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Cytomegalovirus Infection in Pregnant Women - Symptoms, Prevention and Treatment

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Cytomegalovirus infection is one of the various infections transmitted from an infected mother to the fetus. Learn more about this in this article.

Medically reviewed by

Dr. Richa Agarwal

Published At June 3, 2022
Reviewed AtJune 14, 2023

Introduction:

Any infection transmitted to a child from a pregnant mother is called a congenitally acquired infection. Several medical conditions show a transplacental transmission; one such kind with a wide prevalence is a cytomegalovirus (CMV) infection. CMV infection, though prevalent, has not gained much attention as such, as it goes unnoticed by many due to its symptomless nature. It is caused by a type of herpes virus. A thorough awareness of the ill effects and caution are essential factors in fighting this infection and saving infants from serious complications. Read further to know more about how this condition affects a pregnant mother and her offspring.

What Are the Must-Knowings About CMV Infection?

Cytomegalovirus infection is one of the commonly occurring conditions that affect people irrespective of their age, and it noticeably affects almost half of the people in their 40s. It is prevalent among all age groups. Once infected by this virus, there is no end to it; It can never be eradicated from the infected person's body and stays there for a lifetime. CMV does not make the person symptomatic or cause any harm unless the infected person is immunocompromised, like people with HIV, under immunosuppressive medications, or who have had organ transplants. If someone is immunocompromised, they may show symptoms such as CMV pneumonitis, CMV retinitis, CMV gastritis, and CMV encephalitis. This infection also can happen more than once, having different strains as the cause. CMV infection also tends to reactivate other illnesses that are dormant.

How Common Is CMV Infection in Pregnancy?

A pregnant woman usually would not even know of the underlying CMV infection until the baby's CMV reports are positive, as it often remains symptom-free throughout pregnancy. A CMV infection rarely shows symptoms; even if symptoms occur, they are similar to those in other medical conditions such asfever, throat problems, tiredness, lymph node enlargement, etc. But sometimes, when the mother is weak, there can be severe or fatal complications. It is also reported that around half of the women of childbearing age encounter CMV infection, and roughly one to four percent get it when pregnant.

How Does CMV Infection Affect a Pregnant Woman?

Cytomegalovirus infection could cause problems for the pregnant mother and the child. The common complications include the following:

  • The delivery could happen preterm.

  • The child could be born with a relatively low birth weight.

  • The child could be born with a developmental anomaly or show a defect in later stages of life.

  • Unfortunately,cytomegalovirusinfection can cause miscarriages in pregnant women as well.

When Does an Infant Get Infected With CMV?

An infant can get infected with cytomegalovirus anywhere before or after birth if the pregnant woman was infected with the virus before or during pregnancy.

  • If the infection occurs in the mother's womb, it is called congenital CMV.

  • If the newborn gets infected immediately after birth or while feeding on the mother's breast milk, it is called perinatal CMV.

  • In the later stages, the infection gets reactivated or transmitted through factors such as a compromised or weak immune system, getting a blood transfusion, etc.

How Prevalent Is the CMV Transplacental Transmission?

When CMV has infected a pregnant mother, the mother's risk of infecting the child starts being a concern. Reports show that there have been around 40% of reported cases with transplacental transmission, whereas the rest has not demonstrated any transmission. However, the cause of transmission is still unknown. Also, the risk of transmission is more when the mother gets infected during pregnancy than when carrying the infection before getting pregnant.

What Are the Symptoms in a CMV-Infected Baby?

The signs that a baby shows at birth if infected by CMV include,

  • Microcephaly (an abnormally small head).

  • Anemia.

  • Low birth weight.

  • Hepatomegaly (enlarged liver).

  • Splenomegaly (enlarged spleen).

  • Seizures at birth.

  • Skin rashes.

  • Jaundice(yellowish discoloration of skin, sclera (white part) of the eye, and mucus membranes).

The symptoms that might happen in later stages include the following;

  • Hearing and vision loss.

  • Frequent incidence of seizures.

  • Delayed or lack of motor response and mental retardation results in symptoms such as lack of coordination and compromised intellectual capacity.

How Is CMV Infection Confirmed?

  • Though tests are not advised periodically to rule out CMV infection in pregnant women, CMV IgG antibody testing is done when suspected. It rules out if the pregnant woman is infected with CMV or not.

  • A second test called IgM antibody testing rules out if it is a current or a previously existing infection.

  • Only if the first and the second tests come out positive, is a third test called the CMV IgG avidity index done to analyze if the infection is lesser or more than four months old. High and low levels of CMV IgG index represent more than four months old and less than four months old infection, respectively.

  • CMV infection can be ruled out in a newborn by examining the body fluids such as urine, saliva, and blood. Testing for CMV infection in the urine is, however, considered the most reliable testing.

  • Care should be taken that the baby is tested for CMV infection within the first three weeks at maximum since birth.

How Can CMV Infection Be Prevented?

CMV can be prevented from infecting a pregnant mother by avoiding contact with any of the body fluids of an infected person. The habits that need attention include; having sex with an infected partner and kissing, as CMV can pass through saliva. In babies, activities such as kissing should be avoided to prevent contracting CMV infection from an infected parent or a sibling.

How Is CMV Infection Treated?

Also, there is no proper treatment for CMV-infected pregnant mothers; the following treatment options have been considered;

  • The mother should be administered intravenous CMV hyper immunoglobulin as prophylaxis or as treatment. Prophylactic dose prevents transmission to the fetus and minimizes the complications associated.

  • Pregnancy termination has been considered an option as and when CMV infection is ruled out unless it is too late.

  • Administering antiviral drugs could help settle the infection.

  • In addition, ultrasounds are taken to analyze the fetal status.

The treatment in infants is based on how early the infection is ruled out. Earlier the treatment, the lesser the severity. Some minor cases settle down with proper care and rest. Whereas in others, children are prescribed antivirals to fight CMV infection. Taking antivirals at earlier stages decreases the risk of severe health complications and conditions like hearing loss. Also, children should be kept in check for hearing, as it is one of the significant complications of a CMV infection.

Conclusion:

CMV infection is often harmless and asymptomatic, even when pregnant. But, if affected with any other disease or having a weak immune system, there could be associated complications. Hence, keeping the immune system in check, staying away from any other health complications, and being cautious not to come in contact with an infected person play a significant role in protecting the pregnant mother and child from contracting the infection. Precaution helps avoid this viral infection.

Frequently Asked Questions

1.

Can a Pregnant Woman Become Infected With Cytomegalovirus?

Infection with Cytomegalovirus could be harmful to both the pregnant woman and the kid. Because the underlying Cytomegalovirus infection generally remains symptom-free throughout pregnancy.

2.

How Can CMV Harm a Fetus?

An infection with the Cytomegalovirus could be harmful to both the unborn child and the pregnant woman. The following are some of the typical complications:
- A premature birth could occur.
- The newborn can have a relatively low birth weight.
- The child can exhibit a deficiency later in life or have developmental abnormalities at birth.
- Cytomegalovirus infection can also result in miscarriages in expectant mothers.

3.

Do Symptoms Indicate CMV Infection During Pregnancy?

Underlying Cytomegalovirus infection frequently goes symptom-free throughout pregnancy; a pregnant woman typically would not even be aware of having it until the baby's Cytomegalovirus results come back positive.

4.

Which Trimester Has the Highest Risk of CMV?

In the diagnosis of fetal infection, Cytomegalovirus infection must be found in the amniotic fluid after 20 to 21 weeks (fifth month) of gestation and at least six weeks after the mother's infection. 

5.

Should A Pregnant Woman Be Concerned About CMV?

A cytomegalovirus-infected pregnant mother can spread the infection to her unborn child. Congenital Cytomegalovirus can result in birth deformities and other health issues.

6.

What Is the Pregnant Treatment for CMV?

Moreover, there is no effective treatment for women who are CMV-infected during pregnancy; the following possibilities have been taken into consideration:
- Intravenous CMV high immunoglobulin should be given to the mother as either a preventative measure or a therapeutic measure. A prophylactic dose reduces complications by preventing transmission to the fetus.
- Pregnancy termination has been regarded as an option.
- Antiviral medication aids in clearing up the illness.

7.

What Happens If Patients Have CMV?

If the patients have Cytomegalovirus, they may experience the following symptoms:
- Vision and hearing impairment.
- Seizures occur frequently.
- Mental retardation and delayed or absent motor responses cause symptoms, including poor coordination and diminished intellectual capacity.

8.

Can CMV Be Shown on an Ultrasound?

Some of the problems brought on by congenital CMV, including sluggish development, a tiny head, a big placenta, and altered brain anatomy, can be seen on ultrasound. However, a lot of infants with congenital CMV would not show any infection on ultrasonography.

9.

How Long Does It Take for CMV to Heal?

Once a patient is infected, the virus remains in their body forever. While CMV rarely creates issues in healthy individuals, the majority of people are unaware that they have it. CMV is a problem if a patient is expecting a child or has a compromised immune system.

10.

What if CMV Igg Is Found to Be Positive During Pregnancy?

A quick blood test called a CMV Immunoglobulin G antibody can be used to check for CMV infection. It will reveal whether the expectant mother has CMV. A positive test result signifies a CMV infection, either recent or past.

11.

What Destroys the CMV Virus?

The main antiviral therapies for CMV at the moment are:
 - Intravenous Ganciclovir.
 - Oral Valganciclovir.

12.

How Effective Is CMV Treatment?

Depending on the severity of the symptoms and indicators will determine the type of treatment. The most prevalent method of treatment is antiviral medicine. The virus cannot be completely eradicated, but it can halt its growth.
Dr. Richa Agarwal
Dr. Richa Agarwal

Obstetrics and Gynecology

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cytomegalovirus
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