Cytomegalovirus Infection During Pregnancy: Risks and Treatments

Cytomegalovirus (CMV)

Hello, doctor.
I am currently 15 weeks pregnant and recently tested positive for cytomegalovirus (CMV) infection.
What are the potential risks to the fetus? What kind of treatment is necessary? I have read some information online suggesting that termination of pregnancy is recommended, but I really do not want to terminate my pregnancy! I look forward to your response! Thank you!

Xiao Jie, 20~29 year old female. Ask Date: 2014/04/03

Dr. Lü Lizheng reply Obstetrics and Gynecology

Cytomegalovirus (CMV) infection is common, with many people contracting it during childhood.
However, it usually presents with no symptoms or only mild, cold-like symptoms, so individuals often do not remember having had it.
Those who have been infected can be identified through blood tests that reveal the presence of CMV antibodies.
Statistics indicate that up to 50% to 80% of adult women in the United States have detectable CMV antibodies, indicating that it is a widespread virus.
Therefore, if a pregnant woman tests positive for CMV antibodies during adulthood, there is no need for immediate concern; it simply indicates a past infection.
It is essential to investigate whether the infection occurred a long time ago or recently.
If it is a recent primary infection, there is a higher likelihood of affecting the fetus.
In contrast, if it is a long-standing infection or a reactivation, the risk is significantly lower, and monitoring is sufficient.
CMV antibodies can be classified into two types: IgM and IgG.
Measuring IgG levels is crucial; if there is a fourfold increase in IgG antibodies after two weeks, it is more likely to indicate a recent primary infection.
When measuring both IgM and IgG antibodies, a recent primary infection typically shows prominent IgM levels with only low to moderate IgG levels.
Conversely, if it is a long-standing infection with recent reactivation, IgG levels will be significantly elevated, while IgM levels will be less pronounced.
It is advisable to avoid making conclusions based solely on a single blood test report; tracking changes over time provides a more accurate assessment.
If a pregnant woman is indeed experiencing a first-time infection, about half of the fetuses will be unaffected, while the other half may be infected.
Among those infected, approximately 10% may experience severe effects, while 90% will have mild symptoms.
If the infection occurred a long time ago or is a reactivation, it typically poses no risk, and monitoring is sufficient.
The most accurate method for confirming a diagnosis is through amniocentesis, where viral culture or PCR (polymerase chain reaction) testing can detect the virus.
If the virus is found in the amniotic fluid, it indicates that the fetus has been infected, but the severity of the infection can vary from mild to severe.
Only severe cases may lead to long-term complications, which can be assessed through ultrasound to evaluate the development of the fetus's organs.
It is recommended to consult with an obstetrician specializing in prenatal diagnosis at a medical center, such as National Taiwan University Hospital, Chang Gung Memorial Hospital, or Mackay Memorial Hospital.
Sincerely, Dr.
Li-Cheng Lu, Taoyuan General Hospital.

Reply Date: 2014/04/03

More Info

Cytomegalovirus (CMV) infection during pregnancy is a significant concern, as it can pose risks to the developing fetus. CMV is a member of the herpesvirus family and is one of the most common congenital infections. It is important to understand both the risks associated with CMV infection during pregnancy and the available treatment options.

Risks to the Fetus
The primary risk of CMV infection during pregnancy is congenital CMV infection, which occurs when the virus is transmitted from the mother to the fetus. The risk of transmission increases with the gestational age at which the mother becomes infected. If a woman is infected with CMV for the first time during pregnancy, the risk of passing the virus to the fetus is approximately 30-40%.
Congenital CMV infection can lead to a range of outcomes, from asymptomatic infection to severe neurological and developmental issues. Some potential complications include:
1. Hearing Loss: This is the most common long-term consequence of congenital CMV infection. Studies suggest that about 10-15% of infants born with congenital CMV will have hearing loss that may not be apparent at birth.

2. Neurological Issues: Infants may develop developmental delays, intellectual disabilities, or motor impairments.

3. Vision Problems: CMV can cause chorioretinitis, leading to vision impairment.

4. Other Health Issues: Some infants may experience microcephaly, seizures, or other organ-related complications.

Diagnosis and Monitoring
If you have been diagnosed with a CMV infection during pregnancy, it is crucial to have regular follow-ups with your healthcare provider. They may recommend additional ultrasounds to monitor the growth and development of the fetus, as well as tests to assess any potential complications.

Treatment Options
Currently, there is no specific antiviral treatment for CMV infection during pregnancy that is universally recommended. The management of CMV infection primarily focuses on monitoring and supportive care. Here are some considerations:
1. Counseling and Support: It is essential to have open discussions with your healthcare provider about the risks and benefits of continuing the pregnancy. Emotional support and counseling can also be beneficial.

2. Regular Monitoring: Your healthcare provider may recommend regular ultrasounds to monitor fetal development and check for any signs of complications.

3. Postnatal Care: If the baby is born with congenital CMV infection, early intervention services, including hearing assessments and developmental support, can be crucial.

4. Consideration of Termination: While some sources may suggest considering termination of pregnancy in the case of severe infections, this is a deeply personal decision and should be made in consultation with your healthcare provider, taking into account your values and circumstances.

Conclusion
In summary, while CMV infection during pregnancy can pose risks to the fetus, many infants born to mothers with CMV infection are healthy. Regular monitoring and supportive care are essential. It is vital to maintain open communication with your healthcare provider to address any concerns and to receive personalized care tailored to your situation. If you have further questions or need more information, do not hesitate to reach out to your healthcare team for guidance and support.

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