Current Practices in Antenatal CMV Testing and Management in Belgium

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.

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.

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.

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.