Public Health Implications of High Cytomegalovirus Seroprevalence in Pregnancy: A Cross‐Sectional Study in Western Uganda

Abstract

Background: Cytomegalovirus (CMV) is a common maternal infection associated with adverse fetal and neonatal outcomes, yet data among pregnant women in Uganda remain limited. This study assessed CMV seroprevalence and associated factors in western Uganda. Methods: We conducted a cross-sectional study from January to April 2024 among 351 immediate postpartum women consecutively enrolled at Fort Portal Regional Referral Hospital in western Uganda, enrolled through consecutive sampling. Sociodemographic, obstetric, and medical data were collected using pretested questionnaires. Maternal serum samples were tested for CMV immunoglobulin G (IgG) and immunoglobulin M (IgM) using laboratory immunoassays (ELISA/CLIA). IgM-positive or equivocal samples underwent reflex IgG avidity testing to differentiate recent primary from chronic or non-primary infection. CMV serostatus was classified as seronegative or seropositive, with seropositive cases further categorized as acute or chronic infection. Data were analyzed using STATA version 14.2, applying bivariate and multivariate logistic regression at a 95% confidence level. Results: The overall CMV seroprevalence was 81.2% (95% confidence interval [CI]: 76.7%-84.97%). Chronic or non-primary infection accounted for 78.9% of cases, whereas acute infection was identified in 2.3% of participants. CMV seropositivity was independently associated with maternal age 25-34 years (adjusted odds ratio [aOR]: 2.9, 95% CI: 1.44-5.83) and ≥35 years (aOR: 4.6, 95% CI: 1.80-11.52), rural residence (aOR: 2.2, 95% CI: 1.20-4.15), lower education levels, and a history of spontaneous abortion (aOR: 3.2, 95% CI: 1.21-8.72). Conclusions: CMV infection is highly prevalent among pregnant women in western Uganda, predominantly reflecting chronic infection. The identified sociodemographic and obstetric risk factors underscore the need for targeted public health education, consideration of antenatal CMV screening strategies, and interventions to reduce CMV-related maternal and neonatal morbidity.