You may be thinking ‘urgh, not another thing to worry about’. However, CMV is a viral infection that once we are aware of, we can reduce our chances of contracting. We like prevention! Alas, however, many people are not made aware of it. So, in this piece we’re going to talk about exactly what it is, why you should be aware of it and why it is especially important for women who want to have children or are pregnant. Finally, the key thing to know is that this really is a case of knowing your enemy. If we’re aware we can help prevent infection and early detection can significantly improve outcomes. So, knowledge is most definitely power in this case!

Ok so what on earth is CMV? 

CMV or it’s more technical term: Cytomegalovirus is what it says on the tin. A virus, which is actually part of the herpes family. It shares that same characteristic: once you have it, you have it. It can lie dormant and often if you’re a healthy adult you will have absolutely zero symptoms. So, that means you’ll need to ask your doctor to test for it. He/she may test a couple of times through your pregnancy. Universal screening is not currently practised, however, some doctors do it as a matter of course. Make sure you speak up and ask your doctor how they approach it. Here’s why: 

If CMV has no symptoms, why does it matter so much for pregnancy/wanting to have kids?

Whilst adults will not likely see the effects, babies during pregnancy and as newborns are a different story. Unfortunately, CMV contracted by a baby in-utero or new born can potentially cause a range of developmental issues including hearing loss and neurological developmental issues. 

But, before you freak out: some reassuring news: 

Ok before you recoil in horror, here are some important things to keep in mind.

• Not every infected mother will pass it on to her baby (more on this below) in fact on average it’s between 30-35% rate of transfer. (1, 2). 
• Only around 11% of babies who do contract it will show symptoms (although symptoms can be highly variable (3)). 
• It is not super common: in the US for example around 0.5-1% of babies are born with CMV every year. That being said it is the most common congenital infection (meaning from birth) worldwide which can cause disabilities (1). 

Some important things you should know about CMV: 

It matters whether or not you have a ‘primary’ or ‘secondary’ infection. 

What does this mean? 

If you contract the virus during pregnancy that is considered ‘primary’ or: IgM. 

If you have had a while and it ‘flares up’ or you get a second strain it is ‘secondary, recurrent’ or IgG. 

It is the primary form that is more commonly passed to a baby. The recurrent form is transferred in far fewer cases (around 1.5% (1)). 

So how do we avoid contracting CMV? 

Avoiding it during pregnancy is important. The development of a vaccine has been given a high priority by several key medical bodies globally, however we are not there yet. So, the best bet is to do things to prevent getting it in the first place. 

The other good news is that it is not super easy to spread. It is mainly through contact with infected bodily fluid (saliva, urine etc). (4) 

The downside is that this makes pregnant women who have small kids particularly vulnerable as most infections actually happen during childhood. You know what small kids are like. So, for parents: ‘contact with saliva or urine is a major source of infection.’ (4) 

Some easy wins against CMV: 

First and foremost an easy one: Hand hygiene, particularly when caring for children. Particularly after changing nappies/diapers and wiping a child’s nose. Washing your hand before you touch your face is a simple win. 

As much as we all love to kiss our small people, avoid directly on the mouth. 

Avoid sharing food/drinks/utensils. 

What happens if I have CMV or test positive for it during pregnancy? 

Being early and on top of it (like with most things) really is the key. Research has shown that early intervention is your best bet. The other good news is that there are things we can do in order to reduce the impact. So do not fear. 

Firstly, as we said previously; it is not always transferred to the baby. So that is one piece of good news. Around 30-35% of primary cases are transferred (1, 2, 3) which means 65-70% of the time it isn’t. So try not to  stress too much if you do contract it during pregnancy. Your doctor may want to do additional ultrasounds if you are diagnosed to keep on top of development. Depending on your situation, he or she may suggest treatments like antiviral medications (you may hear Ganciclavir/Valganciclavir mentioned (1, 2, 3)). Or Hyper Immunoglobulin injections. So, there are options. 

In fact the International Journal of Molecular Sciences stated the following: 

‘Early diagnosis and early intervention with antiviral drugs have been shown to improve neurological outcomes in infants with symptomatic congenital CMV. Therefore prenatal detection is critical for accurately diagnosing CMV infection.’ (3) 

Newborn screening: 

Many hospitals and paediatricians will check your baby for some of the more obvious signs of CMV. Hearing loss is one of the big ones with 25% of babies/toddlers with hearing loss attributable to CMV. (2) This can occur early or when the child is 2-3 years old. The symptoms can vary and it can masquerade as other things so it is important to have an open and proactive dialogue with your doctor. 

Bottom line: 

We are always going on about knowledge and awareness being power and prevention better than cure. However, When it comes to CMV it is particularly the case. Yet ironically most people don’t know about it. If you are a mother already (or want to be one) simple hand hygiene can go a long way to reducing your chances of contracting the bug. From there, having open dialogue with your doctor and asking for screening is well within your right. What we do know is that although there is no miracle silver bullet getting on top of it early is the best course of action so do not be afraid to speak up! 

References: 

1) Kenneson A, Cannon MJ: Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection: Review in Medical Virology: 2007; 17: 253-276

2) Marsico C, Kimberlin DW: Congenital Cytomegalovirus Infection: advances and challenges in diagnosis, prevention and treatment: Italian Journal of Pediatrics: 2017: 43: 38

3) Tabimura K, Yamada H: Potential Biomarkers for Predicting Congenital Cytomegalovirus Infection: International Journal of Molecular Sciences: MDPI: 2018 Dec: 19(12): 3760

4) Porobic-Jahic H, Skokic F, Petrovic J: Cytomegalovirus Infection in Pregnancy – Our Experiences: Medical Archives: 2019 Jun: 73(3): 149-153 

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