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Editor’s comment: Prof. Dan Farine: CMV in pregnancy what is new?

This study provides more details on the diagnosis and probably more importantly the prognosis of CMV.  The paper starts with a statement that the CMV infection occurs in 0.7% of all births. Although this is probably the best current estimate it is important to note that in North America there is no routine screening for CMV. This in turn alters the presentation of the disease as few patients are screened for CMV (and these are obviously at a higher risk) and even fewer are tested for CMV. Many series are therefore skewed by the entry point of severe ultrasound findings. The question of the need for routine screening for CMV was obviously not addressed in this French study and still remains open. 

In some ways this study confirms what previous studies have already suggested.  For example, the Canadian guidelines that I was involved in are outdated by now but did not have very different conclusions than this study.  This study is unique in being a large series and having used all testing modalities in centers that have studied this infection for a while. The most interesting findings are these of patients who seem based on the combination of all antenatal tests to be at low risk for neonatal infection. Interestingly, the results for this virus are not that different from the risks of other infections (e.g. the recent studies on Parvo virus). The authors should be recommended for being thorough in their approach and getting answers to all different aspects of modern management of CMV and getting specific answers.

The problem (not with the study but with the disease) is that the data is not definitive. The  positive predictive value of 93% seems good however 7% of babies that were exposed to CMV but had no findings or minimal ones will still have a disease in childhood. This number could be even slightly higher as some children do develop symptoms later.  In this era when couples have often 1-2 children this risk may be too high


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Commentaries by Editor Prof. Jim Thornton