Cytomegalovirus (CMV), a member of the human herpesvirus family, is the most common viral cause of congenital infection, affecting 0.2–2.2% of all live births. It is responsible for significant morbidity, especially in infants who are symptomatic in the neonatal period. It is the leading non-genetic cause of sensorineural hearing loss and a major cause of neurological disability. Around 10–15% of neonates with congenital CMV will be symptomatic at birth, with a similar percentage developing problems later in childhood.
This Scientific Impact Paper summarises the issues around screening, diagnosis and treatment of CMV in pregnancy, utilising the best available evidence and highlighting recent advances.
Khalil A, Heath P, Jones C, Soe A, Ville YGon behalf of the Royal College of Obstetricians and Gynaecologists. Congenital Cytomegalovirus Infection: Update on Treatment. Scientific Impact Paper No. 56. BJOG2017; DOI: 10.1111/1471-0528.14836.
Giving low dose aspirin to high-risk women reduced their risk of pre-eclampsia before 37 weeks of pregnancy. Preterm pre-eclampsia developed in 1.6% of women given 150mg aspirin daily compared with 4.3% who took a placebo.
Pre-eclampsia is a condition which can harm mother and baby. In the mother, it causes high blood pressure and protein in the urine, which can show in pregnancy after 20 weeks. Women with risk factors, such as previous pre-eclampsia, diabetes or high blood pressure, are often prescribed 75mg aspirin from 12 weeks onwards. This study aimed to test double this dose (still classified as a `low dose’) after using a new risk assessment with additional clinical tests to better identify those at high risk of the condition. Aspirin did not affect other pregnancy outcomes and didn’t increase the risk of adverse effects.
This research adds to current knowledge about the range of doses that is effective and refines the definition and detection of women at high risk. The research did not compare 75mg with 150mg doses.
The Royal College of Nursing has published Clinical nurse specialist in early pregnancy care. This document outlines the key skills and knowledge required to develop the role of the clinical nurse specialist in early pregnancy care. It is intended to provide direction for commissioners and managers when creating roles to support best practice in local service provision for women and their families.
The National Organisation for Foetal Alcohol Syndrome-UK (NOFAS-UK) has launched new materials designed to increase awareness about the risk of prenatal exposure to alcohol. The new materials include posters and a pre-release version of a booklet, which explains how to identify possible cases of fetal alcohol spectrum disorders (FASD).
The National Pregnancy in Diabetes (NPID) audit is part of the National Diabetes Audit (NDA) programme and is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The NDA is managed by the NHS Digital in partnership with Diabetes UK and is supported by Public Health England (PHE).
The audit is a measurement system to support improvement in the quality of care for women with diabetes who are pregnant or planning pregnancy and seeks to address the three key questions:
– Were women with diabetes adequately prepared for pregnancy?
– Were adverse maternal outcomes during pregnancy minimised?
– Were adverse fetal/infant outcomes minimised?
This report includes data on women with diabetes with completed pregnancies between 1 January 2016 and 31 December 2016.
Almost one in 10 women with Type 1 diabetes had at least one hospital admission for severe hypoglycaemia.
Testing for and then treating pregnant women with mild or “subclinical” underactive thyroid did not improve pregnancy outcomes, newborn baby outcomes, or the child’s IQ at three to five years.
A clearly underactive thyroid (clinical hypothyroidism) in pregnancy has been linked with various adverse outcomes for the mother and baby, including pre-eclampsia, preterm birth, congenital defects and neurodevelopmental delay. This needs treatment. However, there has been debate around the harms and benefits from treating only mildly abnormal blood test results in women who do not show signs of thyroid problems, subclinical hypothyroidism.
These two linked trials randomised 1,203 women with borderline abnormal levels of thyroid-related hormones (but not “clinical” or “overt” hypothyroidism) to receive thyroid replacement treatment, with levothyroxine, or placebo. Treatment had no benefits for mother or baby, including the main outcome of child IQ by three to five years of age.
This supports current UK practice, which does not routinely screen all pregnant women for subclinical thyroid dysfunction.
NHS England has published Manual for prescribed specialised services 2017/18. This manual is the detailed technical document that describes which elements of specialised services are commissioned by NHS England and which by Clinical Commissioning Groups.
Specialist maternity care for women diagnosed with abnormally invasive placenta includes services provided by Specialist Maternal Care Centres including outreach when delivered as part of a provider network.