Diagnosis and management of congenital Cytomegalovirus: Critical Appraisal of Clinical Practice Guidelines

Objectives: To review the currently available Clinical Practice Guidelines regarding the diagnosis and management of Cytomegalovirus (CMV) infection in pregnancy.

Methods: Medline, Turning Research into Practice (TRIP), Web of Science databases and scientific societies' websites were searched electronically up to April 2024. We included national and international Clinical Practice Guidelines regarding diagnosis, treatment and follow-up of CMV infection in pregnancy, published in English language. Quality assessment of the included guidelines was performed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool.

Results: Ten Clinical Practice Guidelines and two expert consensus statements were included. The review showed agreement among national and international guidelines about the diagnostic criteria for primary maternal CMV infection and about the gold standard for confirmation of fetal infection. Regarding treatment, only two societies recommended routine administration of Valaciclovir in case of primary infection in the clinical practing setting. Fetal surveillance including ultrasound and magnetic resonance imaging (MRI) in case of confirmed infection was found to be heterogeneous among the recommendations.

Conclusions: Although consensus was obtained regarding the diagnostic criteria for primary CMV infection in pregnancy, there was heterogeneity among Clinical Practice Guidelines with regards to other aspects of clinical management of CMV in pregnancy. In addition, some topics where not addressed in the current guidelines, including the treatment of non-confirmed fetal infection and the management of non-primary maternal infection. Recommendations regarding prevention of congenital CMV are rapidly evolving based on the new available evidence.