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What is cytomegalovirus?
Cytomegalovirus (CMV) is a member of the herpes virus family. It's the virus most frequently passed on to babies during pregnancy. According to the American Academy of Pediatrics, about 1 percent of babies are born with the infection, a condition called congenital CMV.
Most babies with congenital CMV have no problems from the condition. But some are very ill at birth and may end up with a number of long-term problems. Others may seem fine initially but develop hearing loss and other complications from the infection months or even years later. The Centers for Disease Control and Prevention (CDC) estimates that about 1 in 750 babies are born with or develop disabilities as a result of congenital CMV.
What are my chances of transmitting the infection to my baby if I've been infected with CMV?
It depends on when you first became infected with the virus. At least 50 percent of women already have antibodies to CMV before they get pregnant, meaning they were previously infected. (Most people with CMV don't develop any symptoms, so you probably wouldn't know if you'd ever been infected.)
Like other herpes viruses, CMV remains dormant in your body after your initial infection. The virus can later become reactivated, particularly if your immune system is compromised, resulting in what's known as a recurrent CMV infection.
Fortunately, the risk of passing the virus to your baby during a recurrent infection is very low (the CDC estimates it to be about 1 percent) and the risk of serious complications is even lower. So if you got your first CMV infection at least six months before you conceived, the risk to your baby from CMV is very small.
However, if you become infected for the first time during pregnancy, the chance of passing the virus to your baby is much higher. About 1 to 4 percent of previously uninfected women have a first (or primary) CMV infection during pregnancy. Among these women there's about a 30 to 50 percent chance that the baby will become infected in the womb. And the chance that the baby will end up with serious health problems from the virus is also much higher.
Will my baby have health problems if he's born with the infection?
About 85 to 90 percent of newborns with congenital CMV have "silent" infections, meaning that they have no symptoms at birth. The vast majority of these babies continue to do well and end up having no CMV-related complications. (Some of these babies — about 5 to 15 percent —develop problems later, most commonly hearing loss.)
The other 10 to 15 percent of newborns infected with CMV in the womb have serious complications that are present at birth, such as central nervous system abnormalities, growth restriction, an unusually small head, an enlarged spleen and liver, jaundice, and a rash caused by bleeding underneath the skin. Some of these babies die. And up to 90 percent of the survivors end up with serious long-term health problems, which may include hearing loss, visual impairment, intellectual disability, and other neurological problems.
How might I become infected with CMV?
CMV is spread by direct contact with an infected person's bodily fluids, such as saliva, urine, feces, semen, vaginal secretions, blood, tears, and breast milk.
You can become infected if, for example, you share eating utensils, kiss mouth to mouth, or have sex with an infected person. You can also get CMV if you touch infected fluid and then touch your mouth or nose.
How is the virus transmitted from mother to baby?
During pregnancy, transmission of the virus to your baby may occur through the placenta. Or a baby may get CMV by coming into contact with infectious secretions or blood during birth or later through infected breast milk.
Most babies who contract the virus during birth or from breastfeeding (particularly those who are full-term) develop few or no symptoms or later problems from the infection. So infected mothers may deliver vaginally and, in most cases, breastfeed their babies.
How can I tell if I have CMV?
Without testing, you can't tell. Most people don't know whether they've had a CMV infection in the past or have one currently because unless they have a weakened immune system, they're not likely to develop any symptoms. Those who do tend to have symptoms that mimic mononucleosis— fever, swollen glands, and a sore throat. You may also feel tired and achy.
There are blood tests to check for CMV, but many pregnant women don't get them. (Neither the CDC nor ACOG currently recommend routine blood screening.) But you would be tested in certain circumstances, such as if an ultrasound shows a suspicious finding that may be CMV-related, you happen to have any symptoms of the infection, or you suspect you've recently been exposed to CMV.
Discuss testing with your practitioner if you spend a lot of time around young children, particularly if you work in a daycare center or if a child you have close contact with attends daycare. Many young children get CMV, and they tend to be contagious for a relatively long time.
If you're suspected of having CMV, you may be referred to a high risk pregnancy doctor.
What will happen if I do have CMV?
If the blood tests show that you've had a recent infection, you'll get a thorough ultrasound to look for CMV-related abnormalities in your developing baby or the placenta. You may also have amniocentesis to see if your baby has CMV, but this test won't tell you whether your baby will develop health problems from the infection.
Is there anything I can do to avoid getting CMV while I'm pregnant?
While there's no fail-safe way to avoid CMV, you can lower your risk of getting it and some other infectious diseases by taking these precautions:
- Wash your hands often — and always after contact with diapers or a young child's saliva. Scrub with soap and water for 15 to 20 seconds.
- Don't kiss children under 6 years old on the mouth or cheek. (You can kiss them on the head or give them a hug.)
- Don't share food, eating utensils, or drinking glasses with young children.
- If you aren't in a mutually monogamous relationship, practice safe sex by using latex condoms and avoiding oral sex.
If you work in daycare, find out whether it's possible to change your responsibilities so you have less direct contact with young children, particularly those 1 to 2 1/2 years old. If that's not feasible, be extra vigilant about hygiene. For example, use disposable latex gloves when changing diapers, and be sure to take them off immediately afterward and thoroughly wash your hands with soap and water.
Where can I get more information?
Check out the CDC's CMV section, which offers simple, clear fact sheets on the disease, including information for pregnant women.