CMV depends on kind of infection

CMV depends on kind of infection

Dear Dr. Donya,

I happened to read your article about the CMV virus in The
Jakarta Post. (CMV is a member of the herpes virus group that
includes herpes simplex virus types 1 and 2, varicella-zoster
virus, which causes chicken pox, and Epstein-Barr virus, which
causes infectious mononucleosis).

I am 35 years of age and have one beautiful and smart daughter
of eight years of age. I live in Jakarta and work as a human
resources manager for a pharmaceutical industry.

Back in July 2000, I became pregnant for the second time, and
had an abortion seven weeks into the pregnancy. At that stage,
there was a chicken pox epidemic in the house. Starting with my
daughter (who got it from her friend at school) and then my
husband and my maid. I had chicken pox when I was a teenager. But
realizing that there was a chicken pox virus flying around the
house near the day of conception, I had a CMV test. I was so
afraid that my unborn baby had become infected or would become
infected during birth that we decided to let the baby go. I saw
on the Internet that CMV can caused mental retardation and
gradual hearing loss, with a 70 percent chance the fetus will be
infected during pregnancy.

At the moment, I am seven weeks pregnant (3rd baby) and I have
had my TORCH test, which includes CMV. The results say that I am
still infected with CMV.

The rates are: CMV IgG 100.5 AU/ml (cut off: 15.0) and CMV IgM
0.957 Index (cut off: 0.500). My husband and I have decided to
carry on with this baby, whatever the risk we might have to bear.
However, I still have questions regarding the matter: how do we
recognize if the fetus is infected by the virus? Can we detect if
it is infected and still have an abortion? Do you find a lot of
cases in Indonesia of disabled babies born due to CMV?

Thank you for your attention. I will be anxiously awaiting
your reply.

-- D

Dear D,

A woman can pass CMV on to her baby before birth, during
delivery, or through breast feeding. However, babies who acquire
CMV during delivery or from breast feeding rarely have any
serious problems from the virus.

For your concerns, it depends on what kind of infection you
have; primary or recurrent.

A woman who contracts CMV for the first time (primary) during
pregnancy has about a 30 percent to 40 percent chance of passing
the virus on to her fetus. A recent study suggests that women who
contract CMV for the first time in the third trimester are more
likely to pass the infection on to their babies than women who
develop the disorder earlier in the pregnancy. However, studies
suggest that babies are more likely to be severely affected when
their mother is infected in the first 20 weeks of pregnancy.

Like other viruses in the herpes family, CMV persists in the
body after the initial symptoms disappear. Sometimes the disease
reactivates. However, fewer than 1 percent of fetuses become
infected when their mother has a recurrent infection. And when
they do become infected, they rarely develop any serious CMV-
related problems.

If a pregnant woman is diagnosed with CMV, her fetus can be
tested for the infection by amniocentesis. In amniocentesis, the
physician inserts a thin needle through the pregnant woman's
abdomen to withdraw a small amount of amniotic fluid, in which
the virus can be detected. This test is at least 80 percent
accurate in determining whether or not the fetus is infected with
CMV. However, it cannot tell which fetuses actually have severe
symptoms of the disease. For this reason, ultrasound also is
recommended in order to identify brain abnormalities and other
signs that a fetus may be severely infected.

In newborns, doctors diagnose CMV by identifying the actual
virus in body fluids within three weeks of birth. Take care

-- Dr. Donya