Pre‐conception care: an important yet underutilised preventive care strategy

In reply: We write in response to the letter by Shand and colleagues highlighting the importance of cytomegalovirus (CMV) as a significant congenital infection that deserves attention in the pre‐conception period. We recognise that the only preventive strategy currently available is to raise awareness about hygienic measures during pregnancy. These measures include avoidance of contact with bodily fluids of young children, including with their saliva and urine, due to high levels of CMV excretion in infected infants and pre‐school aged children. Avoiding kissing on the cheeks or mouth, sharing of food, drinks, utensils, towels and washcloths and handwashing after possible exposure is recommended. Several studies, including two cluster randomised trials,1,2 have demonstrated that such behavioural measures in pregnant women reduce CMV seroconversion. More recent evidence from an interventional and observational controlled trial, in which women in the intervention arm received an information session in the first trimester of pregnancy about the virus and were advised to adopt a range of preventive measures to limit contact with bodily fluids,3 found that seroconversion occurred in four of 331 pregnant women (1.2%) in the intervention group, compared with 24 of 315 (7.6%) in the comparison group (absolute risk reduction, Δ = 6.4%; 95% CI, 3.2–9.6; P < 0.001).3

While these interventions are reportedly easy to adopt, we recognise that there is a lack of community and professional understanding of CMV and that greater knowledge about preventive strategies could have a positive impact on the transmission rate.4 However, all the evidence to date relates to women who are already pregnant, and recommendations focus on advice in the antenatal period, with the exception of women who have an occupational exposure.5 While evidence‐informed general information about prevention of CMV in pregnancy can be provided in the pre‐conception consultation, we believe that, for most women, the focus should be on education and interventions during pregnancy.