The (fractured) state of CMV prevention
Most every person within the CMV community knows about CMV prevention—the recommended behaviors, hygienic precautions, etc. But what about the history of CMV prevention as a concept or policy?
The American College of Obstetricians and Gynecologists (ACOG), the leading professional membership organization for OB/GYNs, periodically publishes Practice Bulletins, “evidence-based documents” which “summarize current information on techniques and clinical management issues for the practice of obstetrics and gynecology.”
In September of 2000, ACOG published Practice Bulletin #20 and issued a Level C recommendation (based primarily on consensus and expert opinion) that stated “Pregnant women should be counseled about methods to prevent acquisition of CMV during pregnancy.” The Practice Bulletin went on to state that “the greatest impact obstetrician-gynecologists can have on reducing CMV disease is by educating patients about preventive measures.”
In 2008, the Centers for Disease Control and Prevention surveyed OB/GYNs and found that less than one half (44%) of those surveyed reported counseling their patients about CMV prevention
Most recently, in June of 2015, ACOG published a second Practice Bulletin (#151) addressing CMV and prevention counseling by OB/GYNs. This publication essentially reversed the previous policy from 2000, updating CMV prevention guidelines as “impractical or burdensome” saying that “such patient instruction remains unproven as a method to reduce the risk of congenital CMV infection”.
As a result of ACOG’s policy change, the Centers for Disease Control and Prevention removed CMV prevention information from their website while insisting that their goal is “to better communicate the current science and understanding of CMV and congenital CMV to healthcare professionals and the public, especially pregnant women or those who are planning to become pregnant.”
In light of recent high-profile media attention given to CMV, Medscape has published a commentary entitled “CMV Remains a Concern Because of Lack of Research” by Dr. Christopher Zahn, the vice president for practice at ACOG, and Dr. Brenna Hughes, Associate Professor and Director of the Maternal Fetal Medicine Fellowship at Duke University School of Medicine. Highlighted in this commentary is ACOG’s policy reversal, noting that the previous Practice Bulletin’s recommendations were based on “weak research” and calling for a randomized controlled trial where “the impact of hygiene measures to prevent maternal acquisition of CMV” can be evaluated.
Also mentioned within the Medscape commentary was the profound disparity between federal funding for Zika versus CMV. “Congress approved $1 billion to support Zika virus research and prevention, but CMV does not have a line item for funding in the annual budget,” states Drs. Zahn and Hughes. “This is a priority for ACOG and many ob/gyns across the United States. Governmental and pharma research funding to support these efforts is long overdue.”
In the CMV community and, most specifically, within the National CMV Foundation, we find ACOG’s reversal of their behavioral counseling policy to be unfortunate and disheartening. “There is value in this knowledge and all women reserve the right to make informed decisions about their health,” says National CMV President Kristen Spytek. “We remain deeply committed to our mission of educating women of childbearing age about congenital CMV. We urge women to ask questions regarding the risks of CMV infection before and during pregnancy, and we plan to continue sharing prevention information with the goal of reducing CMV incidence.” While there is agreement between National CMV and ACOG regarding the egregious lack of federal priority and funding for CMV, we believe that the amount and quality of CMV prevention and behavioral counseling research substantiates attention by OB/GYNs, but more importantly, by pregnant woman most at risk for acquiring CMV.
Regardless of ACOG’s Practice Bulletin update, National CMV sincerely hopes that all OB/GYNs will make an effort to discuss CMV with their pregnant patients and that they will answer questions about CMV posed by their patients or anyone within their practice. National CMV will seek to provide the most current and comprehensive information and resources to support the needs of OB/GYNs, their staff, and the pregnant women that they serve.
Category: Awareness, Prevention