Cytomegalovirus during pregnancy: positive and negative. Cytomegalovirus during pregnancy: consequences for the fetus, treatment of CMV infection, decoding of the analysis

Pregnancy is a serious test for the immune system of the expectant mother. It is during this period of time that a woman's health is exposed to all sorts of dangers: infections and viruses never sleep! In addition, the illness of the mother can adversely affect the intrauterine development of her baby. The most serious threat to the fragile tandem of mother and child is cytomegalovirus (CMV). This infection underlies various fetal defects, and can also cause fetal death before birth.

The lips of each of us at least once in our lives were “adorned” with herpes - a scattering of small itchy vesicles filled with a clear liquid. By the way, lips are not the only place where such a “cold” can settle. The skin of the face and the upper half of the body is at risk. Not only does the herpetic reaction negatively affect the appearance, it also causes great discomfort in the form of pain and severe itching. Once in the body, the virus will never leave a person again, manifesting itself at the moments of the greatest weakening of immunity. Cytomegalovirus, which should be feared by all pregnant women, belongs to a large family of herpes viruses.

General information about CMV and how the virus is transmitted

Cytomegalovirus scientists discovered and identified in 1956. Today, cytomegaly (CMV infection) is widespread: we can safely say that most of the inhabitants of our planet are carriers of a positive cytomegalovirus. The most interesting thing is that many of them do not even know about it! As long as there is no gap in our immune system, the infection is latent. This means that all the “charms” of herpes are experienced by people who already get sick often, as their health is very weakened. It is no wonder that pregnant women are at the greatest danger, because their immune system works for two!

How does cytomegalovirus work in the body? After contact with this infection, healthy cells begin to rapidly increase in size (it is no coincidence that the concept of "cytomegaly" is translated as "giant cell"). Pathogens violate the integrity of the cellular structure, as a result of which the cell is filled with fluid and becomes like an owl's eye.

You can “catch” CMV infection during pregnancy in several cases:

during sex. This is the most common way of infection, if we talk about adults. To penetrate the body, the cytomegalovirus uses any “loophole”: kisses, genital sex, oral caresses or anal sex without using a condom;
at home. Infection by this route occurs infrequently, only when the virus is "not sleeping", but is in an active form. The infection can wait in the wings on the bristles of the toothbrush, the pile of the towel, the surface of the dishes;
by blood transfusion. The risk of infection with cytomegalovirus remains during the transfusion of donor blood, during an organ or tissue transplant operation, when using donor eggs and sperm.

A large number of ways of infection is due to the fact that the infection exists quite calmly in all body fluids. Comfortable conditions for the life of the pathogen are blood, tears, breast milk, semen, vaginal discharge, urine, saliva.

The infection can invade the child's body when the baby is in the womb, during his birth or while breastfeeding.

CMV symptoms during pregnancy

It is unlikely that the virus manifests itself in a completely healthy person. In his body, the infection can “doze off” for years, waiting for the right moment. As soon as the immune defenses weaken, CMV will make itself felt.

Extremely rarely, the symptoms of cytomegaly appear in a person with normal immunity in the form of a mononucleosis-like syndrome. Then the patient experiences general malaise and headache, he has a high temperature. The disease develops 1.5 - 2 months after the virus has entered the body. A person may feel bad for 2 to 6 weeks.

During pregnancy, cytomegalovirus most often "masks" as an acute respiratory viral infection (ARVI). It is this feature of CMV that misleads the expectant mother: she takes a dangerous infection for a common cold. Indeed, the symptoms of the virus can hardly be called specific - it is fever, general weakness, constant fatigue, rhinitis, headache, a strong inflammatory reaction covering the salivary glands and tonsils. The main distinguishing feature of cytomegaly from a cold is that all the symptoms of CMV persist for a long time and a person can get sick for 1-1.5 months.

If the immune system is very weakened, CMV infection during pregnancy can be accompanied by various complications such as pneumonia, pleurisy, encephalitis, myocarditis, arthritis. In addition, in some patients with exacerbation of CMV, disorders of the vegetative-vascular system and inflammation of various internal organs are observed.

Particularly severe cases, when the pathology acquires a generalized form and covers the entire body, are accompanied by such complications:

an extensive inflammatory reaction that extends to the kidneys, pancreas, spleen, adrenal glands and liver tissue;
destructive processes affecting the gastrointestinal tract, lungs and eyes;
paralysis (isolated cases);
inflammation of the brain, which can be fatal for the patient.

The generalized form of CMV infection is quite rare.

We emphasize once again that in most cases, CMV infection during pregnancy manifests itself as a common cold. Complications occur when a person's immunity is extremely weakened.

Danger of positive CMV during pregnancy

For an adult, cytomegalovirus does not pose a particular threat, which, unfortunately, cannot be said about a baby that grows under the mother's heart. Infection can cause numerous abnormalities in the intrauterine development of the fetus.

In addition to cytomegalovirus, a pregnant woman is threatened by other forms of herpes infection. Among them, the herpes simplex virus (HSV), which is divided into two types according to the severity and location of localization - the first and second. The greatest danger to the fetus is the herpes simplex virus of the second type. You can get infected with it “through the bed”, and as a result, itchy vesicles will appear on the mucous membrane of the genital organs of the pregnant woman.

CMV and HSV during pregnancy have gained fame as the most serious infectious disease after rubella - their consequences for the health of a tiny man are so serious. If the herpes virus of the second type has settled in the body of the expectant mother, it can penetrate the structure of the amniotic fluid, and thus enter the body of the fetus. However, medical practice shows that the infection of the child occurs mainly through the placenta, it is also not uncommon for the embryo to become infected with CMV through maternal blood.

Primary infection with HSV during pregnancy does not bode well: the risk of spontaneous miscarriage increases significantly. The infection develops predominantly in the nervous tissue, and as a result, babies are born with abnormalities in the nervous system (for example, sensorineural hearing loss). Sometimes the fetus becomes an available target for meningoencephalitis, which provokes the development of dropsy of the brain and slow development in the child after birth.

Unfortunately, intrauterine infection of a baby occurs most often when his mother does not know that she is a carrier of a dangerous virus, that is, she does not have any alarming symptoms.

A woman becomes very vulnerable at the very beginning of pregnancy. If the cytomegalovirus at this time manages to enter the fetus through the placenta, the child may die.

When infection occurs later in pregnancy, the fetus does not die, but its internal organs can be severely affected by the activity of the virus. Among developmental abnormalities, there are also various deformities, congenital heart defects, hepatitis, jaundice, inguinal hernia, microcephaly.

The picture of the consequences of CMV infection is so disappointing that it can plunge a pregnant woman into a panic. However, everything is not really as bad as it seems: with the timely detection of the virus, the condition of the expectant mother and fetus with appropriate treatment is subject to correction, that is, terrible consequences can be avoided. In addition, it is very important to plan motherhood in advance, as well as donate blood to be screened for infections that pose a potential threat to the intrauterine development of the child.

Analysis for CMV during pregnancy

It is not possible to verify the presence of cytomegalovirus in your body on your own. The latent form of the virus does not manifest itself in any way, but if it acquires an active form, then it is easy to confuse it with an elementary cold and not attach special importance to the high temperature and general weakness.

You can protect yourself and your baby by passing an analysis in due time that determines the presence of TORCH infections in the blood of a pregnant woman. Thanks to this examination, it is possible to detect such dangerous diseases as toxoplasmosis, rubella and herpes simplex virus of the first and second types in a timely manner.

For research on cytomegalovirus during pregnancy, the following is used:

polymerase chain reaction;
microscopic examination of sediments of urine and saliva;
serological analysis of blood serum.

The principle of the polymerase chain reaction is to search for deoxyribonucleic acid in a woman's body. In this substance, which is located inside the CMV, the hereditary data of the virus are encoded. Scrapings, urine, sputum or saliva are suitable as biological material for analysis.

The subjects of microscopic examination of the cytological method are the urine or saliva of a pregnant woman. The presence of cytomegalovirus confirms the presence of huge cells.

The study of blood serum during a serological test helps to find antibodies specific for CMV infection. As the most reliable method, enzyme-linked immunosorbent assay (ELISA) has proven itself, with the help of which various types of immunoglobulins - IgM and IgG are identified.

Immunoglobulins are called protein compounds that are synthesized in blood cells. They are sensitive to the presence of infectious agents in the body, immediately connecting with them in an inseparable union.

Immunoglobulins type M (IgM) appear in the carrier's body 4 to 7 weeks after virus entry. Their number begins to gradually decrease as the body's immune response develops, at the same time, the concentration of immunoglobulin type G (IgG) increases.

Thus, in the certificate of the results of the analysis, a pregnant woman can expect one of the options:

IgM was not detected, but IgG was within normal limits;
IgM was not detected, IgG exceeds normal levels (positive IgG of CMV infection in the expectant mother);
IgM is more than normal.

What does this mean? In the case of the first result of the analysis, the pregnant woman’s body did not have contact with a dangerous virus, so all she now needs to do is strictly adhere to preventive measures and make sure not to get infected.

The second analysis contains information that the woman's body was in contact with cytomegalovirus, which, apparently, was in a passive form. This means that the primary infection, fortunately, did not occur, but there is a high risk of reactivation of the virus. The expectant mother needs to carefully monitor her health and increase immunity in every possible way.

The results of the third analysis are the most unfavorable: a woman expecting a baby has a primary infection or is about to show signs of reactivation of the virus, which has been in the body in a latent form all this time.

However, in some cases, the situation is complicated when, for some reason, the IgM connection is not detected analytically. Based on this, doctors first of all take into account the indicators of IgG, the level of which varies from woman to woman. In order for the specialist to have the opportunity to establish the CMV rate during pregnancy, the appropriate analysis must be passed before conception occurs. The fact that a viral reaction is unfolding is indicated by the level of IgG, exceeded by 4 or more times.

Treatment of CMV during pregnancy

Having studied the specifics of CMV infection, it is easy to guess that there are no pills that permanently free the human body from the virus, so all treatment comes down to repaying the symptoms of the infection and keeping the virus in check (in an inactive form).

It is advisable for a future mother who is a carrier of the virus to take multivitamin complexes, pharmacy vitamin herbs and, of course, immunomodulators to increase the body's defenses. This approach is relevant in the case when the infection in a pregnant woman is passive. The drugs that a doctor will prescribe to a woman are designed to prevent the development of an active form of cytomegalovirus.

If the CMV infection “wakes up” and began to pose a real threat to the health of the pregnant woman and the fetus, in addition to vitamins and drugs that increase immunity, the expectant mother will be prescribed antiviral drugs. In this case, it is important to prevent the development of complications for which the unborn baby will have to pay dearly.

With the active form of cytomegalovirus, the expectant mother is prescribed intramuscular injections of anticytomegalovirus immunoglobulin, provided that the gestational age does not exceed 6 weeks. To maintain immunity, drugs such as Rovamycin, Immunoflazid, Engystol, Betadine, Vilprofen can be used.

During treatment, it must be borne in mind that cytomegalovirus can cause other diseases complicating the condition of a woman (for example, SARS or pneumonia). If this happens, the concomitant disease must be treated no less actively than the CMV infection itself - this is the only way to eliminate the danger to the mother and her baby and achieve the return of CMV to a passive form, bringing it under the control of the immune system.

By agreement with the doctor, the experience of traditional medicine can be used in the treatment of cytomegalovirus infection. To strengthen the immune system, calendula, St. John's wort, lemon balm and rose hips are suitable. These plants are brewed and drunk as a tea with the addition of a spoonful of honey (optional). Such drinks are especially useful if the expectant mother was warned about the threat of spontaneous miscarriage.

How to protect yourself from cytomegalovirus

Despite the prevalence of infection, not all people are carriers of a dangerous virus. A healthy woman expecting a baby must responsibly follow a number of preventive measures that will help her protect herself and her baby from possible infection. By the way, these same rules are also relevant for those expectant mothers who could not avoid contact with cytomegalovirus, and the infection “sleeps” in their body.

Casual sex is taboo for a woman, especially for one who lives in anticipation of a baby. The indispensable use of contraceptives in intimate relationships is a reliable way to protect yourself from cytomegalovirus and other sexual infections.
Careful observance of the rules of personal hygiene and keeping your home clean are common truths that are instilled in a person from childhood. Compliance with these rules increases the chances of a pregnant woman to avoid contact with harmful microorganisms. Now is not the time to take risks and use someone else's dishes or towels - the expectant mother should have all things for individual use. In addition, wherever a pregnant woman is, she should always keep her hands clean. They need to be washed before sitting at the dinner table, after going to the toilet, after being in public places, after contact with money.
It's time to start strengthening your immunity and acquire some useful habits of a healthy lifestyle: learn the basics of hardening, not be lazy and do special exercises for pregnant women, visit outside the city more often and breathe clean air. Strong body defenses will keep cytomegalovirus on a "short leash".
Proper nutrition, healthy and balanced, is the main point in the program of improving the health of a pregnant woman. Fresh vegetables and fruits, cereals, lean meat, fish, high-quality dairy products - such a diet will provide the expectant mother with a powerful boost of energy, and her baby will be able to fully develop. A sufficient amount of vitamins and nutrients are the main requirements for food that will appear on the plate of a pregnant woman. If there are no special prescriptions from a doctor, during pregnancy, in no case should you go on a restrictive diet.
The ideal option for replenishment in the family would be early planning for conception, when CMV infection can be detected in the laboratory. Both prospective parents must be tested.

We remind you once again that cytomegalovirus does not bode well for the mother and her baby - sometimes the infection leaves the child no chance of survival or a healthy life. In order not to overlook the danger, if symptoms similar to a cold occur, the expectant mother should definitely seek the advice of her doctor.

CMV and pregnancy are an undesirable neighborhood. Video

Cytomegalovirus (abbreviated as CMV) is one of the most common viruses in the world, causing asymptomatic carriage in 99% of people. According to statistics, in developed countries, the primary infection with the infection occurs in adulthood (30-40 years), in developing countries, the vast majority of the population becomes infected in childhood (2-7 years). With a normal level of immunity, CMV does not pose a health risk. The severe course of the disease and the occurrence of serious consequences occurs in patients with immunodeficiencies and in children with intrauterine infection. Cytomegalovirus during pregnancy is not always a sentence for the unborn child. Severe complications develop in 10-15% of cases under certain conditions of infection.

Cytomegalovirus (Cytomegalovirus hominis) belongs to the family of herpes viruses (Herpesviridae). The infection enters the host's body by contact, airborne, sexual, blood transfusion (during blood transfusion), transplantation (during transplantation of internal organs), during childbirth. lasts 30-60 days, in rare cases 10-14 days. During the incubation period, the virus is carried by the bloodstream throughout the body, invades the cells of the internal organs, and begins to multiply.

Affected cells increase in size. On microscopic cytological examination, the cells look like an "owl's eye". This distinguishes cytomegalovirus from other herpes viruses. As a result of the vital activity of CMV, the host cells die, and the virions penetrate into healthy cells, and the reproduction cycle is repeated. 3-4 days after infection, the immune system produces specific antibodies that recognize foreign antigens of the virus and render them harmless. As a result of primary infection, persistent lifelong immunity develops.

In the first days after infection, IgM antibodies are synthesized, which indicate the acute phase of the disease. The same immunoglobulins appear with a relapse of the disease. IgM persist in the blood for 30-40 days. 10-14 days after infection, IgG are synthesized, which remain in the blood throughout a person's life. Class G immunoglobulins not only neutralize viruses, but also serve as immunological memory. The presence of IgG in the blood indicates a previous disease.

After the acute phase of the disease subsides, CMV remains in the body in a dormant state - it does not multiply, does not cause destruction of host cells and deterioration of the general condition. This phase of the life of the virus is called carriage. In people with a normal immune system, the carrier phase continues throughout life. With the development of immunodeficiency states (AIDS, chemotherapy, taking immunosuppressants), the virus enters the active phase and causes an exacerbation of the infection of varying severity. CMV is dangerous in case of intrauterine infection of the fetus.

When is cytomegalovirus dangerous during pregnancy?

There is an opinion that cytomegalovirus infection during gestation leads to serious consequences for the health of the unborn child. In fact, cytomegalovirus and pregnancy are quite compatible concepts. It is important to know under what circumstances the infection can harm the normal development of the baby and take timely preventive measures. Consider several possible situations of infection with the virus and their consequences for the health of the child.

Primary infection of a woman before pregnancy

If a woman has had a cytomegalovirus infection before conception, then the risk of intrauterine infection of the fetus is no more than 1-2%. Activation of the virus in the body of a pregnant woman can occur with a decrease in the body's defenses. The recurrence of the disease develops against the background of severe immunodeficiencies, according to statistics, this situation rarely occurs - in 1% of cases.

An exacerbation of CMV during pregnancy usually does not lead to severe consequences for the fetus, such as stillbirth, congenital malformations, deafness, and blindness. In the body of the expectant mother, immunity against infection has been developed, antibodies are synthesized immediately after the virus enters the cells. Immune protection does not allow viruses to overcome the blood-brain barrier and enter the child's body. In rare cases, low birth weight, jaundice, and skin rash are recorded.

At the time of pregnancy, a woman does not have immunity against CMV

More than half of the population of our country are already infected with cytomegalovirus infection by the age of childbearing and have strong immunity. If at the time of conception a woman is not a carrier of the virus, then she is at risk for the occurrence of intrauterine infection of the fetus. During the period of bearing a child, the protective forces of the body of the expectant mother can be reduced due to complications of pregnancy, toxicosis, exacerbation of chronic diseases suffered by acute respiratory infections.

Cytomegalovirus during pregnancy can penetrate the weakened mother's body and lead to intrauterine infection of the fetus. Infection is especially dangerous in the first 12 weeks of bearing a child, when all organs and systems are laid down. To reduce the risk of infection of the fetus, a pregnant woman is recommended to adhere to health-improving and preventive measures, regularly undergo laboratory tests, and follow a schedule for visiting a gynecologist.

Primary infection during pregnancy

The first contact of a woman's body with CMV is the most dangerous situation for intrauterine infection of the fetus. This development of events can lead to one of the options.

In 80% of cases, the child's body receives antibodies from the mother, the virus does not adversely affect the body, after birth the child becomes a carrier of the infection. A favorable outcome of intrauterine infection of the fetus occurs during the normal functioning of the immune systems of the expectant mother.
In 20% of cases, intrauterine infection of the child develops against the background of insufficient function of the mother's immune system. Depending on the degree of immunosuppression, there are 2 possible outcomes of CMV infection:

the disease proceeds without the development of intrauterine disorders in the child and clinical signs after birth, sometimes long-term consequences are formed at the age of 3-5 years from the organ of hearing (deafness), vision (blindness), nervous system (mental retardation);
infection causes fetal death (stillbirth, spontaneous abortion), if infection in a pregnant woman occurred in the early stages of a child's development (up to 12 weeks);
infection in the first trimester, less often in the second and third trimester, leads to the formation of malformations of the heart, kidneys, nervous system, the child is born with signs of pneumonia, hepatitis, dropsy of the brain, enlarged spleen, external deformities.

The most dangerous time of primary infection of a woman during the period of gestation is the first trimester of pregnancy, during which internal organs, the brain and spinal cord, and the musculoskeletal system are laid.

Clinical signs of cytomegalovirus infection

CMV during primary infection or exacerbation of the disease, according to clinical signs, resembles an acute respiratory disease or a cold. Specific, allowing to recognize the infection, does not exist. During pregnancy, it is necessary to carefully monitor the state of health and, if the first signs of illness appear, consult a gynecologist. The health and life of the unborn child depends on this.

Clinical signs of CMV:

increased fatigue;
drowsiness;
sore throat;
runny nose;
dry cough;
profuse salivation;
enlargement and soreness of the lymph nodes (cervical, submandibular, axillary, inguinal);
rise in temperature to 38 degrees.

The severe course of the infection develops against the background of immunodeficiency and can take a generalized form. In this case, the virus is carried by the bloodstream throughout the body and affects the internal organs: the heart, liver, salivary glands, uterus, pancreas, and brain. Immunodeficiency states are associated with suppression of the immune system and develop against the background of radiation and chemotherapy in the treatment of cancer, the use of immunosuppressants after organ transplantation, HIV infection and AIDS, beriberi.

Laboratory and instrumental examinations for cytomegalovirus

Prevention of infection with cytomegalovirus when planning pregnancy is carried out by laboratory diagnostics for TORCH infection. Serological analysis includes the study of peripheral blood for the content of antibodies - IgM and IgG to infections that are dangerous for intrauterine infection of the fetus. These include cytomegalovirus, herpes, rubella, toxoplasmosis.

It is important to be diagnosed before conceiving a child in order to establish the risk of intrauterine infection during pregnancy. With a high risk of infection, preventive and therapeutic measures are taken to save the life and health of the unborn baby. If a woman has not been tested for TORCH infection before pregnancy, then a gynecologist prescribes laboratory diagnostics when registering in a antenatal clinic.

The level of specific immunoglobulins in the blood helps to establish an early illness, primary infection or exacerbation of CMV. On the serological test form, each type of antibody will indicate a “positive” or “negative” result. In controversial diagnostic cases, an additional analysis is prescribed to identify the avidity of immunoglobulins - the ability of antibodies to bind to an antigen (cytomegalovirus). Consider several options for the results of serological diagnostics.

Result: IgM and IgG negative

The absence of class M and G immunoglobulins in the blood indicates that there was no CMV infection, respectively, there is no stable immunity to infection. A woman with such an analysis result is at risk for intrauterine infection of the fetus. To prevent infection during pregnancy, doctors recommend adhering to non-specific preventive measures:

every 4-6 weeks to take tests for the detection of IgM and IgG to CMV;
use individually utensils and means for hygiene procedures (toothbrush, washcloth, towel);
minimize the time spent visiting public places with large crowds of people;
avoid close contact with young children, who can be a source of infection;
avoid contact with patients with acute respiratory infections and colds.

For specific prophylaxis, injections of human immunoglobulin "Octagam" are made every month during the pregnancy period.

Result: IgM negative, IgG positive

IgG antibodies to cytomegalovirus indicate a previous infection and the presence of stable immunity. During pregnancy, a woman needs to protect herself from colds, acute respiratory infections, stressful situations, eat right and follow a healthy lifestyle. These measures are enough to exclude a recurrence of the disease.

Result: IgM positive, IgG negative

The detection of class M immunoglobulins in the blood indicates the acute phase of the infection - the primary infection. This is a dangerous situation for intrauterine infection of the child. To establish the infection of the fetus and the negative effect of the virus on the body, ultrasound and amniocentesis are prescribed. Ultrasound of the fetus is carried out from 21 weeks of pregnancy, not earlier than 7 weeks from the onset of infection. The examination helps to identify malformations and external deformities.

Amniocentesis allows you to take amniotic fluid and conduct a laboratory analysis to detect the genetic material of the virus - PCR. In case of detection of virus DNA and severe malformations, a woman is offered an abortion.

Result: IgM and IgG positive

The detection of class M and G immunoglobulins in the blood indicates either a relapse of the disease or a primary infection in the recovery stage. To clarify the time of infection of a woman and the fact of infection of the fetus, a laboratory test for IgG avidity is prescribed.

If the avidity of the immunoglobulin is high, with an indicator of more than 60%, then the infection occurred no earlier than 20 weeks ago and the risk of infection of the fetus in the first trimester is minimal. In the case of an intermediate or low indicator, the risk is high. To confirm the diagnosis, ultrasound of the fetus and amniocentesis are prescribed. A positive PCR result and malformations on ultrasound testify in favor of intrauterine infection of the fetus. The doctor decides on the further management of pregnancy after agreeing on the tactics with the patient.

Medical tactics

Treatment of cytomegalovirus during pregnancy is carried out in case of a high risk of infection of the fetus. The primary occurrence of the disease during pregnancy, especially in the first trimester, and the recurrence of the disease are indications for the appointment of complex therapy.

Conservative therapy includes:

antiviral human immunoglobulin - megalotect, neo-cytotect;
preparations based on interferon - cycloferon, viferon;
antiviral drugs - valtrex, ganciclovir.

The appointment of antiviral drugs is carried out in minimal therapeutic doses under the strict supervision of a physician. These drugs can cause a violation of intrauterine development of the fetus and lead to malformations of internal organs. It is advisable to treat CMV in pregnant women with high doses of antiviral drugs if the woman's life is threatened due to the severe course of the disease and the generalization of the infectious process. At the same time, the prognosis for the life and health of the child is unfavorable.

Intrauterine infection of the fetus with CMV in some cases leads to its death, the formation of malformations and deformities. Therapy of the disease during pregnancy is associated with a danger to the health of the child. Prevention of infection reduces the risk of developing the disease and increases the chances of having a healthy baby.

What is cytomegalovirus in women during pregnancy

The cause of the violation in the body of a pregnant woman is herpesvirus with DNA containing. It has a two-layer protective shell and a spherical shape. Small spikes are located on the surface of the virus; they are necessary for cell recognition and attachment inside the body.

The infection enters the body when the protective functions of the immune system are weakened. CMV can be:

congenital;
acquired.

Depending on this, therapy is selected. Doctors at the stage of diagnosis try to determine the method of infection. We list the most common of them:

A high probability of infection of the child appears with the primary infection of CMV during gestation.

If a woman has previously had this disease, then there are antibodies in her body, they help to fight the disease more effectively and prevent infection of the child. Such women give birth to healthy children, who in 80% of cases are carriers of cytomegalovirus.

What does igG positive mean in pregnant women

When registering, women donate blood to detect infection. It is impossible to refuse or skip this examination, since this is how it is determined whether there is a threat to the development of the child. The analysis reveals the presence of IgG and igM antibodies.

If a woman has not previously had cytomegalovirus, she will detect the absence of IgG in the form. This indicator indicates a high risk of infection during pregnancy. All patients who have a negative sign in the corresponding column are included in the risk group.

After primary infection with cytomegalovirus, IgG antibodies will remain in the blood for life, but this does not mean that the patient has immunity to CMV. The presence of IgG indicates the possibility of re-development of the disease against the background of a weakening of the protective functions of the body during pregnancy. Immediately after infection, IgG titers rise and then slowly begin to decline.

How to diagnose in pregnant women

Diagnosis of CMV should be carried out before planning a child.

To do this, a swab is taken from the genitals, scraping, blood, urine and saliva are examined. During pregnancy, diagnosis is carried out by analyzing the blood. Detecting cytomegalovirus is problematic due to the lack of characteristic symptoms. The presence of antibodies in the body is analyzed and, on the basis of this, appropriate conclusions are drawn.

The main methods for determining CMV:

serological, allows you to detect the presence of IgG and igM antibodies, which indicates a recent infection;
cytological, enlarged cells are found in secretory fluids;
virological, expensive and time-consuming method, during which the pathogen is placed in a nutrient medium in order to observe its development;
molecular biological, with its help determine the DNA of the pathogen in human cells.

Most often, doctors perform a smear and take blood for examination. In the presence of cytomegalovirus, doctors conduct complex therapy and regularly monitor the condition of the pregnant woman to prevent reactivation of the disorder. In the absence of antibodies, expectant mothers are checked every trimester in order to detect CMV in a timely manner when immunity is weakened.

Which doctors should be visited

If you feel unwell or have symptoms of cytomegalovirus, a pregnant woman should contact the gynecologist who is monitoring her pregnancy. The doctor will conduct a survey, examination and laboratory tests to obtain a clinical picture. If the indicators deviate from the norm, drug therapy and subsequent preventive treatment are prescribed.

Signs and symptoms

In most people with good immunity, the infection is asymptomatic. During pregnancy, hormonal changes occur, which causes a weakening of the body's defenses. Therefore, the disease in this period is more often exacerbated and symptoms of the disorder appear.

Clinical manifestations depend on individual characteristics and the presence of concomitant diseases in the body.

Some women have almost asymptomatic lesions of the salivary glands, while others suffer from severe pathologies of the brain, liver or respiratory system.

Symptoms of cytomegalovirus infection may resemble mononucleosis or a respiratory infection. More often, the development of CMV is associated in pregnant women with a cold, so they do not go to the doctor for a long time and seek to cure the disorder on their own. If you have good immunity, the symptoms of the virus will disappear, otherwise the following manifestations will appear:

Severe headaches. They are a sign of intoxication of the body.
Aches. General malaise and weakness disrupt the usual rhythm of life.
Temperature increase. A slight excess of the norm is not always felt by a woman. Body temperature does not exceed 38 degrees.
A sore throat. When using local medicines or gargling, it will not be possible to get rid of the discomfort.
Enlarged lymph nodes. This symptom of cytomegalovirus will be noticeable on palpation.
Nasal congestion. A runny nose will become chronic and will constantly cause discomfort to a pregnant woman.

Treatment and drugs

The causative agent of CMV is able to develop resistance to drugs, therefore, complex therapy is prescribed by a doctor after a diagnostic examination. Before prescribing medication, the doctor determines the form of the disorder, cytomegalovirus can be:

sharp;
chronic.

Depending on this, medicines are selected. Medicines must be prescribed by a doctor, otherwise there will be an opposite effect from their use and complications will arise.

In the treatment of cytomegalovirus, the following drugs are used:

Antiviral. This class of drugs is used to stop or slow down the development of the virus and to reduce the burden on the fetus.
Anticytomegalovirus immunoglobulin. The medicine is prepared using substances taken from the blood of people who have already had CMV. Due to its use, the risk of infection of the child and the recurrence of the virus is reduced.
Immunomodulators. Appointed as an aid to strengthen the immune system.
Fortifying agents. Vitamins and complex preparations are used for maintenance therapy in an inactive state of the disease. Thanks to them, it is possible to ensure the birth of a healthy baby and further contain the pathology.

During the treatment of cytomegalovirus, doctors pay attention to the symptoms of the disorder. For local lesions, creams, ointments or intravaginal suppositories are used.

An important factor is the nutrition of a pregnant woman.

Doctors recommend giving up heavy and fatty foods. During CMV therapy, preference should be given to fresh seasonal vegetables and fruits. The diet should be dominated by vegetable and animal proteins. Vegetarianism and various diets for weight loss should be abandoned for the duration of treatment and throughout pregnancy, this can adversely affect the condition of the child.

Instead of coffee and the usual tea, you can use decoctions or herbal infusions, but they are consumed after consulting a doctor. Traditional medicine methods can be used to treat cytomegalovirus, but as an adjuvant.

Chronic form

Chronic cytomegalovirus occurs with untimely or incorrect treatment. The disease progresses if pregnant women try to cure their illness on their own or seek help too late.

In this case, symptoms of the disease appear, and disappear after a few weeks or months. The absence of symptoms does not indicate that the disease has disappeared. So there is a transition to the chronic form. If the immune system is weakened or there are favorable conditions for the development of the virus, the symptoms of the disorder will resume. Over time, the condition of the pregnant woman will worsen. The negative consequences of the chronic form affect the condition of the expectant mother and child.

What is dangerous and the consequences for the fetus during pregnancy

Intrauterine infection leads to the development of a congenital form of the disorder. Depending on the period at which infection occurred, an acute form of infection, chronic damage to internal organs and pathological changes in the development of the embryo can be observed. A child can be born much prematurely and be underweight. Symptoms of the disorder may not appear immediately after birth, but after a few months or a year.

We list the complications that indicate the presence of cytomegalovirus in a child:

When infected with cytomegalovirus a few weeks or months before delivery, the symptoms of the disorder will not be observed immediately after the birth process. Usually in children after 1 or 2 months there is a general malaise, which outwardly resembles SARS. With natural feeding, the symptoms are stopped due to the antibodies produced by the mother's body and the disorder becomes latent.

Premature babies and those who are bottle-fed have immunodeficiency, so severe complications and generalization of the process can be observed.

A well-known pediatrician and TV presenter recommends that parents be attentive to the health of a newborn child. If during pregnancy a woman was sick with cytomegalovirus, then she and the baby need regular preventive treatment. It should be periodically observed by a doctor and show him the child that to detect the disease at an early stage during its development.

It is impossible to completely get rid of cytomegalovirus, the patient can only eliminate its symptoms. Timely treatment and prevention will allow you to forget about the violation for several years.

What is cytomegalovirus infection in pregnant women

Cytomegalovirus is a typical representative of human opportunistic infections, the clinical manifestations of which manifest only against the background of immunodeficiency states. CMV is a member of the herpesvirus family that causes a widespread latent infection in the population. Postnatal transmission of the infection occurs by contact, airborne or sexual contact with saliva, semen and genital secretions. Due to the low concentration of the virus in the secretions and because of the lability of the pathogen, prolonged and close physical contact is necessary for the transmission of the infection.

Antibodies to CMV are present in 50-95% of women of childbearing age, the proportion of seropositivity depends on age, social status, level of material well-being and sexual activity. At the same time, the real frequency of congenital CMV infection among newborns does not exceed 0.2-2.5%. This is explained by the fact that the risk of infection of the fetus, the severity and prognosis of the disease in congenital CMV infection depend not so much on the presence of the virus in the mother's body, but on the activity of the infectious process during pregnancy.

Pathogenesis (what happens?) during Cytomegalovirus infection in pregnant women

With antenatal infection of the fetus in the vast majority of cases, there is a transplacental route of transmission of CMV. With intranatal infection, the virus enters the body by aspiration or ingestion of infected amniotic fluid and / or infected secrets of the mother's birth canal.

The greatest risk of intrauterine CMV infection of the fetus and the development of severe forms of the disease is noted in cases where a pregnant woman suffers a primary CMV infection. Its frequency in women during pregnancy does not exceed 1%. Intrauterine infection of the fetus with cytomegalovirus in women with primary CMV infection reaches 30-50%. At the same time, 5-18% of infected children have a manifest congenital CMV infection, which is characterized by a severe course and often ends in death. Among the surviving children, the majority continue to have serious complications that lead to disability and significantly reduce the quality of life.

In case of secondary infection during pregnancy (reactivation of a latently persistent CMV infection or infection with a new strain of the virus in a seropositive woman), the risk of infection of the fetus and the development of severe forms of congenital CMV infection is significantly lower. This is due to the fact that in women who had a primary infection before pregnancy, in the vast majority of cases, effective anti-CMV immunity was formed. Therefore, with the development of secondary CMV infection during pregnancy, factors of specific immunity of the mother provide effective protection of the fetus from infection and the development of severe cytomegalovirus infection. As a result, the risk of intrauterine infection with cytomegalovirus in secondary CMV infection during pregnancy does not exceed 2%. At the same time, even with an asymptomatic course of congenital CMV infection, 5-17% of children may develop various health problems in the future.

With postnatal infection, the incubation period is from 3 to 8 weeks. After the penetration of the virus through the mucous membrane of the respiratory or genital tract and its local reproduction, the phase of viremia begins. In this case, free virus or virus-containing leukocytes affect the main target organs: kidneys, salivary glands, heart, respiratory and genital tracts, liver, followed by reproduction in fibroblasts, epithelial and endothelial cells. Primary infection is limited by cellular immune responses and the formation of humoral antibodies. Macrophages are considered the main place of latent residence of the virus. Once in the human body, CMV multiplies and is excreted from it for weeks, months (if an adult is infected) and even years (if a child is infected). Penetrating into lymphocytes, it remains in the human body throughout his life and therefore can be transmitted through blood transfusion or organ transplantation. From time to time, the reactivation of the virus occurs, accompanied by its release from the host body through the genitourinary and respiratory tract, with milk and saliva. At the same time, in most cases, reactivation of CMV infection in adults with a normal state of the immune system occurs asymptomatically. CMV shows a special tropism for the salivary glands, therefore it is often transmitted by kissing ("kissing disease"). There is a correlation between sexual activity and CMV infection.

Symptoms of cytomegalovirus infection in pregnant women

Most women who become infected with CMV during pregnancy do not have any clinical symptoms of the disease, and only a few present with an influenza-like or mononucleosis-like syndrome. The association of influenza-like syndrome with lymphadenopathy and hepatosplenomegaly in pregnant women is always suspicious of primary CMV infection.

Diagnosis of cytomegalovirus infection in pregnant women

Due to the wide spread of the infection and its asymptomatic course, today all pregnant women registered in the antenatal clinic are screened for CMV antibodies.

Seronegative women with symptoms of primary infection should be retested 3–4 weeks later to confirm seroconversion. If intrauterine infection is suspected in the first trimester in pregnant women with a primary infection at 20-22 weeks, amniocentesis can be performed to confirm the diagnosis (PCR for CMV) and cordocentesis to detect IgM in the fetus.

Virus culture is the gold standard for diagnosing CMV infection. The PCR method is most sensitive for detecting small amounts of CMV DNA. Samples can be taken from a variety of sites, including the nasopharynx, cervix, urethra, as well as urine, semen, saliva, tears, feces, and blood. However, the detection of the virus does not indicate the nature of the infection (primary or chronic). For this, it is necessary to conduct serological studies with the determination of the titer of antibodies of class G and M.

Detection of IgM indicates a primary acute infection or reactivation of a latent infection or reinfection with a new strain of CMV while detecting a sufficient titer of IgG.

To confirm the primary infection after 3-4 weeks, it is necessary to re-examine the serum for the presence of antibodies: during a primary infection, IgG appears against the background of IgM in repeated samples when only IgM is detected in the primary sample. The presence of an increasing level of IgG in paired sera without detection of IgM indicates reactivation of a latent infection. The detection of a small amount of IgG indicates a previous infection, but does not indicate reactivation at the present time.

Information on the fetal immune response to intrauterine infection is limited. At a period of 15-20 weeks, there are already protective cellular reactions. The formation of virus-specific IgM antibodies is possible from 10-13 weeks, IgG - from 16 weeks, IgA - from 30 weeks.

In newborns with CMV infection, the virus is shed in the urine and throat for many months. The formation of IgM occurs only in 60-70% of IUI cases.

The risk of intrauterine infection during primary infection in the mother is 40%, with reactivation of the infection - 2%. At the same time, 10% of prenatally infected newborns have severe symptoms: microcephaly, mental retardation, chorioretinitis, deafness, intracranial calcifications, and hepatosplenomegaly. Congenital infection may be asymptomatic, but in the future, 5-20% of infected children develop neurological disorders, hearing loss and decreased vision.

Prenatal diagnosis. In the early stages of pregnancy (at 11-19 weeks), chorionic villi and amniotic fluid are examined, at later stages of pregnancy (at 22-23 weeks and later), fetal blood and amniotic fluid are tested. Prenatal diagnosis is carried out in pregnant women with seroconversion, as well as on the basis of unusual ultrasound data. However, unusual ultrasound data with positive tests for the virus in fetal blood, amniotic fluid and a positive test for CMV IgM in fetal blood are still decisive for maintaining or terminating a pregnancy. In newborns from women with suspected CMV infection, it is necessary to determine the virus in urine, saliva or throat secretion at 1-2 weeks. It should be borne in mind that with congenital CMV infection, IgM antibodies in 35% of cases may be absent at birth.

The risk of primary infection during pregnancy is about 1%, but differs depending on the spread of the virus in a particular region. Pregnant women with acute CMV infection and reactivation of latent CMV infection are more likely to have spontaneous miscarriage, missed pregnancy, and intrauterine fetal death later in gestation.

Vertical transmission of CMV is possible antenatal (transplacental), intranatal and postnatal (through breast milk). The virus is often detected in cervical smears of seropositive women, 40% of newborns from women who excrete the virus on the eve of childbirth become virus carriers during the newborn ™, In 30% of cases, CMV is excreted in the breast milk of seropositive women, and it is believed that very often infection of newborns is associated precisely with this way of transmission. However, if IUI of the fetus is associated with the risk of developing its defeat, then intranatal and postnatal infection, as a rule, does not pose a threat to the life and health of newborns due to a sufficient titer of antiviral antibodies transmitted by the mother, with the exception of premature babies and children with various "immunodeficiencies".

In the primary infection of a pregnant woman, intrauterine infection is caused by viremia. The endothelial cells of the vessels of the placenta and chorionic fibroblasts are infected, then the virus enters the target organs through the fetal circulation. The spread of the virus to the fetus can also occur through the amniotic fluid. With recurrent infection, it is also necessary to take into account the persistence of the virus in the endometrium, in the tubes and ascending infection. Intranatal infection occurs when passing through an infected secret during childbirth. Early postnatal infection is primarily associated with infection during breastfeeding.

Primary CMV infection is rarely diagnosed due to uncharacteristic symptoms or a subclinical course. So far, primary CMV infection can only be accurately diagnosed by seroconversion. To determine the reactivation of CMV infection, virus DNA is detected in the urine and cervical smear by PCR.

Treatment of cytomegalovirus infection in pregnant women

Unfortunately, due to the impossibility of antiviral treatment during pregnancy (the required doses of acyclovir are very high to suppress CMV and can be toxic to the fetus, ganciclovir is not approved for treatment during pregnancy) and the asymptomatic course of the infection, it is only necessary to observe such patients in order to identify signs IUI of the fetus.

It is possible to use intravenous normal or specific immunoglobulin, some immunostimulants (splenin, dibazol) to maintain the immune system and reduce the spread of the virus. If fetal malformations are detected, taking into account the desire of a woman, she should be offered termination of pregnancy at any time.

The treatment regimen for CMV infection during pregnancy is as follows.

Treatment in the first trimester:
- immunocorrection: cytotect, normal human immunoglobulin 25-50 ml intravenously 3 times a day;
Treatment in the second trimester:
- antiviral therapy: only with disseminated CMV infection - acyclovir intravenously;
- immunocorrection: cytotect, normal human immunoglobulin 25-50 ml intravenously 3 times a day, Viferon-1 suppositories 2 times a day rectally for 10 days;
- control: after 4 weeks - cervical scraping for CMV (PCR).
Treatment in the III trimester:
- antiviral therapy: acyclovir 200 mg 4 times a day for 2-3 weeks;
- immunocorrection: cytotect, normal human immunoglobulin 25-50 ml intravenously 3 times a day, Viferon-2 suppositories 2 times a day rectally for 10 days;
- control: after 4 weeks - cervical scraping for CMV (PCR).

Special conducting childbirth is not provided. Even in women who are actively shedding the virus during pregnancy, vaginal delivery is not contraindicated, as there are no clear advantages of delivery by caesarean section (infection rates are about the same). In addition, intranatal infection does not pose a threat to the life and health of the child compared to intrauterine infection with CMV. However, it is still advisable in childbirth to treat the birth canal with antiviral drugs (poludan solution).

Congenital CMV infection. To confirm the diagnosis of congenital CMV infection, it is necessary to examine cord blood for the presence of CMV in the blood, as well as to determine the titer of antibodies (IgM, IgG) to CMV and compare with that of the mother. If a child has CMV or class M antibodies, as well as an excess of class G antibodies in the mother, neonatal CMV infection should be diagnosed. Also examine saliva, urine and scraping from the conjunctiva by PCR for CMV DNA during the first 3 weeks of a newborn's life and again a month later, together with IgM and IgG to CMV.

The risk of vertical transmission of the virus to the fetus during primary CMV infection during pregnancy is 30-40%. At the same time, the risk of fetal damage is higher when a woman is infected in early pregnancy. Of these infected, 5-10% have clinical manifestations of the infection and 2-4% of children have some form of malformation.

Transplacental infection in the first trimester leads to malformations of the central nervous system (microcephaly, hydrocephalus, calcifications in the brain), chorioretinitis, blockade of the conduction pathways of the heart, deformation of the auricles.

Infection at a later date can lead to the development of progressive neonatal jaundice, hemorrhagic syndrome, hepatosplenomegaly, pneumonia, and fetal IUGR.

In the future, these children are more likely to develop hearing impairment, epilepsy, mental and psychomotor retardation, optic nerve atrophy, various speech disorders and learning difficulties.

In women who are seropositive at the beginning of pregnancy, the risk of transmitting the virus to the fetus is small and amounts to 1-2%. At the same time, 99% of children will not have any clinical manifestations at birth. However, subsequently, 5-10% of children will have a delay in the development of speech and learning difficulties associated with various sensorineural hearing impairments up to deafness. These disorders may have a delayed onset (at the age of 4-5 years and later) due to the ongoing replication of the virus, therefore, for several years, a dispensary registration of such children has been carried out in order to detect neurosensory and other disorders early. However, still 80-90% of children with congenital CMV infection will be completely healthy.

Clinical picture of congenital CMV infection:

thrombocytopenic purpura;
jaundice;
hepatosplenomegaly;
microcephaly;
hypotrophy;
prematurity;
hepatitis;
encephalitis;
chorioretinitis.

With secondary CMV infection during pregnancy, its congenital form is often asymptomatic, but later clinical manifestations are observed in 5-17% of children.

Prevention of cytomegalovirus infection in pregnant women

Exposure prophylaxis is hardly possible due to the different routes of transmission and poor symptoms. Seronegative women planning pregnancy should be informed about the main sources of infection (sexual activity, physical contact during daily childcare).

The best way to prevent primary CMV infection during pregnancy and its consequences for the baby is active vaccination. For this, various types of vaccines have been created - live attenuated and subunit glycoprotein B vaccine. Currently, they are undergoing clinical trials. Routine vaccination of all women aged 15-25 years is considered to be cost-effective. Prior to the use of appropriate vaccines, other options should be explored to prevent primary CMV infection during pregnancy. This requires screening for CMV antibodies in early pregnancy.

Knowledge of CMV status in early pregnancy has the following positive aspects:

in case of negative results of the IgG test of the pregnant woman, recommendations can be given to reduce the infectious risk;
with a positive test for IgG and a negative test for IgM, a woman can be informed that the child should not have birth defects;
with a positive test for IgG and IgM, other tests can be used to differentiate primary from reactivated infection, and with suspicious results, prenatal diagnosis can be performed to recognize a fetal infection.

Seronegative women with symptoms of primary infection should be retested 3–4 weeks later to confirm seroconversion. If IgM is detected in seropositive women, and especially with an increase in antibody titer upon re-examination, infection may be suspected in early pregnancy or before pregnancy (IgM persist in the blood for up to 3-5 months). Also, IgM can be detected in 20% of women with reactivation of the infection. Newer immunoblot-based IgG affinity and IgM reactivity tests have recently emerged to better differentiate between primary and latent infection, but are not yet widely used.

Thus, the main provisions in the prevention of congenital CMV infection are as follows.

Screening for CMV antibodies at the stage of preconception preparation - inform seronegative women about the main sources of infection (seropositive partner, contact with children who excrete the virus). Provide recommendations to reduce infection risk.
Passive prevention of pregnant women in contact with CMV (cytotect).
Active Prevention - Vaccines are undergoing clinical trials.
Therapy of CMV infection in a pregnant woman - cytotect, viferon.
With a proven primary infection in a pregnant woman, prenatal diagnosis is carried out.
Newborns with CMV infection - therapy (cytotect, ganciclovir).

Which Doctors Should You See If You Have Cytomegalovirus In Pregnancy?

Gynecologist Infectionist

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Cytomegalovirus infection- this is a fairly common pathology, which in the vast majority of people is asymptomatic and does not cause any serious disorders of their health. However, cytomegalovirus is of particular relevance during pregnancy, since infection of expectant mothers with this infection can lead to the development of complications during the course of pregnancy itself, as well as provoke the formation of various pathologies of the fetus and newborn.

Cytomegalovirus and pregnancy

Cytomegalovirus, or CMV (Cytomegalovirus; CMV) belongs to the fifth type of members of the herpesvirus family that are pathogenic to humans. A common feature of such viruses is their long (and more often lifelong) stay in the human body - persistence with the development of a chronic course of the disease.

For pregnant women, the danger of cytomegalovirus lies primarily in the risk of damage to the fetus and newborn.

Some facts about cytomegalovirus during pregnancy:

According to various sources, 60-95% of the adult population of the world are infected with cytomegalovirus infection, which has a latent course.
That is why most pregnant women have specific antibodies against cytomegalovirus in their blood.
Cytomegalovirus infection can be congenital or acquired.
During pregnancy, cytomegalovirus infection can be primary (acute) or chronic activation can occur.
According to statistics, primary cytomegalovirus infection occurs in approximately 1-2% of all pregnant women.
If pregnancy occurs, and cytomegalovirus enters the woman's body for the first time, infection of the fetus occurs in almost half of the cases. This is due to the lack of protective antibodies in the body of a pregnant woman.
Obvious manifestations of congenital cytomegalovirus infection are diagnosed in 7-20% of these newborns. In other children, the disease is asymptomatic or has late manifestations.
When a latent infection is reactivated, the virus is transmitted to the fetus in only about 1% of all cases.

Ways of transmission of cytomegalovirus during pregnancy

This virus is found in almost all biological fluids of the body: blood, saliva, urine, seminal fluid, cervical and vaginal discharge, breast milk, amniotic fluid, nasopharyngeal mucus, feces, etc.

The highest concentration of cytomegalovirus is found in the salivary glands.

The source of infection is an infected person with an overt or latent (latent) course of infection.

During pregnancy, cytomegalovirus can be infected in various ways, but the most common of them is airborne and sexual.

The probability of transmission of infection during kisses is high, given its "favorite" localization in the salivary glands.

Transmission of CMV to a child:

During pregnancy, cytomegalovirus can be transmitted to the fetus and newborn in two ways: transplacental (intrauterine) and during childbirth - intranatally.
Intrauterine infection of the fetus is possible at any stage of pregnancy.
The most severe consequences for the fetus occur when it is infected in the first half of pregnancy.
At the same time, cytomegalovirus affects the course of pregnancy in direct proportion to the period at which the infection occurred. For example, a miscarriage may occur in the first half of pregnancy.
During childbirth, the unborn child can become infected with this virus by coming into contact with the infected secretions of the cervix and vagina.
According to statistics, intrapartum infection with cytomegalovirus occurs several times more often than intrauterine.
A newborn can become infected with a cytomegalovirus infection if the mother does not follow hygiene standards or through infected breast milk.

Symptoms of CMV

In a significant number of cases in healthy people with a normal state of immunity, cytomegalovirus infection is completely asymptomatic. However, pregnancy is a temporary physiological factor in the weakening of the body's defenses. Therefore, during this period, cytomegalovirus infection occurs more often with the appearance of clinical symptoms.

The range of clinical manifestations of the disease varies from almost asymptomatic lesions of the salivary glands (sialadenitis) to severe pathology of the liver, respiratory system and brain.

Most often, during pregnancy, the symptoms of infection with cytomegalovirus can resemble the course of another disease - mononucleosis. This is manifested by weakness, fever, muscle pain, swollen lymph nodes.

Sometimes infection with cytomegalovirus occurs against the background of an acute respiratory disease. In this case, the symptoms of cytomegalovirus infection are completely covered by manifestations of concomitant respiratory pathology.

In the case of frequent exacerbation of latent chronic cytomegalovirus infection, the disease may also be asymptomatic. However, such women often have evidence of non-developing pregnancy or miscarriage in the past, stillbirth or the birth of children with malformations.

The main consequences of cytomegalovirus during pregnancy are a variety of signs of damage to the fetus and newborn.

Signs of CMV infection in the fetus and newborn:

With primary infection in the first trimester of pregnancy, the fetus may die. It is also possible for him to develop severe malformations, often incompatible with life.
Infection of the fetus in the last trimester and during childbirth often leads to the formation of congenital cytomegalovirus infection.
Its main manifestations are: damage to the liver and spleen, eyes, hearing organ, brain structures, a decrease in the number of platelets in the blood, etc.
Often such children are born small, have signs of intrauterine growth retardation.
But still, congenital CMV infection is more often asymptomatic.
According to some scientists, CMV infection in utero is fraught with damage to the central nervous system. At the same time, the first signs of such a lesion (mental retardation, psychomotor disorders, etc.) may appear in a child even several years after birth.
Due to the impaired immune response, bacterial complications often occur in these newborns.

Detection of cytomegalovirus in pregnant women

Currently, two methods for diagnosing cytomegalovirus infection in pregnant women are widely used: enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR).

ELISA is used to determine the state of specific immunity as a result of the determination of antibodies to cytomegalovirus. Usually, IgM, IgG and, in some cases, IgG avidity are detected.

Principles for diagnosing CMV using ELISA:

In most countries, screening for cytomegalovirus infection is mandatory for all registered pregnant women.
The appearance of IgM in the blood indicates a primary infection (acute phase of infection) or reactivation of a chronic infectious process.
The definition of IgG may indicate a past infection.
If positive cytomegalovirus IgM is detected in the absence of IgG, then this is an acute infection.
If both IgM and IgG are detected, primary infection should be differentiated from reactivation of a chronic infection.
For this purpose, the avidity of IgG is determined. Low avidity indicates a recent infection, while high avidity indicates a long-term infection process.
If it is not possible to conduct an avidity test, the analysis of the so-called paired sera is performed: a re-examination of antibodies of both classes in two to three weeks.

The norm of cytomegalovirus in enzyme immunoassay in pregnant women: IgM is not determined, IgG is in a low titer. Unfortunately, it is not possible to indicate the exact figure for the IgG level, since these indicators are different for different laboratories. Usually, reference values \u200b\u200b(norm) are indicated in the response form of a particular laboratory so that the doctor can correctly interpret the results of the analysis.

The polymerase chain reaction is used for the qualitative determination of the pathogen in the biological media of the body in the event of questionable ELISA results, as well as for prenatal diagnosis of infection (for example, the study of amniotic fluid).

Principles of treatment and prevention

Antiviral treatment of CMV during pregnancy is contraindicated in most cases. The only indication for the appointment of such therapy is a life-threatening condition of a pregnant woman, which is provoked by cytomegalovirus and its consequences (for example, a generalized form of infection with damage to vital organs).

In order to reduce the negative impact of the virus on the fetus in case of primary infection during pregnancy, it is possible to introduce specific CMV immunoglobulin, as well as the appointment of certain types of immunomodulators.

If abnormalities in the development of the fetus that are incompatible with life are detected, the woman may be asked to terminate the pregnancy.

The method of delivery, according to most experts, is not of fundamental importance.

Fundamentals of CMV prevention:

It is important that a woman asks herself: what kind of disease is this and how to prevent its negative consequences, even at the stage of pregnancy planning.
When conducting pregravid preparation, it is necessary to examine the level of antibodies to cytomegalovirus in the blood.
Based on the results of such a study, the attending physician will be able to give the necessary recommendations.
Prevention of CMV infection during pregnancy is the restriction of visiting large crowds of people, maintaining a healthy lifestyle, personal and sexual hygiene.

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