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