Primary prevention of cytomegalovirus in pregnancy: addressing the gaps
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5 April 2022 — completed May 2022
Primary prevention of cytomegalovirus in pregnancy: addressing the gaps
Cytomegalovirus (CMV) is the most common congenital infection in the UK and the leading non-genetic cause of sensorineural hearing loss and a common cause of neuro-disability.
children are born every day in the UK with congenital CMV infection
When CMV is caught before birth, particularly when organs are still developing in early pregnancy, it can cause deafness and affect the child’s physical and mental development. Congenital CMV also has significant implications for the NHS — with estimated costs of £732 million each year.
Acquisition of CMV infection in the first trimester of pregnancy is associated with the highest risk of adverse outcomes for the infant.
The risk of acquiring CMV in pregnancy can be reduced by making simple adaptations to behaviours to avoid direct contact with the saliva and urine of young children — who are the most common transmitters of CMV infection to pregnant women. Yet there are currently no national policies that recommend CMV risk reduction measures in pregnancy.
Project aims
To establish and build effective partnerships with policymakers and stakeholders to identify policy priorities and gather essential evidence required to fully inform policies to reduce the risk of CMV infection in pregnancy.
Specific objectives:
Engage with policymakers and key stakeholders to identify policy priorities and evidence gaps needed to routinely recommend CMV risk reduction measures in pregnancy
Determine the proportion of women at risk of primary CMV infection and rates of CMV infection in the first trimester by testing blood samples routinely collected at antenatal booking at representative sites in England
Investigate ways of implementing, sustaining or enhancing CMV educational interventions in real-world routine antenatal care settings
Explore the feasibility of conducting a future large implementation study to test the efficacy of delivering a CMV educational intervention in routine antenatal care settings
How the research was carried out
The project comprised three activities employing different methods:
A policy roundtable meeting with key stakeholders to identify policy priorities and research gaps. Policy stakeholders were invited to respond to key findings and shape recommendations to local and national policy audiences. Combined work will be used to create policy briefs. Stakeholders were supportive of introducing CMV in routine antenatal education.
Testing of routinely collected blood samples at antenatal booking at representative sites in England to determine the proportion of women at risk of primary CMV infection and rates of infection in the first trimester.
Investigation of ways to implement, sustain or enhance a CMV educational intervention in real-world antenatal settings, including:
Work with a Public Involvement Group to gather feedback on a previously developed CMV educational film, targeting diverse and underrepresented groups to direct future modifications
In-depth interviews with antenatal staff, healthcare professionals from various NHS sites, and digital providers engaged in antenatal education, to explore barriers, facilitators, and sustainability potential
Background to the study
This study built upon findings of a previous study (RACE-FIT) funded by NIHR Research for Patient Benefit, where a film-based intervention was co-produced by families affected by CMV and pregnant women. The feasibility study for a larger scale randomised controlled trial was conducted at St George’s University NHS Trust.
This project investigated policy and implementation gaps to reduce risk of CMV in pregnancy and reduce burden of neuro-disability in children. It also considered issues of inclusion and diversity in antenatal education, seeking to engage with inequities in maternal health among women living in communities of social disadvantage and ethnic diversity — of particular relevance to south London.
Our collaborators
The research team included people from:
- Kingston University
- Southampton University Hospital (PI)
- University of Cambridge
- University College London
- CMV Action charity
NHS Trust collaborators included:
How patients and the public were involved
Public involvement was embedded throughout the project. PPI members provided advice and feedback in the planning, implementation and evaluation of the work. The team consulted throughout with families living with a child with CMV, the charity CMV Action, pregnant women from diverse backgrounds, and charities working with under-represented communities, including Mosaic Trust, Maternity Voices, Sure Start (Pickles Coppice, Southampton) and the Royal College of Obstetricians and Gynaecologists.
“By carrying out this research to identify these gaps, we can ensure future successful inclusion of CMV education into routine antenatal care. Now is the time to engage with policymakers and other stakeholders to ensure that women have the advice they need to protect them and their unborn children from CMV infection.”
Professor Tushna Vandrevala — Co-lead, professor of health psychology, Kingston and St George’s, University of London
Potential benefits of the research
Despite being the most common infection caught before birth, most people have never heard of CMV. Many women know to avoid cat litter and soft cheese during pregnancy, but have never been told about ways to avoid CMV. Previous research showed that pregnant women and families affected by CMV express shock and anger about not being told.
Engaging with policymakers and stakeholders to provide a clear action plan so that all pregnant women are routinely told about ways to reduce the risk of catching CMV
Testing routinely collected blood samples to demonstrate the burden of CMV that could potentially be prevented by policy action, and the women failed by policy inaction
Identifying ways to meaningfully integrate CMV information into routine antenatal care without overloading women or the midwives and obstetricians caring for them
Meet the team
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Professor Tushna Vandrevala Professor of health psychology, Kingston and St George’s, University of London |
 Dr Christine Jones Associate professor in paediatric infectious diseases and immunology, University of Southampton (PI) |
Related content
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CMV Action charity — raising awareness and supporting families affected by congenital CMV - →
Improving health outcomes for women and babies at higher risk of complications - →
Maternity and perinatal mental health research at ARC South London
Original source: arc-sl.nihr.ac.uk — NIHR ARC South London legacy content archived May 2026.