 [1,46-3,63], p = < 0,001). Significant differences in the multiple-choice questions were related to all correct options but not partially correct answers. Knowledge of the Pregnant Women Among the pregnant women, 72% (505/700) completed the survey. The median (interquartile range) age of the participants was 34.5 (30.5–37.5) years. Their descriptive data are summarized in Table 2. Table 3 shows their responses to the survey compared to risk factors for infection (mothers of children < 0.001; occupational exposure: 43% vs. 20%, p < 0.001) and had received more information (mothers of children < 0.001; exposición ocupacional: 23% vs. 9.3%, p = 0.001). However, when analyzing specific knowledge regarding the infection and preventive measures, there were no differences between pregnant

women according to their epidemiological risk. Irrespective of the presence of risk factors, nearly 90% of the pregnant women included in this survey admitted there was a need for more information about congenital CMV. The knowledge about transmission and preventive measures significantly increased across educational level (linear trend p < 0.001), as shown in Table 4

Discussion The present study highlights that professionals involved in prenatal care in the Catalan public health system have insufficient knowledge regarding CMV infection. Inadequate and/or infrequent advice about behavioral measures could limit awareness of infection among first-trimester pregnant women, including those with risk factors such as having a young child or occupational exposure. The CDC, the American College of Obstetricians and Gynecologists, and the most recent consensus recommendations emphasize the importance of advising pregnant women on CMV infection and preventive measures; however, in our setting, less than 50% of health providers routinely provide information about CMV. The importance of primary prevention has been stressed in previous studies and shown to be effective. Vauloup-Fellous et al. [12] concluded that providing information about hygienic measures can be a highly effective intervention in reducing the rate of maternal infection, describing a reduction in the seroconversion rate from 3% to 0.19% in a high-risk population. Moreover, in a study in Italy of 308 seronegative women with a childIn keeping with Shand et al. [14], only one-third of health care professionals were able to accurately identify all the preventive measures regarding CMV infection. Moreover, less than half of the obstetricians and only 28% of midwives routinely provided such information to pregnant women. Insufficient knowledge and the fact that this did not correspond to their tasks were cited as the main reasons for not offering information. Such findings are also consistent with those identified by Shand et al. [14] in which 37% of the health care professionals stated that they only occasionally offered information on CMV prevention, 32% claimed this was not standard practice, and 22% felt unsure of their knowledge. The significantly lower information given by midwives in our setting is particularly striking. It might have been due to a self-selection bias among obstetricians as low-risk pregnancies are usually followed by midwives who are generally responsible for behavioral interventions. Obstetricians and midwives in our setting had low scores regarding knowledge about the infection, similar to results observed by other authors. In the Netherlands

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