孕期巨細胞病毒感染與台灣產檢政策建議

Cytomegalovirus infection during pregnancy and recommendations for prenatal screening policy in Taiwan

新生兒先天性CMV感染（cCMV）來自母體孕期，發生率約1/100，其中1/5有神經發展或聽損後遺症，此發生率高於台灣多數公費與自費產檢項目所預防疾病。新近研究證實：對「第一孕期、初次感染」孕婦，抗病毒藥物valacyclovir能減少70%垂直感染；羊水CMV PCR可診斷胎兒感染，valacyclovir能預防、治療胎兒感染。雖然cCMV發生率高、危害大、可檢出、可預防，在台灣卻非公費產檢項目，也缺乏篩檢共識與照護準則。此外在臨床實務上，胎兒感染cCMV常衍生晚期終止妊娠倫理難題，本文就此釐清現行優生保健法施行細則的文字疑慮，並提出建議修改方案。為增進母胎健康，本文參考國際近年相關研究，建議在台灣執行母血CMV抗體篩檢。初步試算可用199.6萬元減少一個胎兒感染，具有相對公共衛生效益。普遍篩檢也可及早用藥預防胎兒感染，減少晚期終止妊娠倫理困境。最後，本文草擬防治cCMV三級防護架構，並提出衛教資料範本：一、全面衛教；二、對第一孕期孕婦全面公費篩檢CMV抗體；三、治療胎兒感染。

Congenital cytomegalovirus (cCMV) infection in newborns, which is contracted via transmission from the mother during pregnancy, affects approximately 1 in 100 births. Approximately one-fifth of these cases lead to neurological impairment or hearing loss—sequelae more common than those prevented by most publicly or privately funded prenatal screening programs in Taiwan. Recent studies have demonstrated that valacyclovir can reduce vertical transmission by 70% in women with primary infection during the first trimester. CMV PCR testing of amniotic fluid can be used to diagnose fetal infection, and valacyclovir can prevent and treat fetal infections. Despite its high incidence, substantial risks, detectability, and preventability, cCMV screening is not included in Taiwan’s publicly funded prenatal programs, and a consensus on screening or care guidelines has not been established. In practice, diagnosed fetal cCMV often raises ethical dilemmas regarding late-term pregnancy termination. This article clarifies the wording of the Reproductive Health Act and proposes amendments. To improve maternal and fetal health in Taiwan, this article—drawing on recent international research—recommends universal serological screening for CMV antibody in pregnant women. Preliminary calculations suggest that this could reduce the burden of one fetal infection by NT$1.996 million, representing a relative public health benefit. Universal screening can also enable early antiviral intervention for preventing fetal infection, minimizing ethical dilemmas over late-term pregnancy termination. Finally, this paper drafts a three-tiered framework for cCMV prevention and proposes a template for health education materials: 1. comprehensive health education; 2. publicly funded CMV antibody screening for all pregnant women in the first trimester; and 3. treatment of fetal infections.