Screening of Cytomegalovirus Infection in Pregnant Women. Recommendation by the Italian National Institute of Health and Ministry of Health, December 2023

Congenital cytomegalovirus (cCMV) is the most common congenital infection and a leading cause of non-genetic sensorineural hearing loss and neurodevelopmental disability in newborns. Despite its clinical burden, routine CMV screening in pregnancy has not been recommended so far due to the lack of effective treatment to prevent transplacental transmission. In December 2023, the Italian National Institute of Health, on behalf of the Ministry of Health, has issued a new recommendation supporting universal CMV serological screening during pregnancy. This recommendation is based on the results of a systematic review of the literature, including randomized controlled trials, observational studies, and systematic reviews. Recent high-quality evidence demonstrates that valacyclovir significantly reduces vertical transmission when administered during early primary maternal infection. In addition, cost-effectiveness analyses support universal screening in settings with moderate-to-high CMV seroprevalence among childbearing age women. Based on this evidence, the updated Italian guideline recommends CMV serological screening at the first antenatal visit within the first trimester, with monthly testing until 24 weeks in seronegative women, and targeted information on CMV prevention to all pregnant women. This article summarizes the evidence and decision-making process behind this new national recommendation and highlights its potential relevance to other countries currently considering the implementation of a similar screening policy.