How does CMV affect the fetus? Treatment of cytomegalovirus during pregnancy: what to do? CMV symptoms in pregnant women

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 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. People with normal jobs 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 and clinical signs in the child 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, 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 laboratory diagnostics appoints a gynecologist 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 visiting time public places with a large crowd 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 prevention make injections of human immunoglobulin "Octagam" 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 observe healthy lifestyle life. 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 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 important to know about cytomegalovirus

Pathogen cytomegalovirus infection is a large DNA-containing virus of the herpesvirus family. It has a spherical shape and is covered with a two-layer protective outer shell. On its surface are numerous spike-like outgrowths formed by lipoprotein molecules. They are necessary for recognition of macroorganism cells, attachment and introduction into them.

The features of the life cycle of cytomegalovirus include:

Cytomegalovirus has no gender and age preferences, it can affect people of any race. It is quite stable in the environment, which explains its ubiquitous distribution.

Epidemiology

Cytomegalovirus infection is mainly transmitted by household contact, airborne droplets and sexual contact, and the source of infection can be a person without obvious clinical manifestations of the disease. This explains the high degree of infection of the population. According to WHO, almost 90% of urban residents in developed countries and 60-70% of those living in rural areas are infected with this virus. More than half of healthy children born by school age become carriers of CMV infection.

Of great importance is the vertical route of transmission, which contributes to intrauterine infection of the fetus. The fact is that cytomegalovirus is able to overcome the hematoplacental barrier at any gestational age, which contributes to the development of congenital cytomegalovirus infection. A child can become infected from an infected mother also during the passage of the birth canal and during breastfeeding. In addition, there is a possibility that the fetus will receive the virus from the father if his spermatozoa contain the built-in DNA of this pathogen.

Transmission of cytomegalovirus is possible during organ transplantation and transfusion of blood (and its components) from infected donors. In rare cases, infection occurs through contaminated medical instruments during various medical procedures.

The main manifestations of acquired infection

In people infected during their lifetime, cytomegalovirus infection can exist in several forms:

latent course, the virus does not lead to the appearance of any external symptoms, but can be detected by laboratory methods;
subclinical persistent infection, manifestations are minimal and non-specific, viral particles are found in various biological secretions of an infected person;
the appearance of diseases associated with CMV: pneumonia (pneumonitis), hepatitis, parotitis, cytomegalovirus mononucleosis, enterocolitis, encephalitis, nephritis, chronic urogenital pathology;
a generalized form of cytomegalovirus infection with multiple organ damage and a severe course, the development of dementia due to chronic encephalitis, with the appearance of multiple bleeding ulcers in various parts of the gastrointestinal tract.

The vast majority of people infected with cytomegalovirus have a latent course of the disease. In this case, the infection is detected during a targeted examination in the period of preparation for transplantation, donation, at the stage of pregnancy planning and treatment.

Activation of the virus occurs most often when the immune status changes with the development of immunodeficiency of any origin. This is possible with HIV, after severe infections, with immunosuppressive therapy after transplants, with certain blood diseases and during chemotherapy. All this can lead to a decrease in immunological control over the existing cytomegalovirus infection and the transition of the pathogen into the active phase. Often there is also reactivation of cytomegalovirus during pregnancy.

The elimination (or correction) of immunodeficiencies and the ongoing treatment contribute to the inhibition of virus replication, a significant purification of biological fluids from viral particles. But pathogens located intracellularly are not destroyed, the infection passes into a latent phase. Repeated violation of the immune status causes a new exacerbation of cytomegalovirus.

Is cytomegalovirus dangerous during pregnancy?

Cytomegalovirus infection during pregnancy may be due to the primary infection of a woman or the reactivation of a virus that she already has. The severity of the symptoms arising in this case depends on the functional state of the immune system, which affects the rate of increase in the level of the pathogen freely circulating in the blood.

Acute CMV infection during pregnancy can manifest itself as an intoxication-fever syndrome, signs of damage to the submandibular and parotid salivary glands, kidneys, liver and lungs. The appearance of mucous discharge from the nose is possible, which, coupled with intoxication, gives rise to false assumptions about SARS. Often also noted with increased vaginal discharge, which have a white-bluish color and are quite liquid in consistency. Such symptoms of cytomegalovirus during pregnancy indicate damage to all new organs, but are not life-threatening for a woman and her developing child.

But cytomegalovirus can also affect the internal genital organs. This poses a threat to the safe carrying of pregnancy, increases the risk of spontaneous abortion by early dates, premature birth. And if a premature detachment of a normally located placenta occurs against the background of hypertonicity, intrauterine fetal death is possible.

The greatest danger is the defeat of the cytomegalovirus of the placenta. At the same time, cysts are formed in it, its premature aging is noted. And with infection in the early stages of gestation, intimate attachment to the body of the uterus of the chorionic tissue of the placenta is possible, which threatens with uterine atony and bleeding in the postpartum period.

Consequences of cytomegalovirus infection for the fetus

The presence of CMV in a pregnant woman poses an immediate danger to the child. Intrauterine infection is fraught with the development of a congenital form of the disease with the development of severe complications. Therefore, this infection belongs to the TORCH embryopathogenic group; women are advised to be tested for cytomegalovirus when planning pregnancy.

Depending on the gestational age, the newborn may show signs of acute cytomegalovirus infection, the consequences of impaired embryogenesis, or symptoms of chronic damage to many internal organs. Children are often born prematurely, with signs of prematurity. At the same time, an asymptomatic (at first) course of the disease is possible with the onset of the consequences of infection after the first six months of life.

The main clinical signs of congenital intrauterine infection in children early age:

pastosity and yellowness of the skin in newborns, the appearance of characteristic dark blue spots and multiple petechiae is possible;
tendency to protracted jaundice;
lethargy, drowsiness, inactivity of children, even with obvious physical discomfort;
persistently and diffusely reduced muscle tone, tremor of the limbs, lagging behind peers in motor development;
violation of sucking and swallowing, which causes persistent malnutrition and polyhypovitaminosis;
microcephaly (with infection in the early stages of gestation);
hematological abnormalities: anemia of mixed origin and thrombocytopenia;
cytomegalovirus retinitis with a decrease in visual acuity;
sensorineural hearing loss with a tendency to gradually increase the degree of hearing loss;
lag in mental development;
interstitial pneumonia, nephritis, myocarditis, colitis, pancreatitis and damage to other parenchymal organs and the brain.

When a child is infected shortly before childbirth or in the process of passing through the birth canal, he does not show signs of organ damage. But during the first 20-50 days a condition develops, the clinic of which resembles SARS. It is usually quickly stopped due to the intake of protective antibodies with breast milk, and the infection becomes latent. But in premature and hypotrophic newborns, especially if they are predominantly on artificial feeding and suffer from immunodeficiency states, possibly a more severe course of the disease with a tendency to generalization.

When and who should be examined for CMV?

In the absence of immunodeficiency in a person, the cytomegalovirus infection that he has does not pose a potential danger to life and usually does not affect its quality. Therefore, a widespread routine examination of the population for cytomegalovirus is not practiced, moreover, the presence of signs of infection (which is observed in almost 90% of people) is not a basis for active therapeutic measures.

Direction for analysis is received by:

women with a history of habitual;
infertile couples, including at the stage of preparation before conducting other assisted reproductive technologies;
suffering from chronic inflammatory diseases of the urogenital area;
mothers of children born with signs of intrauterine infections;
persons with immunodeficiencies;
prospective donors.

But it is advisable to take an analysis for cytomegalovirus when planning pregnancy for all women. Determining the presence of infection and the degree of activity of the process will help to further assess the risk of infection of the fetus.

Diagnostics

Cytomegalovirus infection does not characteristic symptoms and therefore clinical diagnosis is difficult. And laboratory research is key.

Currently used for diagnostics:

cultural method (cultivation of a virus taken from biological fluids or tissues on special media);
PCR - allows you to determine even a small amount of virus DNA in the studied biomaterial (in a smear from the urethra, vagina, cervical canal, in blood, urine, cerebrospinal fluid or saliva);
ELISA is the most commonly used test based on the determination of different classes of specific antibodies in the blood;
The cytological method, in which tissue pieces taken by the biopsy method are examined under a microscope, makes it possible to identify characteristic changes in cells.

ELISA is used in everyday clinical practice. This inexpensive and technically relatively simple study is carried out automatically and has no age restrictions. It can be repeated required amount times, which allows you to dynamically assess the course of the infectious process and approximately determine the duration of infection.

ELISA decoding

When conducting ELISA, the presence and titer of immunoglobulins Ig M and Ig G are determined. These are different classes of specific protective antibodies produced by immune cells. Their ratio must be evaluated if the analysis for cytomegalovirus during pregnancy is positive.

The presence of Ig M indicates a current infectious process, is a sign of a recent infection or activation of cytomegalovirus. The detection of such antibodies requires a decision on the need for treatment, and in pregnancy - a commission risk assessment for the fetus. Ig G indicate the presence of persistent immunity. They appear some time after infection and persist for life. It is this class of antibodies that provides the body with immunological control over the virus, restraining its reproduction and spread.

A result of up to 0.9 IU / ml is the norm of Ig G to cytomegalovirus, indicating the absence of contact with the virus. An indicator of 0.9-1.1 IU / ml is considered doubtful, and above 1.1 IU / ml is positive. In children under 3 months of age, the level of Ig G is not determined. After all, they have not yet developed their own antibodies, and the complexes circulating in the blood were obtained in utero from an infected mother.

A positive Ig M in a pregnant woman with questionable Ig G results indicates an active stage of primary infection. And the combination of a low titer of M-class antibodies with a good level of G is a sign of reactivation of a chronic infection. If only Ig G is positive, the inactive phase of the disease (remission) is diagnosed.

Determining the duration of infection has prognostic value. If a woman has chronic cytomegalovirus activated during pregnancy, its dissemination is restrained by already existing antibodies. The risk of intrauterine infection of the fetus is 3-5%. In the case of fresh infection, the transplacental route of transmission is observed in almost 60% of pregnant women, which is explained by the absence of protective antibodies in them and the unhindered spread of the pathogen.

ELISA is not always informative enough to determine the duration of infection. A more reliable result can be obtained by examining the detected G antibodies for avidity to cytomegalovirus. This determines the strength of their binding to antibodies.

The more stable the resulting immune complexes, the more time has passed since the infection. Avidity above 35% indicates that the infection was more than 3 months ago. An indicator of 50-60% is considered a threshold, it indicates the transition of the disease to the chronic stage. And highly avid antibodies are a sign of carriage or a current chronic infection.

Carrier of CMV during pregnancy: what is it?

The carrier state of cytomegalovirus is the most commonly diagnosed condition. They talk about it when a woman was previously infected, but the pathogen in her body is in an inactive phase. At the same time, no external signs of the disease are detected in her, and ELISA shows only the presence of highly avid Ig G.

Carrying is not dangerous either for a woman or for her developing child in utero. However, every 4-6 weeks, it is advisable for such a pregnant woman to undergo a re-examination to rule out virus activation. Fortunately, in most cases, exacerbation of CMV infection during pregnancy does not occur.

How to treat cytomegalovirus during pregnancy?

Whether cytomegalovirus treatment will be carried out during pregnancy depends on the activity of the process, the duration of infection and the presence of a confirmed immunodeficiency in a woman.

If the obtained laboratory data indicate infection immediately before conception or at the beginning of the first trimester of gestation, expectant management is taken. A dynamic monitoring of the development of the embryo is established. When there is evidence of a violation of embryogenesis and the appearance of defects, a commission makes a decision on the presence of indications for termination of pregnancy for medical reasons. The procedure is carried out only with the consent of the woman. To confirm the infection of the fetus, amniotic fluid can be taken for analysis.

Treatment of CMV during pregnancy is carried out upon receipt of data on a fresh infection (acute phase of the disease) or on the reactivation of an existing virus. Antiviral, vitamin, immunomodulatory drugs are prescribed. Immunoglobulins and interferons can also be used. If necessary, symptomatic remedies are used to alleviate the woman's condition. In case of damage to internal organs, drugs are introduced into the treatment regimen to correct emerging functional disorders.

Infection with cytomegalovirus in pregnant women is by no means a rare occurrence. But, despite the prevalence and relative availability of tests, many women are not aware of the presence of the disease and cannot adequately assess the risks to their unborn child. Although CMV is included in the TORCH group, even a fresh infection in a pregnant woman does not always lead to fetal damage. In addition, if you treat cytomegalovirus in early pregnancy, you can quickly transfer the infection to an inactive phase and avoid damage to the placenta and embryo.

Viral infections that occur in women during pregnancy pose a danger to both the woman herself and the fetus. This is especially true for measles, herpes viruses, rubella, cytomegalovirus infection.

Is the child often sick?

your child constantly sick?
A week in kindergarten (school), two weeks at home on sick leave?

Many factors are to blame for this. From bad ecology, to weakening of immunity with ANTIVIRAL DRUGS!
Yes, yes, you heard right! By stuffing your child with powerful synthetic drugs, you sometimes do more harm to a small organism.

In order to radically change the situation, it is necessary not to destroy the immune system, but to HELP IT ...

The leading position among congenital viral diseases is occupied by cytomegalovirus infection, which is observed in 0.2-2% of newborns. Therefore, cytomegalovirus and pregnancy is a dangerous combination.

Features of cytomegalovirus

Cytomegalovirus (CMV) is the largest DNA virus in the herpes family. It can affect various tissues in the body, but it most often replicates in fibroblasts (connective tissue cells).

The name of the disease "cytomegaly" means "giant cell" in translation. Under the influence of the virus, the affected cell increases in size, fills with fluid, which destroys its structure. The virus can be found in blood, saliva, tears, breast milk, urine, semen, and vaginal secretions.

Infection is transmitted:

through infected blood, urine, saliva (through dishes, with kisses);
upon contact with infected biomaterial;
sexually (with any kind of unprotected sex).

The source of the virus is a person. The virus always enters the blood during the initial infection, although viremia cannot be ruled out during exacerbation or activation of the virus.

In persons with normal immunity, antibodies are produced that prevent the development of severe consequences of the disease. Once in the body, the virus in a "dormant" state can be for life. Although under certain conditions it can be activated and pose a threat to life.

Re-infection occurs either when an existing virus is activated, or when infected with a new strain of the virus.

Prevalence

Why is my child's immune system weakened?

Many people are familiar with these situations:

As soon as the season of colds begins - your child is bound to get sick and then the whole family...
It seems that you are buying expensive drugs, but they only work while you are drinking them, and after a week or two baby gets sick again...
Are you worried that your child's immune system is weak very often disease takes precedence over health ...
Afraid of every sneeze or cough...
It is necessary to strengthen YOUR CHILD'S IMMUNITY!

According to research results, in developed countries, infection with the virus under the age of 35 is 40-60%, and after 60 years - about 90%. In developing countries, almost the entire adult population is carriers of cytomegalovirus.

The most dangerous cytomegalovirus infection for:

pregnant women;
cancer patients;
HIV-infected;
patients after organ transplantation;
patients receiving corticosteroids for a long time.

Children's groups, especially kindergartens, are distinguished by a high frequency of infection. Children then become a source of infection in families for other family members.

Clinic of cytomegalovirus infection

The incubation period lasts from 4 to 8 weeks (more often it is 40 days). Already in 2-3 weeks. after infection, the virus can be detected in the blood. Infection in most cases (up to 98%) proceeds without clinical manifestations.

Only some individuals may have signs that resemble a mononucleosis-like syndrome.

Manifestations of infection can be:

fever;
muscle pain;
general weakness;
sore throat;
enlarged lymph nodes;
loosening of the stool;
enlargement of the spleen and liver.

Some patients may have a rash on the skin, catarrhal manifestations. In a blood test, the number of platelets may decrease, the number of lymphocytes may increase or decrease. Sometimes the level of transaminase activity increases.

CMV infection and pregnancy

Cytomegalovirus primarily enters the body during pregnancy in 0.7-4% of pregnant women. And the reactivation of the virus already present in the body occurs in 13.5% of pregnant women. But re-infection with another strain of the virus can also occur.

Primary infection of a pregnant woman is more dangerous for the fetus: according to European experts, infection of the fetus occurs in 75% of cases. and causes more damage. With the reactivation of the virus, such a danger is noted from 0.15 to 2% of cases.

The following factors increase the likelihood of a woman getting infected:

non-compliance with personal hygiene;
age under 30;
low educational level;
transferred STDs;
a large number of sexual partners;
close contact with children in the first 3 years of life.

Most often, cytomegalovirus infection during pregnancy is manifested by symptoms resembling SARS: fever, weakness, headache, runny nose, sore throat, enlarged lymph nodes. Many women regard it as a common "cold". The main difference between cytomegalovirus infection in pregnant women and ARVI is its duration up to 4-6 weeks.

The danger of CMV infection during pregnancy

The consequences for the fetus depend on the time of infection of the woman. If the infection occurred before the onset of pregnancy, then in most cases it does not pose a danger to the child. Only in 1-2 pregnant women out of 100 previously infected, the virus becomes active and causes congenital cytomegalovirus infection.

The risk of transmitting the virus to the fetus increases to 30-40% when a woman is infected during the period of bearing a child.. The virus in any period of pregnancy first enters the placenta, multiplies in it, and already the placenta becomes a source of infection for the fetus. When a woman is infected in the 1st trimester, up to 15% of cases. spontaneous miscarriage occurs.

The consequences for the fetus during infection in the 1st trimester can also end in his death. Infection of the fetus at a later date leads to congenital cytomegalovirus infection occurring in utero.

A child can also become infected during childbirth by swallowing secretions and mucus in the birth canal. More than 50% of children become infected with the virus through breast milk.

Manifestations of infection in 90% of infected children are absent at birth and their prognosis for life is favorable. The mortality rate of newborns with manifestations of infection reaches 10-15%. In surviving children, lesions of many organs and systems are noted.

Manifestations of congenital CMV infection:

developmental and growth retardation, low birth weight;
enlargement of the liver and spleen;
prolonged jaundice;
skin rashes;
heart defects;
microcephaly (underdevelopment of the brain);
hydrocephalus (accumulation of fluid in the cranial cavity);

Consequences in the form of visual impairment, hearing loss and mental retardation appear later.

Diagnosis of cytomegalovirus infection in a pregnant woman

Testing for TORCH infection includes rubella, herpes virus, toxoplasmosis, and cytomegalovirus. Ideally, the examination should be carried out in preparation for conception. Serological analysis reveals specific early IgM antibodies and late IgG antibodies.

If a serological blood test for CMV by ELISA is carried out already during pregnancy, then the interpretation of the results may be different:

IgM to CMV is negative and IgG to CMV is negative. This result means that there has never been an infection and there are no antibodies. Nothing threatens the fetus, subject to the rules of prevention and exclusion of infection. If infected, the risk to the fetus will be very high. It is recommended to repeat the analysis every 2 months, since the infection may be asymptomatic.
IgM to CMV - negative; IgG to CMV - positive. A result in the 1st trimester means that the body is infected, but the virus is in an inactive state. The risk of virus activation does not exceed 2%, but you need to monitor the condition and consult a doctor for manifestations similar to SARS. If the test was taken in the 2nd or 3rd trimester, then infection could occur in early pregnancy with a high risk of infection of the fetus. An additional examination is needed.
IgM - positive, IgG - negative. This result indicates a recent infection and the risk of transmission of the virus to the fetus.
IgM - positive, IgG - positive. Such a result can be in the case of infection several months ago (IgM disappear after 1-2 months, but sometimes detected up to 18 weeks) or activation of the virus has occurred, but there is a potential risk to the fetus.

Many experts believe that testing for cytomegalovirus when planning pregnancy should be carried out only for women with a high risk of infection (working in kindergartens, hospitals, with promiscuity, having had STDs).

Diagnosis of congenital CMV infection

If there is a threat of infection of the fetus, in order to clarify the degree of danger, the following methods can be used:

Ultrasound makes it possible to detect abnormalities and fetal growth retardation. Signs of CMV infection may include:

microcephaly;
calcifications in the brain;
cerebral ventriculomegaly ( big sizes ventricles of the brain);
intrauterine growth retardation of the fetus;
an increase in the size of the liver;
dropsy of the fetus (ascites or free fluid in the abdominal cavity);
calcifications in the intestines and liver;
oligohydramnios.

But not pronounced changes may not be detected, so the absence of changes in ultrasound does not guarantee that the child is healthy.

The most reliable diagnostic method for detecting intrauterine infection is amniocentesis or the study of amniotic fluid. It is applied from the 21st week. pregnancy, but not before 7 weeks. after suspected infection.

Amniotic fluid is examined by PCR (the reliability of the method is 90-95%). If the DNA of the virus is not detected, then it is more likely that the child is healthy. If a qualitative PCR analysis detects the DNA of the virus, then the viral load is determined using a quantitative PCR analysis: the higher it is, the more difficult the prognosis for the child.

Pregnancy management and treatment

If a primary or recurrent CMV infection is detected in a pregnant woman, an abortion may be offered in such cases:

with primary infection and detection of serious developmental anomalies in the fetus during ultrasound (brain damage);
with primary infection with CMV during pregnancy and the study of amniotic fluid by PCR, indicating a high risk of congenital infection in the fetus.

Childbirth is possible naturally, as C-section does not reduce the risk of infection.

In the treatment of CMV infection during pregnancy, Neo-Cytotec or CytoGam, a human specific (anticytomegalovirus) immunoglobulin, can be used. The drug is prescribed for the primary infection of a pregnant woman and in case of detection of virus DNA in the amniotic fluid. It contains ready-made antibodies to the CMV virus and reduces the risk of infection of the fetus.

Application antiviral drugs (Ganciclovir, Valtrex, Valaciclovir, Cidofovir, Valavir) is significantly limited due to the pronounced toxicity of the drugs. Moreover, there is no drug that would get rid of the virus. Their impact on the body of a pregnant woman and the fetus has not been fully studied.

Immunomodulators(Wobenzym, Kipferon, Viferon) are not used in the WHO recommendations in the treatment of pregnant women, since their effectiveness has not been proven.

The use of CMV-specific monoclonal antibodies for infected children is at the stage of clinical study.

Prevention

A vaccine against CMV infection has not yet been registered.

If studies have shown that the pregnant woman is not infected, infection should be prevented by observing preventive measures:

limiting contact with young children and avoiding kissing on the lips;
thorough hand washing with soap, especially after contact with biological material;
use of individual crockery and cutlery;
exclusion of contact with sick people.

Cytomegalovirus infection poses a great danger to a pregnant woman due to the possibility of infection of the fetus. Congenital CMV infection is manifested by multiple deformities, including mental retardation and deafness of the child. If symptoms of a “cold” appear, a pregnant woman should consult a doctor to exclude CMV infection.

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Cytomegalovirus is one of the most common pathogenic microorganisms, many women are not aware of infection with the disease, but during pregnancy they begin to notice the symptoms of the disorder. Carrying the virus for expectant mothers can become a serious threat to the life of the child, so the analysis for the presence of CMV is included in the mandatory list of examinations when planning pregnancy.

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:

B
domestic. The risk of infection with cytomegalovirus during pregnancy through household items is minimal. The virus lives on personal hygiene items for several hours; for infection, the pathogen must be active.
Sexual. The most common mode of transmission of CMV. Unprotected intercourse in 70% of cases will lead to the development of a violation, especially when the immune system is weakened.
Genetic. For a lifetime, a carrier of the virus may not suspect that he is sick. In this case, the likelihood of transmission of the violation by inheritance increases.
Transfusion. It is observed in isolated cases. During a blood transfusion or organ transplant, you can become infected with cytomegalovirus. Doctors carefully check donors, so such incidents are exceptions.
Placental. During the prenatal period, a child can become infected with cytomegalovirus from a sick mother. Therefore, before pregnancy, it is worth undergoing a complete examination and regularly taking tests when observed by a gynecologist.
During breastfeeding. Carriers of the virus transmit the disease through breast milk, but complications and aggravation of the disease do not occur.

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. These 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 rise. A slight excess of the norm is not always felt by a woman. Body temperature does not exceed 38 degrees.
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. Methods traditional medicine 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. Negative consequences 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 childbirth, 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.

Cytomegalovirus, or CMV for short, is a virus that is extremely widespread throughout the world. Just like the herpes virus, rubella virus, toxoplasma and some other infections, cytomegalovirus during pregnancy can cause congenital diseases in the unborn child.

According to some data, from 40 to 100% of the world's population is infected with cytomegalovirus, that is, this virus is present in the body of almost every second person.

Infection with cytomegalovirus is possible through contact with the saliva or urine of an infected person (for example, during kissing, sneezing or coughing, sharing cutlery, changing diapers for young children), as well as during sexual contact.

During pregnancy, cytomegalovirus can pass from the mother's body into the body of the unborn child. CMV passes into breast milk, so a woman can pass this infection to her baby during breastfeeding.

How dangerous is cytomegalovirus?

Cytomegalovirus poses virtually no threat to a healthy person with good immunity. At the first meeting of the immune system with cytomegalovirus, special antibodies are produced in the body that prevent the virus from multiplying and generally manifesting itself in any way.

Most people infected with cytomegalovirus are not even aware of it, since the infection is often asymptomatic or causes short-term (fever, swollen lymph nodes, sore throat, etc.)

Cytomegalovirus poses a serious threat only to people with weakened immune systems: for HIV-infected people, for those who have to take large doses of steroid hormones for a long time, for people receiving cancer treatment, after organ transplantation, etc.

CMV during pregnancy can cause birth defects in the unborn child.

How dangerous is cytomegalovirus during pregnancy?

It all depends on when the woman contracted the virus. If the infection occurred before pregnancy, then the virus is practically not dangerous for the unborn child. In most pregnant women, the virus will remain dormant and will not cause any harm to the fetus. In only 1-2 women out of 100, the virus can be activated during pregnancy and enter the body of the unborn child, causing congenital cytomegalovirus infection.

If a woman has been infected with cytomegalovirus already during pregnancy, then the risk of transmitting CMV to an unborn child will be higher and amount to 30-40%. In this case, the child may develop a congenital cytomegalovirus infection.

What is congenital cytomegalovirus infection?

To understand what risks await the unborn baby, imagine 100 newborns who became infected with cytomegalovirus from their mothers during pregnancy.

Of those 100 newborns, 85-90 babies will have no signs of infection at all, and in only 10-15 babies, congenital cytomegalovirus infection will cause one or more of the following symptoms:

low birth weight
prolonged jaundice
enlargement of the liver and spleen
brown rash on the skin
decreased platelets in the blood with an increased risk of bleeding
small brain size with possible future mental retardation

Of these 10-15 children with symptoms of congenital cytomegalovirus infection, 2-4 children may die from bleeding, liver damage, or bacterial infection, while the rest of the children will recover.

Of the 85-90 children who did not have any symptoms of cytomegalovirus infection at birth, 5-10 children may have some consequences in the future. These children may develop hearing loss or deafness, mental retardation, or decreased visual acuity.

Cytomegalovirus during pregnancy

If you are already pregnant and have not been tested for cytomegalovirus before, your doctor may recommend this test during pregnancy. The analysis for cytomegalovirus is included in the complex (, cytomegalovirus and virus).

In order to clarify your immune status (that is, to determine if you are immune to cytomegalovirus), you will need to take a blood test for antibodies to CMV (CMV).

What do cytomegalovirus antibody test results mean during pregnancy?

After receiving the results of the test for antibodies to cytomegalovirus, you can find one of the following four options:

Antibodies IgG to cytomegalovirus - negative
IgM antibodies to cytomegalovirus - negative

If an immunoglobulin test does not detect antibodies to CMV, this means that your body has never met this infection and you are not immune to the virus.

Nothing threatens your unborn child, but so that there is no further threat, you need to strictly observe the rules of personal hygiene. Detailed recommendations for the prevention of cytomegalovirus during pregnancy are presented at the end of this article.

In case of infection during pregnancy, the risk of infection of the unborn child will be quite high. Some experts believe that an analysis for antibodies to cytomegalovirus should be taken prophylactically every 1-2 months throughout pregnancy. This may be justified, since most pregnant women with cytomegalovirus infection are asymptomatic.

IgG antibodies to cytomegalovirus (CMV, CMV) - positive
IgM antibodies to cytomegalovirus (CMV, CMV) - negative

A positive IgG to cytomegalovirus during pregnancy means that you are infected with cytomegalovirus, but in this moment the virus is inactive. If you passed this test in the first trimester of pregnancy, then nothing threatens your unborn child. There is a risk that CMV is activated during pregnancy and passed on to the unborn child, but it is not large, and does not exceed 1-2%. That is, out of 100 women with IgG antibodies to cytomegalovirus during pregnancy, only 1-2 will “wake up” the virus and enter the fetus. Unfortunately, it is impossible to predict such a situation, so you need to carefully monitor your well-being. You will need to see a doctor if you experience symptoms similar to those of a cold.

If you passed this test in the second or third trimester of pregnancy (and have never been tested for antibodies to CMV before), then there is a risk that the infection occurred in the early stages of pregnancy and the infection was transmitted to the unborn child. In this case, it is necessary to check the avidity of antibodies. You can read about what this indicator is by clicking on the link:

High avidity of antibodies (more than 60%) means that the infection occurred at least 18-20 weeks ago. Thus, your child is most likely not in danger. If the antibody avidity is intermediate or low (less than 60%), then you may need additional testing.

IgG antibodies to cytomegalovirus (CMV, CMV) - negative
IgM antibodies to cytomegalovirus (CMV, CMV) - positive

Positive IgM to cytomegalovirus during pregnancy, this means that you have been infected very recently (several weeks or months ago) and there is a risk of passing cytomegalovirus to an unborn child. In this case, you will need an additional examination, which we will discuss below, in the section

IgG antibodies to cytomegalovirus (CMV, CMV) - positive
IgM antibodies to cytomegalovirus (CMV, CMV) - positive

There may be two options: either you became infected with cytomegalovirus a few months ago and there is a potential threat to the unborn child, or you became infected with cytomegalovirus a long time ago, but at the moment the virus has “woken up” (reactivation of the infection).

If test results are positive for cytomegalovirus, it is recommended to determine the avidity of IgG antibodies. You can read about what this indicator is by clicking on the link:

If the avidity is high (more than 60%), then the infection occurred at least 18-20 weeks ago, and the risk for the unborn child is very small. If the antibody avidity is intermediate or low (less than 60%), then you may need additional testing.

What should I do if I contracted cytomegalovirus during pregnancy?

If a woman first became infected with CMV during pregnancy, then they speak of a primary cytomegalovirus infection. This is a rather dangerous condition, since the virus can enter the body of the fetus and cause some complications.

In order to find out if the virus has entered the fetus, the doctor may prescribe the following examinations:

ultrasound

Ultrasound can detect pronounced developmental anomalies in the fetus, provoked by cytomegalovirus: intrauterine growth retardation, brain development anomalies, microcephaly, ascites, etc. Oligohydramnios can also be a sign of cytomegalovirus infection in the fetus. Minor deviations may go unnoticed, so good ultrasound results are not yet a guarantee of the health of the unborn child.

Amniocentesis

Analysis of amniotic fluid () is the most effective method for diagnosing intrauterine cytomegalovirus infection. This analysis can be done from the 21st week of pregnancy, but not earlier than 7 weeks after the expected date of infection. A negative result of the analysis allows us to say with a high degree of confidence that the unborn child is healthy.

If the results of the analysis are positive (that is, DNA of the virus is found in the amniotic fluid), then the laboratory performs a quantitative PCR analysis for CMV (determines the number of viruses, or viral load). The higher the viral load, the worse the prognosis for the fetus:

<10*3 копий/мл означает, что с вероятностью 81% будущий ребенок здоров

the number of sets of CMV DNA ≥10 * 3 copies / ml means that the virus has entered the fetus with a probability of 100%

number of CMV DNA kits<10*5 копий/мл означает, что с вероятностью 92% у ребенка не будет никаких симптомов инфекции при рождении

the number of sets of CMV DNA ≥10*5 copies/ml means the baby will have symptoms of congenital cytomegalovirus infection at birth. Your doctor may suggest that you terminate your pregnancy.

Is it necessary to terminate the pregnancy?

Despite the fact that cytomegalovirus can cause serious malformations in an unborn child, termination of pregnancy with this disease is not always required.

Your doctor may suggest that you terminate your pregnancy if:

you first became infected with cytomegalovirus during pregnancy and an ultrasound scan revealed serious fetal abnormalities (brain damage that inevitably leads to disability).

you first contracted cytomegalovirus during pregnancy and amniotic fluid test results showed a high risk of congenital cytomegalovirus infection in the fetus.

How to treat cytomegalovirus during pregnancy?

The following medications may be used in the treatment of CMV during pregnancy:

Human anticytomegalovirus immunoglobulin (Neo-Cytotect)

This medicine contains antibodies against cytomegalovirus, which are obtained from the blood of other people who have recovered from cytomegalovirus and have developed their own immunity. According to some reports, anticytomegalovirus immunoglobulin during pregnancy can reduce inflammation of the placenta, neutralize the virus and reduce the risk of transmission to the fetus.

Immunoglobulin against CMV can be prescribed for primary cytomegalovirus infection (if the woman became infected already during pregnancy), with low avidity of IgG antibodies to CMV, and when cytomegalovirus DNA is detected in the amniotic fluid.

Antiviral drugs (Valacyclovir, Valtrex, Valavir, Ganciclovir)

Antiviral drugs can prevent the reproduction of cytomegalovirus during pregnancy and reduce the viral load (number of viruses) in the body of the fetus.

The dosage of the drug and the duration of treatment is determined by the attending physician. Do not self-medicate!

Immunomodulators (Viferon, Kipferon, Wobenzym, etc.)

Drugs from this group are often prescribed by doctors in the CIS countries, but none of these drugs appears in international recommendations for the treatment of cytomegalovirus infection during pregnancy. The effectiveness of these drugs is still questionable.

The dosage of the drug and the duration of treatment is determined by the attending physician. Do not self-medicate!

Prevention of cytomegalovirus during pregnancy

If tests for cytomegalovirus have shown that you are not immune to this infection, then during pregnancy you need to take precautions so that you do not become infected yourself and not infect your unborn child. Young children are frequent carriers of cytomegalovirus, so during pregnancy you should limit contact with young children as much as possible.

To prevent CMV infection during pregnancy, follow the recommendations of infectious disease doctors:

Wash your hands with soap for at least 15-20 seconds, especially after interacting with young children (after changing diapers, feeding, contact with saliva, snot or other bodily fluids)
Do not share your food or drink with other people, and especially with children.
Do not finish eating or drinking after other people, especially after children.
Use a separate container that only you will eat or drink from.
Do not kiss young children, or if this is not acceptable, avoid contact with the child's saliva.
Thoroughly clean toys and other items that may have been contaminated by your child's saliva.
Do not interact with people who currently have symptoms of a cold.