Clinical and economic impact of universal screening for cytomegalovirus infection among pregnant women in Italy

Objective: To evaluate the clinical and economic impact of universal screening for cytomegalovirus (CMV) in pregnant women in Italy, with valacyclovir (VCV) therapy in the case of maternal primary CMV infection, compared with no screening. Methods: We developed a decision-analytic model using a deterministic decision tree and compared the no-screening strategy (Scenario 1) with universal screening until 13 + 6 weeks' gestation (Scenario 2), and universal screening until 23 + 6 weeks' gestation (Scenario 3) as recommended by the Italian National Health Service. The model was applied in a hypothetical population of 400 000 pregnant women, representative of the annual number of women giving birth in Italy. Only women susceptible to primary CMV infection were considered, in whom CMV screening by serological testing (IgG/IgM testing ± IgG avidity), followed by VCV treatment (8 g/day) in the case of primary CMV infection, is recommended. Outcomes included the numbers of primary maternal CMV infections diagnosed, fetal congenital CMV (cCMV) infections, terminations of pregnancy (TOPs) and symptomatic and asymptomatic neonatal cCMV infections, and the cost per symptomatic cCMV case avoided (in Euros (€)) from the perspective of the Italian National Health Service. Results: Universal screening until 13 + 6 weeks' gestation would identify 910 maternal primary CMV infections. Compared with no screening, it would prevent 92% of symptomatic cCMV infections (183 vs 15 cases) and prevent 70% of TOPs (33 vs 10 cases). Extending the universal screening period to 23 + 6 weeks' gestation would result in 280 additional diagnoses of maternal primary CMV infection and a further 2% and 9% reduction in symptomatic cCMV infections and TOPs, respectively. Both screening strategies would increase costs by approximately €7 million compared with Scenario 1, with a cost per symptomatic cCMV case avoided of ~ €45 500 for Scenario 2 and ~ €44 400 for Scenario 3. Conclusion: Universal serological CMV screening in pregnancy until 24 weeks' gestation, with VCV treatment in the case of maternal primary infection, substantially reduces the burden of cCMV-related disabilities and appears economically justifiable in the Italian healthcare context. These findings may inform policy decisions in countries with a similar CMV seroprevalence and National Health Service. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.