Elena Costa

Objective: To describe current practices regarding antenatal cytomegalovirus (CMV) testing, valaciclovir treatment and termination of pregnancy (TOP) in Belgium, where universal antenatal CMV screening is not recommended and testing during pregnancy is not reimbursed. Method: We conducted an online survey of practitioners involved in antenatal care or specialist management of CMV (obstetricians, midwives, general practitioners, fetal medicine specialists) between September and November 2024. Quantitative data from complete questionnaires were analyzed using descriptive statistics, and responses to open questions underwent thematic analysis. Results: We analyzed 298 complete responses. Most respondents (89.4%) reported requesting antenatal CMV testing despite antenatal CMV screening not being recommended in Belgium and the absence of routine reimbursement for CMV testing during pregnancy. Antenatal testing may have included both determination of maternal serostatus and testing intended to detect primary maternal infection or seroconversion. Testing objectives included fetal imaging follow‐up, hygiene counseling, and prevention of vertical transmission with valaciclovir, while considering TOP was less frequently cited. TOP was perceived as occurring at all stages after maternal infection, but predominantly in cases of severe fetal involvement. Among fetal medicine specialists, 51.7% prescribed valaciclovir routinely, while others prescribed it non‐routinely. Treatment acceptance and adherence were perceived as good, with cost identified as the main barrier for treatment acceptance and high pill burden identified as the main barrier for treatment adherence. Conclusion: Antenatal CMV testing was commonly reported among respondents, despite heterogeneous use due to cost barriers. TOP may occur even in cases without severe fetal involvement, underscoring the need for high‐quality counseling and updated national guidance.

Introduction: During the COVID-19 pandemic, gestational diabetes mellitus (GDM) prevalence showed variable changes across regions, with most reporting increases and others decreases; anxiety and lifestyle modifications linked to pandemic-related restrictions have been proposed as potential contributors in case of increase, while changes to less stringent screening strategies in case of decrease. The correlation of the GDM variation according to the intensity of pandemic restrictions has not been described to date. Our study aimed to examine the correlation between hyperglycemia in pregnancy (HIP) prevalence and pandemic-related restrictions measured by the Stringency Index (SI) and compare neonatal weight percentiles between the pre pandemic and the pandemic period. Materials and Methods: We included all singleton live births in Belgium in 2019 and 2020 from Belgian birth registry data (n=229,170). We compared monthly proportions of HIP prevalence and Small for gestational age (SGA) and Large for gestional age (LGA) newborns in 2019 and 2020. Crude and adjusted odds ratios (ORs, aORs) for socio-economic status, maternal age, parity and BMI were estimated with logistic and multinomial regression. The Spearman correlation coefficient was used to assess the correlation between the monthly average SI and the monthly aORs of HIP. Results: For deliveries from January to June 2020, no significant differences in HIP prevalence were observed compared with 2019. For births occurred July to December 2020, there was a significant increase in HIP, with peaks in July (GDM screening in April) (aOR 1.41, 1.26–1.58) and November (GDM screening in August) (aOR 1.33, 95% CI 1.18–1.49). The Spearman correlation coefficient between the SI and HIP aORs was 0.82 (p = 0.01).There was no significant change in neonatal weight percentiles. Conclusion: During the pandemic, we observed an increase in the prevalence of HIP and its increase during the was strongly correlated with the corresponding SI. There was no measurable impact on the frequency of LGA or SGA newborns. These results may be useful to anticipate unintended consequences of future public health emergencies requiring similar containment measures.

À l’heure actuelle, en Belgique, la prise en charge des infections à cytomégalovirus (CMV) au cours de la grossesse varie beaucoup d’un prestataire de soins à l’autre. Avec son nouveau guide clinique, le Centre Fédéral d’Expertise des Soins de Santé (KCE) espère l’harmoniser davantage et améliorer les soins aux futures mamans et à leurs bébés. En cas d’infection primaire au début de la grossesse, le médecin peut prescrire un inhibiteur viral (valaciclovir) à forte dose pour abaisser le risque de symptômes à la naissance, mais des recherches supplémentaires à ce sujet restent nécessaires. Le KCE plaide pour que ce traitement soit temporairement remboursé pendant que des données sont collectées de façon systématique en vue du suivi de son efficacité et de sa sécurité.

De huidige aanpak van cytomegalovirus (CMV)- infectie bij zwangerschap varieert in België sterk tussen zorgverleners. Een nieuwe richtlijn van het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) wil deze aanpak harmoniseren en de zorg voor moeder en baby verbeteren. Bij primaire infectie vroeg in de zwangerschap kunnen artsen een hoge dosis virusremmer (valaciclovir) voorschrijven, om de kans op symptomen bij de geboorte te verlagen, al is meer onderzoek nodig. Het KCE pleit voor een tijdelijke terugbetaling van het middel, terwijl systematisch gegevens worden verzameld om de effectiviteit en veiligheid ervan op te volgen.