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Cytomegalovirus (CMV Virus) and Pregnancy

Cytomegalovirus (CMV) PlacentitisCytomegalovirus, or the CMV virus, is a common virus in the herpes virus family that infects individuals of all ages. CMV is a common viral infection, especially among young children. The virus spreads from person to person through bodily fluids such as blood, saliva, mucus, urine, semen, and breast milk. Infection with CMV after birth rarely causes illness and is usually harmless with no long-term health consequences. Some infected individuals experience mild symptoms including sore throat, fever, swollen glands, fatigue, muscle aches, loss of appetite, and joint stiffness. By the age of 40, over half (50 to 80 in 100) of all adults have been infected with CMV. Although typically mild, CMV infection can cause serious health problems in individuals with weaken immune systems such as from HIV. CMV infection during pregnancy can cause serious disease in unborn babies.

CMV is the most common cause of congenital infection. Congenital CMV occurs when the cytomegalovirus crosses the placenta from a pregnant woman to her developing baby. Although many babies exposed to the CMV virus during pregnancy are born healthy, some babies with congenital CMV infection show signs at birth. Approximately one to four percent of women have CMV during pregnancy. A pregnant woman with CMV infection has a one-in-three chance (33 percent) of passing the virus onto her baby. Infection with CMV is most dangerous during the first trimester. CMV during pregnancy can cause miscarriage, stillbirth, and birth defects.

Most babies born with congenital CMV never develop symptoms or disabilities. Among the babies born with symptoms, some are temporary while others are permanent. Temporary symptoms of congenital CMV include liver problems, spleen problems, jaundice, purple skin splotches, lung problems, small birth size, and seizures. Permanent symptoms and disabilities associated with congenital CMV include hearing loss, vision loss, mental disability, microcephaly, intracranial calcifications, lack of coordination, Cerebral Palsy, feeding problems, failure to thrive, sleeping problems, behavior problems, sensory problems, seizures, hydrocephalus, and death.

Of all babies born with congenital CMV, 90 percent present as asymptomatic with no obvious and visible symptoms of the virus. Asymptomatic children typically live healthy lives following standard growth and development patterns. Some asymptomatic children experience minor challenges such as hearing loss (10 to 15 percent) and vision problems or loss (one to two percent). Children born with asymptomatic congenital CMV have a cognitive outcome typically within normal ranges for the majority of children and do not appear to experience major or minor motor or muscle tone difficulties.

The remaining 10 percent of babies born with congenital CMV present as symptomatic at birth and may exhibit visible symptoms such as small size for gestational age, jaundice, “blueberry muffin” skin rash called petechiae/purpira, enlarged liver, enlarged spleen, small head size (microcephaly), blood cell count problems, and low platelets. Three-fourths of symptomatic babies have signs of brain involvement and may experience major challenges during growth and development. Three-fourths of babies with symptomatic congenital CMV experience hearing problems and loss that progresses throughout life. Ten to 20 percent of symptomatic children experience vision problems or loss. Symptomatic children born with microcephaly and moderate-to-severe brain calcifications usually experience cognitive issues.

No licensed medications currently exist to treat congenital CMV infection, and no vaccines yet exist to prevent congenital CMV infection. However, the Institute of Medicine has ranked the development of a CMV vaccine as a highest priority for saving lives and preventing disability. Some evidence exists that ganciclovir, an antiviral drug, may prevent hearing loss and developmental outcomes in babies born with symptomatic congenital CMV infection with central nervous system involvement, but the drug has serious side effects and has been tested only in children with severe symptoms.

Pregnant women who acquire new CMV infections for the first time, or primary CMV infection, are at greatest risk for complications from the virus. CMV is not highly contagious but does spread in households and among young children in daycare centers, meaning pregnant women with other young children or who work with young children are at greatest risk of infection. The main way that women become infected with CMV is through the saliva and urine or small children. Pregnant women can minimize exposure through proper handwashing after coming into contact with body fluids such as after feeding a baby, wiping a nose, or changing a diaper. Pregnant women should also avoid sharing food, drinks, and cutlery with others and avoid kissing on the mouth.

Cytomegalovirus (CMV) Infographic

References

Congenital CMV Outcomes: https://www.nationalcmv.org/congenital-cmv/outcomes.aspx
Cytomegalovirus (CMV) and Congenital CMV Infection: http://www.cdc.gov/cmv/index.html
Cytomegalovirus (CMV) and Pregnancy: http://www.cdc.gov/pregnancy/cmv/
Cytomegalovirus (CMV) and Pregnancy: http://www.health.nsw.gov.au/Infectious/factsheets/Pages/cmv-and-pregnancy.aspx
Cytomegalovirus and Pregnancy: http://www.marchofdimes.org/complications/cytomegalovirus-and-pregnancy.aspx
Cytomegalovirus (CMV) and Congenital CMV Infection: Overview: http://www.cdc.gov/cmv/overview.html
Cytomegalovirus (CMV) Infection: http://americanpregnancy.org/pregnancy-complications/cytomegalovirus-infection/
Cytomegalovirus Infection in Pregnancy: Should All Women Be Screened?: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046747/
The “Silent” Global Burden of Congenital Cytomegalovirus: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553672/

Image Credits

Cytomegalovirus (CMV) Placentitis: https://commons.wikimedia.org/wiki/File:Cytomegalovirus_(CMV)_Placentitis_(3272294924).jpg
Cytomegalovirus (CMV) Infographic: http://photokapi.com/2013/03/cmv-by-the-numbers/

  • Amber Ludwig

    Whoa… this is something Ive never heard of!! Are we tested for this in pregnancy??

  • GillisHills

    Yikes, I’ve never heard of this virus. Thanks for sharing!

  • @Erin_Havel

    Thanks for posting this. It’s something our fertility specialist tried to explain, but not in quite so much detail.

  • Dogvills

    This is great information. I knew about the herpes virus, but I thought this is only a sexually transmitted disease. I learned a lot today.

  • PennyPincherJenny

    Great information!! I have not heard of the CMV virus before, I know when I was pregnant I was so scared of getting any viruses.

  • I hadn’t heard of CMV. Thankful that is not a concern for me since I am done having babies.

  • It’s a little nerve wracking that it can spread in daycare centers. This is all great info.

  • Aeryn Lynne

    That’s an interesting infographic. Its wild to see how the most common illness attributed to long term medical conditions in childreb, CMV, according to that graphic, is the one women are made least aware of.

    • I had never heard of CMV until recently. Pregnant women definitely need more information about the virus.

  • Chelley Martinka

    I’ve never heard of this before! Thank you for sharing- this is such important information.

  • Julie Wunder

    Wow! I have never heard of this before. Thanks for the lesson and raising awareness. Sounds like this a great vaccine to work on.

  • Brianna

    WOW. I haven’t heard of this before in such detail. I had no idea it caused so many issues in prenancy.

  • Laura

    I actually haven’t heard of this before. Thank you for sharing!!!

  • That’s a really interesting post. I didn’t know that a CMV virus exists.

    http://www.mydailywear.co.uk

  • How interesting! I never heard of CMV during my pregnancy.

  • Lola

    Scary! I only vaguely new abour CMV before. I will be more aware if I ever have another baby!

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