BEHAVIORAL INTERVENTION FOR CONGENITAL CMV DISEASE

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DESCRIPTION: The investigators propose to use behavioral modification during pregnancy to prevent the child-to-mother transmission of a common virus called cytomegalovirus (CMV). This is important because annually intrauterine infection with CMV causes up to 8,000 infants to be mentally retarded and/or deaf. This occurs because mothers without immunity (seronegative) with young children attending day care have annual rates of infection of nearly 50 percent per year compared to a rate of less than five percent among women not in daily contact with young children in day care. Fetal damage occurs if seronegative women acquire CMV during pregnancy and three quarters of seronegative mothers who conceive another child do so with a previous child under 30 months of age in group day care. At least 15 percent of these children are shedding CMV. The investigators have completed two pilot studies to determine if behavioral modification reduced child-to-mother transmission of CMV. They found that behavioral intervention was unlikely to be effective for nonpregnant women but likely to be highly effective for pregnant women. To determine the true reduction in relative risk for pregnant women afforded by behavioral intervention and to determine whether a motivational factor is knowledge by seronegative pregnant mother of whether her child is shedding CMV, seronegative pregnant women will be recruited from 200 day care centers in five cities in the United States and randomly assigned by day care center to either a control group or one of two education groups. Mothers in the control group and one education group are not told whether if their child is shedding CMV. Mothers in the other education group know their child's status. Mothers in both education groups will be given instructions about protective behaviors (frequent hand washing, wearing latex gloves) and risky behaviors to avoid (intimate contact with the child). Glove and soap use will be monitored for an indirect objective measure of adherence to the protective behaviors. Mothers self-report percentages of protective and risky behaviors throughout the study. The results of this trial will determine the effectiveness of behavioral intervention and the motivation necessary to adhere to recommendations and prevent child-to-mother transmission of CMV.