Cytomegalovirus Among Women Of Reproductive Age: Newborn Screening Acceptability, Seroprevalence, And Viral Shedding

Abstract

Background: Cytomegalovirus (CMV) is the most common congenital infection in the U.S. Approximately 0.5-0.7% of newborns are infected with CMV in utero, translating to about 22,800 infants infected each year. This dissertation focused on women of reproductive age, considered here to be 18-44 years, as this is the population who may make decisions regarding newborn CMV screening, and who could potentially transmit CMV congenitally during a pregnancy. Methods: Data from two sources were used. First, a survey was conducted at the 2018 Minnesota State Fair, where women ages 18-44 years asked about their preferences related to newborn CMV screening. Second, publicly available data from the National Health and Nutrition Examination Survey 1999-2004 were obtained, including the most recently available data on CMV seropositivity and urinary shedding in adults. Seroprevalence and prevalence of recent infections were assessed in women ages 18-44 years and stratified by racial and ethnic groups. Associations between physiological and social stressors and CMV urinary shedding were evaluated among seropositive women. Results: Women surveyed were generally supportive of newborn screening for CMV, with 86% stating they would choose to have their newborn screened. Women who also supported other newborn health activities were 30% more likely to choose newborn CMV screening than women who were not supportive of these activities. Non-Hispanic White women had lower CMV seroprevalence (48%) than non-Hispanic Black (85%) or Mexican American women (85%) but appeared to be slightly more likely to have evidence of a recurrent CMV infection (1.3% compared with 0.6% and 0.4%). When examining associations between physiologic and social stressors and CMV urinary shedding, point estimates suggested higher prevalence relative to not having the stressor, consistent with our expectation. However, for most stressors the 95% confidence intervals were extremely wide and consistent with associations ranging from much lower prevalence to much higher. Discussion: This dissertation adds evidence that women of reproductive age are supportive of newborn screening for CMV, especially women who also support other routine newborn healthcare activities. This finding is particularly timely, as universal newborn CMV screening was just implemented in Minnesota this year and is being considered in other states. A better understanding of factors related to CMV seroprevalence, timing of primary or recurrent infections, and shedding may help define risk factors for transmission among seropositive women and inform subsequent counseling among the 60% of pregnant women who are CMV positive so that the number of congenitally infected infants can be reduced.