Cytomegalovirus (CMV) infection during pregnancy is potentially dangerous for the fetus. But there is no vaccine and its screening is not systematic in pregnant women, hence the importance of implementing preventive measures throughout pregnancy to reduce the risk of infection.
Cytomegalovirus is a virus of the herpes family. It is transmitted by direct contact with secretions (saliva, tears, urine, etc.), through blood or sexually. Cytomegalovirus infection usually begins in childhood, before 3 years of age. Young children with the virus often have no symptoms, so the disease goes unnoticed. In adolescents and young adults, the primary infection can result in mononucleosis syndrome with an increase in monocytes and lymphocytes in the blood.
This viral infection can, more rarely, occur during pregnancy and have serious consequences on the fetus.
What are the risks of a CMV infection on the fetus?
A pregnant woman who contracts cytomegalovirus for the first time (primary infection) has a 30 to 40% risk of passing it to the fetus through the placenta. “Maternal-fetal cytomegalovirus infection has, in most cases, no consequences for the fetus”, Insists the National College of French Gynecologists and Obstetricians (CNGOF). But in 10 to 15% of cases, the infection is serious for the unborn child, especially if it occurs during the first 12 weeks of pregnancy. It can cause:
- neurological sequelae (epilepsy, psychomotor delay, etc.).
- brain damage.
- hearing (deafness) or ocular sequelae.
- stunted growth.
- mental retardation.
- death in utero.
- the disease of cytomegalic inclusions.
If you have CMV infection, a pregnant woman may have symptoms similar to mild flu: fever, muscle aches, headache and fatigue. This is why the occurrence of unexplained fever during pregnancy is a reason for urgent medical consultation.
A disease that is not systematically screened for
CMV infections concern around 0.4% of births in France. They are the leading cause of mental retardation and the leading cause of non-genetic deafness. However, this infection is not the subject of systematic screening during pregnancy in France and pregnant women are little aware of the subject. A situation denounced in 2019 by a young mother whose daughter was born with multiple disabilities. Three months after her birth, Pia was diagnosed with deafness, epilepsy, and a rare brain defect that causes severe psychomotor delays due to maternal CMV infection. “CMV is this virus that stole my baby, it is this virus that is similar to a cold and that nobody talks about, it is this virus that France chooses not to screen but which does more damage than toxoplasmosis is this devastating virus that silently damaged you when you were in my womb. And yes Pia, I dare tell you, if these three little letters had not touched you, today you would be a child like the others: you would walk, you would speak, you would hear ", wrote Jessy Kosman Fbg in a poignant letter posted to Facebook on June 1, 2019.
The latter particularly regrets not having been informed about preventive measures to avoid contamination when she was pregnant.
If today there is no systematic screening for CMV in France, it is because "the criteria for good screening as specified by the World Health Organization (WHO) are not met”, Indicates the CNGOF. Namely that there is no treatment available to treat the infection, the termination of pregnancy can be adapted for the forms presenting severe damage but it cannot be recommended in all the situations, the results of a serology CMV can be difficult to interpret and the socio-economic cost is against screening.
In the event of alarming signs visible on ultrasound or in the event of fever in pregnant women, screening for CMV may be proposed.
How to treat cytomegalovirus infection during pregnancy?
The diagnosis of CMV infection is made by a blood test that measures the level of anti-CMV antibodies in the mother's blood. If the test is positive, however, it does not make it possible to determine the precise date of infection and therefore to differentiate an old infection (not dangerous for the baby) from a recent primary infection potentially dangerous for the fetus.
If infection is detected during pregnancy, amniocentesis should be performed. Faced with normal results, reinforcement of ultrasound monitoring is implemented. If alarming signs are detected, medical termination of pregnancy may be offered.
How can you prevent CMV infection during pregnancy?
There is no vaccine against CMV infection. If you are pregnant and you are not immune to the disease, prevention therefore involves taking measures to limit the risk of transmission of the virus from infected third parties. They are recommended for all pregnant women and their spouses in family or professional contact with children under 3:
- do not suck on the spoon or pacifier and do not finish the meal of children under 3 years old.
- do not share toiletries (washcloth) with children under 3 years old.
- limit oral contact with tears and / or saliva of children under 3 years old (do not kiss children on the mouth).
- wash hands thoroughly with soap and water after each change and each blowing of a child under 3 years old.
These gestures are to be observed until childbirth. In a statement, the CNGOF reminds obstetrician-gynecologists of the importance of reminding their patients of these preventive measures, "best from early pregnancy”.
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