Australian general practitioners’ perspectives on antenatal congenital cytomegalovirus prevention and screening: a cross-sectional survey

Technical Summary: Australian General Practitioners' Perspectives on Antenatal Congenital Cytomegalovirus Prevention and Screening

Problem Statement
Congenital cytomegalovirus (CMV) is the most common congenital infection and a leading infectious cause of childhood disability in Australia, including sensorineural hearing loss and neurodevelopmental impairment. Despite the high burden of disease, with an estimated 34–50% of pregnant women being seronegative and susceptible to primary infection, CMV prevention and screening have historically received limited attention in routine antenatal care. Current Australian guidelines emphasize primary prevention through hygiene counseling, yet fewer than 10% of healthcare providers routinely discuss these measures. Furthermore, while recent guideline updates recommend offering CMV IgG testing to women at increased risk, and evidence suggests antiviral therapy (valaciclovir) can reduce fetal infection if administered early, the applicability of universal screening models in Australian general practice remains uncertain. As general practitioners (GPs) manage most early pregnancy care, their readiness and perspectives are central to implementing prevention recommendations and planning future screening guidance.

Methodology
The study employed a national cross-sectional online survey conducted between May and October 2025. The target population included Australian-registered GPs and GP registrars currently providing antenatal care. Recruitment occurred through Primary Health Networks (PHNs), hospital shared maternity care mailing lists, professional networks, medical education events, and social media.

A purpose-designed questionnaire, administered via REDCap™, was developed by a multidisciplinary team including two GPs and piloted with four GPs to ensure clarity and relevance. The survey took approximately 10 minutes to complete and utilized multiple-choice, Likert scale, and open-text responses. It assessed:

1. Current CMV risk-reduction and testing practices.
2. Attitudes toward a hypothetical model of universal first-trimester CMV screening followed by repeat testing at 12–13 weeks for seronegative women.
3. Confidence in counseling and follow-up.
4. Perceived system and resource gaps.

Data analysis involved descriptive statistics, with subgroup comparisons (metropolitan vs. non-metropolitan; shared maternity care vs. non-shared) performed using chi-squared tests. Ethics approval was obtained from the University of Melbourne Human Research Ethics Committee.

Key Results
A total of 263 eligible respondents participated, representing all Australian states and territories. Key findings include:

• Current Practices: CMV risk-reduction counseling is inconsistent; only 30% of GPs routinely counsel all pregnant patients, while 33% provide no counseling. The primary barriers cited were lack of awareness of recommendations, lack of confidence, and limited consultation time. Counseling is predominantly verbal (96%), with minimal use of digital or printed materials. Routine serological testing is also uncommon, with only 18% testing all patients and 36% testing selectively.
• Attitudes Toward Screening: There is overwhelming support (98%) for a hypothetical model of universal antenatal CMV screening if recommended by a health authority. Most respondents (94%) agreed it would be easy to incorporate CMV IgG testing into the first antenatal visit.
• Confidence and Systems: While 78% of GPs felt confident in pre-test counseling, confidence dropped for post-test counseling (64%). Regarding follow-up, 81% felt they could easily ensure repeat serology for seronegative women, and 85% reported having practice systems (e.g., recall functions) to support this. Shared maternity care GPs reported significantly higher confidence and system availability compared to non-shared care GPs.
• Resource and System Gaps: The most frequently identified need was formal guidance from professional bodies (e.g., RANZCOG, RACGP). GPs highlighted a lack of access to patient information in languages other than English and resources for low health literacy. Notably, fewer than half (47%) were confident that specialist review would occur within 10 days of referral, with shared care GPs expressing higher confidence than non-shared care GPs.

Key Contributions
This study provides the first national baseline data on Australian GP readiness for universal antenatal CMV screening. It identifies that while clinician acceptability is high, current implementation of prevention and testing is inconsistent due to operational barriers rather than resistance to the concept itself. The paper delineates specific gaps in the healthcare infrastructure, including the need for standardized guidance, improved access to culturally and linguistically diverse patient resources, and clearer referral pathways to tertiary care. It also highlights potential inequities in implementation capacity between shared maternity care and general practice settings, as well as between metropolitan and non-metropolitan regions.

Significance and Claims
The authors claim that Australian GPs are receptive to guideline-endorsed universal antenatal CMV screening and view its integration into routine early pregnancy care as feasible. However, the paper modestly concludes that consistent and equitable delivery is currently hindered by infrastructure deficits rather than clinician reluctance. The study suggests that successful implementation depends less on changing clinician attitudes and more on addressing practical factors: clarifying current guidance, expanding GP-specific education, disseminating appropriate patient resources, and establishing accountable, timely referral pathways between primary and tertiary care. The findings serve as a foundational reference for policymakers and health systems considering the evolution of CMV screening policy in Australia.