Cytomegalovirus (CMV) in pregnancy: symptoms, remedies and how it is contracted

Cytomegalovirus (CMV) in pregnancy: symptoms, remedies and how it is contracted
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Cytomegalovirus in pregnancy

What is Cytomegalovirus

Cytomegalovirus (CMV) is a very common virus belonging to the herpes virus family (such as chicken pox, cold sores or mononucleosis virus).





Symptoms

In adults and children who contract the infection on their own, symptoms are usually mild and general, such as:

  • temperature,
  • fatigue,
  • sore throat.

Often we do not even notice the disease.

The virus, however, can be a lot dangerous if contracted during pregnancy, because in this case it can pass to the fetus, with consequences that can be serious.

In this article

  • infection in pregnancy;
  • how do you know if you have contracted CMV ?;
  • but does it really make sense to take the test ?;
  • if you have already contracted the infection in the past, can you rest easy ?;
  • how do you know when you got the infection ?;
  • cytomegalovirus infection? Careful monitoring during pregnancy and after birth;
  • Is there a cure to prevent fetal infection or prevent harm to the baby?
  • how to avoid Cytomegalovirus infection.

See also the video on Cytomegalovirus in pregnancy

1. Infection in pregnancy

"If a woman contracts the virus for the first time during pregnancy, there is a risk that the fetus will also be infected and in this case we speak of congenital infection"underlines, head of the Operational Unit of Obstetrics and Gynecology at the Luigi Sacco Hospital in our city and professor at the University of our city. In this case, the risk of transmission to the fetus ranges from 30 to 40%. This means that out of ten babies of mothers who contract CMV during pregnancy, 3 or 4 also contract CMV.



But beware: even if the fetus has contracted the virus, it does not necessarily have consequences, short or long term. "Only 2 or 3 out of 10 fetuses with congenital infection will have consequences," she explains.

The problem is that, however rare, these consequences can be rather serious. He explains: "They can affect the central nervous system with malformations visible even in ultrasound, or they can cause mental retardation, congenital deafness, chorioretinitis (a pathology of the retina that causes blindness): all conditions that cannot be diagnosed in utero and which are noticeable only after the baby is born, sometimes even months or years later ".

The likelihood that a child with congenital CMV will exhibit one of these disabilities is greater if they had already shown symptoms as a newborn. Fortunately, 85-90% of newborns with congenital infection are asymptomatic and only about 10-15% of these babies show symptoms at birth, particularly liver, spleen, lung problems, or seizures.

Read also: Cytomegalovirus

2. How do you know if you have contracted CMV?

To find out if you have already contracted CMV, just take a blood test with the greed test, which searches for it presence of specific antibodies (called immunoglobulins) against the virus. In particular, two types of immunoglobulins are sought:



  • le IgM are the immunoglobulins that are formed when there is an acute infection in progress, so they signal that the disease is in progress.
  • le IgG they are the immunoglobulins of the 'memory' of the infection: if they are positive, it means that the disease has been contracted in the past and therefore the body has developed antibodies.

CMV: how to read the test results

  • IgM e IgG negative (i.e. lower than the reference values ​​indicated by the laboratory): it means that the woman has never contracted the infection. This means that you should pay attention to certain hygienic rules of prevention, especially if you have frequent contact with small children, who are more likely to get sick.
  • IgM negative e IgG positive: it means that the woman has already contracted CMV in the past but does not have an infection in progress. It is the most reassuring case since, even if the woman were to become infected again, it would be asecondary infection, which is much less dangerous than the primary one (i.e. contracted for the first time in pregnancy).
  •  IgM positive e IgG negative: indicates that the woman had never contracted the infection in the past, but that at this moment the infection is ongoing. It is a rare occurrence, since it would mean that the examination was done at the very beginning of the infection, when the IgG have not yet had time to activate. But it is also the riskiest occurrence, as it means that it is certainly a very recent infection. In this case, however, the test must be repeated in a specialized center that uses more sensitive methods of analysis (at least a second level hospital), to really confirm the positivity of IgM. "It can happen that women who tested positive in a test performed in a normal laboratory then tested negative in a test performed in a more suitable facility," she explains.
  •  IgM and IgG both positive: it means that the infection was there and could still be in progress, as well as it could mean that it occurred up to 3-4 months earlier, since IgM takes 3-4 months before becoming negative. "In this case, it is essential to try to know as precisely as possible when you contracted the disease" he points out "and this is possible with an examination called greed test: it may be that the infection dates back to the preconception period and therefore one can rest assured. If not, an amniocentesis will allow us to know if the infection has passed to the child. "
Read also: Cytomegalovirus, how to read the results

3. But does it really make sense to take the test?

The question of the appropriateness of routine screening is still very controversial, both because the risk of serious permanent consequences is still low, and because, once the infection has been identified, there are currently no effective therapies to counter it. Because of this many gynecologists prefer not to prescribe the test.

"Screening can make sense in the preconception stage or within the very first few weeks of pregnancy, so you know if you've already had the disease," she says. "If the woman is negative on the first test, it should be repeated in mid-pregnancy, around the 20th week".

The most serious consequences can be had if you contract the infection in the first half of pregnancy and at this point there is still time to evaluate a possible termination of pregnancy. After 20 weeks, however, it makes less sense: given that the risk of consequences is low and that in any case nothing can be done, there is only the risk of generating unnecessary anxiety.

4. If you have already contracted the infection in the past, can you rest easy?

"If the woman has had the infection in the past, she already has the antibodies and cannot be reinfected," he replies. "But it can happen a secondary infection, that is, it may happen that there is a reactivation of the viraemia. As it happens for chickenpox: the infection is caught only once, but the virus remains in the body in a latent form and then reactivates at some moments in life in the form of herpes, but it is not a new infection. In case of secondary infection, the risks are much lower and the possible harm less severe: the risks essentially concern women who contract CMV for the first time during pregnancy ".

5. How can I know when I got the cytomegalovirus infection?

Knowing exactly when an infection has occurred is very important, because the consequences for the fetus can be different. Before the second month of gestation, in fact, the 'all or nothing' rule applies: any infection either causes a miscarriage or is overcome without problems. The most critical situation, on the other hand, is due to primary infections contracted in the first half of pregnancy.


But how do you know when the infection has occurred, if for example you do the test for the first time in mid-pregnancy and the IgM are negative (so the infection is not in progress) but the IgG are positive? "In that case you can perform the so-called avidity test"replies the gynecologist." It is a further blood test that allows us to know if the infection has occurred in the previous three months or even earlier.

If primary infection is confirmed during pregnancy, it is advisable to contact a specialized facility. "At this point, in fact, it may be appropriate to understand if the infection has passed to the child or not" she stresses. The first step is asecond level fetal ultrasound, which can be performed in a specialized center, which carefully assesses the child's morphology. Even if, as we have said, the damage is not always visible ultrasonographically in the prenatal period.

To know for sure if the child has contracted the infection or not, the only possible test is theamniocentesis, which allows to identify any virus in the amniotic fluid. If the outcome of the amniocentesis is negative, you can rest assured. If the outcome is positive, prenatal counseling together with an expert is essential to analyze the individual case.

6. Cytomegalovirus infection? Careful monitoring during pregnancy and after birth

Pregnant

In case of primary infection, and even more so if fetal infection has also been confirmed, pregnancy is usually followed as high-risk pregnancy and more careful and assiduous checks are carried out. For example, a second level ultrasound is done on a monthly basis, for carefully monitor growth: a fetal CMV infection can in fact also involve a growth retardation, for this it may be necessary to give birth to the woman before term.

After birth

After birth, the newborn is followed according to more accurate protocols, which include serological and immunological tests, hearing tests, magnetic resonance imaging, brain ultrasound. This is why it is important to contact a level II or III facility, where the opportunity to carry out antiviral therapies is also evaluated.

7. Is there a cure to prevent fetal infection or prevent harm to the baby?

Unfortunately to date there is no proven effective therapy, neither to prevent maternal-fetal transmission nor to prevent any harm to the baby.

The good news is that scientific studies are underway on particular immunoglobulins (antibodies that should give a hand to the immune system of mom and baby) and if targeted antivirals that should fight the infection. At the moment, however, the research is still in an experimental phase and it is not known if it will really work. At the same point is also the research on a vaccine against CMV. "The only really effective measures to avoid CMV are preventive hygiene rules," he concludes.

8. How to avoid Cytomegalovirus infection

To limit the risk of infection, the most important precautions are of a hygienic nature:

  • avoid too close contact with children;
  • if there are children in the house wash your hands often, especially after touching a child's mouth or nose and changing it;
  • do not put the baby's pacifier in the mouth and do not share cutlery or glasses;
  • even if you don't live in contact with children, however, avoid very crowded places

Sources for this article: web page of OMaR, Rare Diseases Observatory; Epicentro web page (Higher Institute of Health); consultancy by, head of the Obstetrics and Gynecology Operational Unit at the Luigi Sacco Hospital in our city and professor at the University of our city.

9 PHOTOS

Ultrasound of the fetus: the images month after month

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What happens if the ultrasounds become author's? The result is the following: nine wonderful images documenting the development of the fetus in the mother's womb month by month ....

Video: The story of a positive mother for Cytomegalovirus

TAG:
  • toxoplasmosis
  • cytomegalovirus
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