An observational study to assess Italian obstetrics providers’ knowledge about preventive practices and diagnosis of congenital cytomegalovirus

Chiara Boccherinihttp://orcid.org/https://orcid.org/0000-0002-4629-0299 1 , Valentina D’Ambrosio 1 , Sara Corno 1 , Flaminia Vena 1 , Cristina Pajno 1 , Maria Grazia Piccioni 1 , Francesco Rech 1 , Paola Ciolli 1 , Roberto Brunelli 1 , Pierluigi Benedetti Panici 1 , Antonio Pizzuti 2 , Ludovico Muzii 1 , and Antonella Giancotti 1
  • 1 Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
  • 2 Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
Chiara BoccheriniORCID iD: https://orcid.org/0000-0002-4629-0299, Valentina D’Ambrosio
  • Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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, Sara Corno
  • Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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, Flaminia Vena
  • Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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, Cristina Pajno
  • Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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, Maria Grazia Piccioni
  • Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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, Francesco Rech
  • Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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, Paola Ciolli
  • Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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, Roberto Brunelli
  • Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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, Pierluigi Benedetti Panici
  • Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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, Antonio Pizzuti
  • Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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, Ludovico Muzii
  • Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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and Antonella Giancotti
  • Department of Maternal and Child Health and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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Abstract

Objectives

Congenital cytomegalovirus (cCMV) infection can be easily prevented by hygienic measures. Up to date the majority of the studies in literature highlighted a reduction in cCMV antenatal counseling and its prevention. Our purpose was to evaluate obstetrics providers’ knowledge about cCMV infection, management and the behavioral practices to avoid it.

Methods

This is a cross-sectional survey carried out in Umberto I Hospital, “Sapienza” University of Rome between November 2019 and January 2020. We recruited 148 specialists and residents in Obstetrics and Gynecology through online anonymous multiple-choice 13-questions, 10 min-survey comparing responses between the two groups.

Results

A total of 94.6% of all participants said they always prescribe cytomegalovirus (CMV) serum screening: 73.6% of them regularly counsel about preventive practices, with specialists recording higher percentages (85.4 vs. 65.1%, p<0.005). We identified a good knowledge about the diagnostic pathway, but only 58.1% of our population knows the correct time of late amniocentesis. 12.2% of providers do not consider magnetic resonance (MRI) as a complementary exam.

Conclusions

Prevention of maternal seroconversion is crucial: even if our data show an acceptable knowledge about antenatal counseling, we encourage clinicians to firmly inform and educate women about behavioral measures.

  • 1.

    Kagan, KO, Hamprecht, K. Cytomegalovirus infection in pregnancy. Arch Gynecol Obstet 2017;296:15–26. https://doi.org/10.1007/s00404-017-4380-2.

    • Crossref
    • PubMed
    • Export Citation
  • 2.

    Leruez-Ville, M, Khalil, A, Kagan, KO, Donner, C, Lazzarotto, T, Ville, Y. Antenatal screening for cytomegalovirus infection: to know the chance, the chance to know. Lancet 2019;3:675–7. https://doi.org/10.1016/s2352-4642(19)30271-8.

  • 3.

    Hambrecht, K, Jahn, G. Humanes Cytomegalovirus und kongenitale Infektion. Bundesgesundheitsbla 2007;50:1379–92. https://doi.org/10.1007/s00103-007-0194-x.

    • Crossref
    • Export Citation
  • 4.

    Muldoon, KM, Armstrong-Heimsoth, A, Thomas, J. Knowledge of congenital cytomegalovirus (cCMV) among physical and occupational therapists in the United States. PloS One 2017;12:e0185635. https://doi.org/10.1371/journal.pone.0185635.

    • PubMed
    • Export Citation
  • 5.

    Manicklal, S, Emery, VC, Lazzarotto, T, Boppana, SB, Gupta, RK. The “silent” global burden of congenital cytomegalovirus. Clin Microbiol Rev 2013;26:86–102. https://doi.org/10.1128/cmr.00062-12.

    • Crossref
    • Export Citation
  • 6.

    Cannon, MJ, Schmid, DS, Hyde, TB. Review of cytomegalovirus and demographic characteristics associated with infection. Rev Med Virol 2010;20:202–13. https://doi.org/10.1002/rmv.655.

    • Crossref
    • PubMed
    • Export Citation
  • 7.

    Saldan, A, Forner, G, Mengoli, C, Gussetti, N, Palù, G, Abate, D. Testing for cytomegalovirus in pregnancy. J Clin Microbiol 2017;55:693–702. https://doi.org/10.1128/jcm.01868-16.

    • Crossref
    • PubMed
    • Export Citation
  • 8.

    Sistema nazionale per le linee guida (ISS-SNLG), Gravidanza fisiologica. Linea guida 20, Rome - Italy: Italian Ministry of Health; 2011.

  • 9.

    Prevention of congenital (CMV) infection. Australia, (C-Obs-64)-New-Statement. The Royal Australian and New Zealand College of Obstetrician and Gyneacologist. RANZCOG; 2019.

  • 10.

    Khalil, A, Heath, P, Jones, C, Soe, A. Ville YG on behalf of the Royal College of obstetricians and gynaecologists. Congenital cytomegalovirus infection: update on treatment. Scientific impact paper No. 56. BJOG 2018;125:e1–11. https://doi.org/10.1056/nejmoa043337.

    • Crossref
    • PubMed
    • Export Citation
  • 11.

    Shand, AW, Luk, W, Nassar, N, Hui, L, Dyer, K, Rawlinson, W. Cytomegalovirus (CMV) infection and pregnancy-potential for improvements in Australasian maternity health providers’ knowledge. J Matern Fetal Neonatal Med 2017;31:2515–20. https://doi.org/10.1080/14767058.2017.1344968.

    • PubMed
    • Export Citation
  • 12.

    Centers for Disease Control and Prevention. Knowledge and practices of obstetricians and gynecologists regarding cytomegalovirus infection during pregnancy—United States, 2007. Morb Mortal Wkly Rep 2008;57:65–8.

  • 13.

    Candiani, G, Daghini, R. Linee Guida Italiane Gravidanza Fisiologica. SNLG 2011;20:138–42.

  • 14.

    Werner, E, Hughes, B, Albright, C. Cytomegalovirus screening in pregnancy: a cost-effectiveness and threshold analysis. Am J Perinatol 2019;36:678–87. https://doi.org/10.1055/s-0038-1676495.

    • Crossref
    • PubMed
    • Export Citation
  • 15.

    Hosseinzadeh Adli, A, Karami, C, Baghban Rahimi, S, Mirarab, A, Tabarraei, A. What family doctors know about congenital CMV: a regional survey in Iran. Int J Pediatr 2018 44:31. https://doi.org/10.1186/s13052-018-0470-4.

  • 16.

    Cordier, AG, Guitton, S, Vauloup-Fellous, C, Grangeot-Keros, L, Benachi, A, Picone, O. Awareness and knowledge of congenital cytomegalovirus infection among health care providers in France. J Clin Virol 2012;55:158–63. https://doi.org/10.1016/j.jcv.2012.06.022.

    • Crossref
    • PubMed
    • Export Citation
  • 17.

    Ross, DS, Rasmussen, SA, Cannon, MJ, Anderson, B, Kilker, K, Tumpey, A, et al. Obstetrician/gynecologists’ knowledge, attitudes, and practices regarding prevention of infections in pregnancy. J Womens Health 2009;18:1187–93. https://doi.org/10.1089/jwh.2008.1288.

    • Crossref
    • Export Citation
  • 18.

    Revello, MG, Tibaldi, C, Masuelli, G, Frisina, V, Sacchi, A, Furione, M, et al. Prevention of primary cytomegalovirus infection in pregnancy. EBIOM 2015;2:1205–10. https://doi.org/10.1016/j.ebiom.2015.08.003.

    • Crossref
    • Export Citation
  • 19.

    Hughes, BL, Gyamfi-Bannerman, C. Society for Maternal-Fetal Medicine (SMFM) Consult #39: diagnosis and antenatal management of congenital cytomegalovirus (CMV) infection. Am J Obstet Gynecol 2016;214:B5–11. https://doi.org/10.1016/j.ajog.2016.02.042.

    • Crossref
    • Export Citation
  • 20.

    Leruez-Ville, M, Foulon, I, Pass, R, Ville, Y. Cytomegalovirus infection during pregnancy: state of the science. Am J Obstet Gynecol 2020. https://doi.org/10.1016/j.ajog.2020.02.018.

    • PubMed
    • Export Citation
  • 21.

    Nigro, G, Adler, SP, La Torre, R, Best, AM. Passive immunization during pregnancy for congenital cytomegalovirus infection. N Engl J Med 2005;353:1350–62. https://doi.org/10.1056/nejmoa043337.

    • Crossref
    • PubMed
    • Export Citation
  • 22.

    Revello, MG, Lazzarotto, T, Guerra, B, Spinillo, A, Ferrazzi, E, Kustermann, A, et al. CHIP study group. A randomized trial of hyperimmune globulin to prevent congenital cytomegalovirus. N Engl J Med 2014;370:1316–26. https://doi.org/10.1056/nejmoa1310214.

    • Crossref
    • Export Citation
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