Cytomegalovirus in pregnant women is normal. Cytomegalovirus during pregnancy: positive and negative. At the time of pregnancy, a woman does not have immunity against CMV

Cytomegalovirus infection is the leading disease among congenital viral infections of newborns. This virus can be a silent life partner in the human body or become a potential killer under certain conditions. This is one of the most dangerous viruses for newborns, since CMV infection can cause mental retardation and death in children. Both the primary infection with the virus during pregnancy and the reactivation of an infection already living in the body are dangerous.

The concept of "immunity to CMV" does not exist!

Cytomegalovirus was discovered relatively recently - in 1956, and has not yet been sufficiently studied. It belongs to the group of herpes viruses. Carriers of the CMV virus at the age of 30 to 40 years is 50-90% of the population. IGG antibodies to cytomegalovirus are also detected in people who did not have any symptoms of herpetic diseases at the time of the examination.

CMV is transmitted from person to person through contact with infected blood, saliva, urine, breast milk, and also through sexual contact. The virus is not very contagious, close contact is required for infection in the household. However, he feels great in the salivary glands, and any, even the most innocent kiss, a sip of water from a common bottle or a cup of coffee "for two" can be fatal.

The latent (incubation) period lasts from 28 to 60 days. The likelihood of infection increases with, and this condition is natural during pregnancy. That's why Pregnant women are much more likely to contract this virus. And it is even higher in pregnant women undergoing immunosuppressive therapy (receiving metipred).

Primary infection occurs in 0.7-4% of all pregnant women. Recurrent infection (reactivation) may occur in 13% of infected pregnant women. In some cases, secondary infection is observed, but with other strains of cytomegalovirus (a total of 3 strains were registered).

Most people (95-98%) infected with CMV do not have clear symptoms during the initial infection - usually the disease proceeds under the guise of SARS. Symptoms include fever, muscle pain, and diarrhea. The main difference between cytomegalovirus infection and the common cold is that the course of cytomegalovirus is usually longer - up to 4-6 weeks.

With a generalized (universal, severe) form of cytomegalovirus infection damage to internal organs is possible. This form of cytomegaly usually occurs against the background of a sharp decrease in immunity. In this case, an overlaying septic bacterial infection is possible, usually difficult to cure. The parotid and submandibular salivary glands may increase, inflammation of the joints occurs, the skin becomes covered with a rash. Approximately one third of patients will have cervical lymphadenitis (tenderness of the cervical lymph nodes), pharyngitis (sore throat), and splenomegaly (enlarged spleen). Changes in the blood: a decrease in hemoglobin, leukopenia (a decrease in the level of leukocytes), an increased number of lymphocytes (observed with any viral exacerbation), thrombocytopenia (a decrease in the level of platelets), transaminases (a special substance in the blood) are moderately increased in more than 90% of patients.

Genital cytomegalovirus infection in women may be characterized by the development of inflammatory reactions in the form of vulvovaginitis, colpitis, inflammation and, the inner layer of the uterus, salpingo-oophoritis. Patients are concerned about discharge from the genital tract and rectum of a whitish-bluish color. On examination, there are often seals with a diameter of 1-2 mm, located on the small and large labia. The mucosa is usually hyperemic (reddened) and edematous.

In men, a generalized form of cytomegalovirus infection affects the testicles, causes inflammation of the urethra and discomfort during urination.

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After infection with CMV in the human body, an immune restructuring occurs, which adapts the body to new conditions. pursues the virus in the blood, driving it, as a rule, into the salivary glands and kidney tissues, where the virus passes into an inactive state and “sleeps” for many weeks and months.

How does a fetus become infected with cytomegalovirus?

At primary infection infection of the fetus with cytomegalovirus occurs in 30-40% of cases, and according to some European scientists, infection of the fetus can be observed in 75% of cases. At reactivation of the current infection transmission of the virus to the fetus is observed in only 2% of cases, although there is evidence that indicates a much greater likelihood of infection. Congenital CMV infection is present in 0.2-2% of all newborns.

There are three main mechanisms of transmission of the virus to the fetus:

the embryo may be infected with a virus from semen;
cytomegalovirus can penetrate from the endometrium or cervical canal through the fetal membranes and infect the amniotic fluid, and then the fetus;
cytomegalovirus can infect the fetus transplacentally.
possible infection during childbirth.

(Different studies estimate the likelihood of a particular route of infection differently.)

The CMV infection virus is transmitted to the fetus through the placenta in any period of pregnancy in the same way (although the likelihood of reactivation of a latent infection in the mother's body is higher in the third trimester). If the infection of the mother occurred in the first trimester, then in 15% of these women the pregnancy ends in a spontaneous miscarriage without viral damage to the embryo itself, that is, the infectious process is found only in the placenta. Therefore, there is an assumption that the placenta is first infected, which still continues to function as a barrier in the transmission of CMV to the fetus. The placenta also becomes a reservoir for CMV infection. It is believed that CMV multiplies in the placental tissue before it infects the fetus.

In early pregnancy, spontaneous miscarriage with cytomegalovirus infection occurs 7 times more often than in the control group.

Why is cytomegalovirus infection dangerous for the fetus? What are the consequences for the fetus infection with cytomegalovirus?

Transmission of the virus to the fetus in some cases leads to

giving birth to a low birth weight baby
the development of infection with intrauterine fetal death (miscarriage, spontaneous abortion, stillbirth - up to 15%),
the birth of a child with congenital CMVI, which is manifested by malformations (microcephaly, jaundice, enlarged liver, spleen, hepatitis, heart defects, inguinal hernia, congenital deformities),
the birth of a child with congenital CMVI, which does not appear immediately, but at 2-5 years of age (blindness, deafness, speech inhibition, mental retardation, psychomotor disorders).

It is possible to exclude the transmission of cytomegalovirus to the fetus if both partners of CMV carriers undergo therapy before conceiving a child.

Cytomegalovirus infection can provoke the appearance of antiphospholipids in the mother's body, which will attack the cells of her body (autoaggression). This is a very dangerous complication of CMV. Antiphospholipids can damage placental vessels and disrupt uteroplacental blood flow.

CMV diagnosis. Analysis for cytomegalovirus

Over the past thirty years, many laboratories around the world have developed a lot of diagnostic methods for detecting CMV in the human body. Diagnostic study in pregnant women it is important to at the slightest suspicion for the presence of cytomegalovirus infection, especially with an unfavorable outcome of a previous pregnancy and with clinical manifestations (symptoms) of CMV infection.

Clinical manifestations of cytomegalovirus infection

If both the herpes simplex virus and CMV are in the human body at the same time, they often become aggravated at the same time. Therefore, a "cold" on the lip is a reason to be examined for CMV.
White-bluish discharge from the vagina.
Any rashes on the skin (even single ones). They differ from acne in that they appear at the same time and do not have a purulent head - just red dots.
The appearance on the small or large labia of small solid subcutaneous formations.
In some cases, the only sign of the disease is inflammation of the salivary glands, in which the cytomegalovirus feels most comfortable.

If you have at least one of these symptoms during pregnancy, you need to urgently start testing for cytomegalovirus!

Toxicosis in the first half of pregnancy and bloody issues in the second, they may be associated with cytomegalovirus.

Analysis for antibodies to cytomegalovirus (ELISA - enzyme-linked immunosorbent assay)

The analysis for antibodies to CMV includes the determination of two specific immunoglobulins: IgM and IgG. About IgM they write "positively" or "negatively" (qualitative characteristic), for IgG they determine the titer (quantitative characteristic).

IgM antibodies appear in the blood during primary infection (always, but their appearance can be delayed up to 4 weeks) and when an existing infection is activated (in 10% of cases). If the CMV analysis says "IgM positive", it means that the infection is active. Against the background of active CMV, it is impossible to become pregnant !!! In this case, you should determine the level of IgM antibodies in dynamics (quantitative method) to find out if your IgM titers are rising or falling, and, accordingly, at what stage the infection is. A rapid fall in IgM titers indicates a recent infection/exacerbation, a slow one indicates that the active phase of the infection has passed. If IgM is not found in the blood serum of an infected person, then this indicates that the infection occurred at least 15 months before the moment of diagnosis, however, it does not completely exclude the current reactivation of the virus in the body, that is, the absence of IgM in the blood test does not give grounds to consider that you can begin to conceive! More research is needed (see below). Question: why then do this analysis at all? Answer: it is still able to detect the active form of the virus and is inexpensive. In some situations, as a result of the very high sensitivity of the tests, false positive results are possible when determining IgM.

If a person has never met with CMV, then the IgG titer will be below the reference value indicated on the analysis form. This means a high risk of CMV infection during pregnancy. Women who do not have a CMV IgG titer are at risk!

After primary infection with CMV, IgG antibodies remain in the blood for life. But this - not immune to cytomegalovirus! The presence of IgG allows the possibility of reactivation of the infection against the background of immunity weakened by pregnancy. After infection / reactivation, IgG titers rise (an increase in titer by 4 or more times relative to the baseline characteristic of this patient indicates CMV activation), then fall VERY SLOWLY.

The level of latent IgG antibodies depends both on the state of the virus at the moment and on the state of human immunity, therefore, a single analysis that showed the presence of Ig G antibodies in the body, even at values several times higher than the reference one, does not unequivocally indicate an exacerbation of CMV.

What do IgM and IgG antibodies to cytomegalovirus show?

Primary infection or reactivation? In the case where IgM is positive, the avidity of IgG antibodies should be determined. Avidity (lat. - avidity)- characterization of the strength of the connection of specific antibodies with the corresponding antigens. In the course of the body's immune response, IgG antibodies initially have low avidity, that is, they bind the antigen rather weakly. Then the development of the immune process gradually (it can be weeks or months) goes towards the synthesis of highly avid IgG antibodies by lymphocytes, which bind more strongly to the corresponding antigens. Low-avidity IgG antibodies (avidity index (AI) up to 35%), on average, are detected within 3-5 months from the onset of infection (this may to some extent depend on the method of determination), but sometimes they are produced for a longer period. By itself, the detection of low-avid IgG antibodies is not an unconditional confirmation of the fact of fresh infection, but serves as additional confirmatory evidence in a number of other serological tests. High avidity of specific IgG antibodies (avidity index greater than 42%) makes it possible to exclude recent primary infection.

However, a blood test for antibodies, especially a single one, cannot provide sufficient information about the course of cytomegalovirus infection in the body. If an antibody test is positive, another method is usually used, both to confirm the presence of antibodies and to check for the presence of the active virus itself.

Polymerase chain reaction (PCR) method for the diagnosis of cytomegalovirus

This method of diagnosing cytomegalovirus is based on the identification of the DNA of the infectious agent, since cytomegalovirus belongs to DNA-containing viruses. Material for research may be discharge from the urethra, cervix, vagina, urine, saliva, cerebrospinal fluid. The time from taking material for research to obtaining results is usually 1-2 days, and this is the main advantage of the PCR method over the method of cultural diagnostics (inoculation).

PCR method due to its high sensitivity, it detects even a segment of CMV DNA and is considered very progressive. Its most important advantage is the ability to diagnose the early stages of the process, latent and persistent infection, however, it has a low predictive value, due precisely to the fact that PCR detects virus DNA even in a latent state. In other words, this method does not distinguish between an active virus and a dormant one.

Qualitative and quantitative determination of CMV DNA in almost any fluid of the human body has an accuracy of 90-95% - if the virus is present in this tissue. A feature of CMV is its optional presence in all biological fluids at once.

Detection of CMV by PCR in human biological tissues does not make it possible to determine whether the infection is a primary or repeated reactivation of the current infection.

Isolation of cell culture (seeding) for the diagnosis of CMV

This is a diagnostic method in which the test material taken from blood, saliva, semen, secretions from the cervix and vagina, amniotic fluid is placed in a special nutrient medium favorable for the growth of microorganisms. The disadvantage of this method is that obtaining results requires a large number time: a week or more.

A positive test ("virus detected") is 100% accurate, a negative test may be false.

Cytology for the diagnosis of cytomegalovirus

Cytological examination reveals typical giant cells with intranuclear inclusions, but is not a reliable method for diagnosing CMV infection.

The likelihood of infection of the fetus and the level of antibodies

The probability of infection of the fetus is directly proportional to the concentration of the virus in the blood. It does not matter whether it is primary infection or reactivation, it is the concentration of the virus that is important. The concentration of the virus is determined by the level of protective antibodies: the more antibodies, the lower the concentration of the virus. People who first encounter CMV do not have antibodies, and therefore the concentration of the virus is high, which means that infection of the fetus is most likely. CMV carriers have antibodies, and the concentration of the virus in the blood is lower. The exception is pregnant women receiving immunosuppressive therapy (usually metipred). Metipred suppresses the production of all types of antibodies in the body, which means that protection against CMV is weaker than it could be in the absence of metipred, and the likelihood of transmitting the virus to the fetus increases.

There is another aspect related to the degree of damage that the virus inflicts on the fetus. IgG antibodies cross the placenta and in the blood of the fetus are able to fight the cytomegalovirus. The level of antibodies in the body of the fetus is determined by the level of antibodies in the body of the mother. If this level is high enough, the harm caused by CMV can be completely reduced to zero: in a child infected with CMV in utero, signs of CMV infection may not appear either immediately or later.

The most severe lesions occur in children whose mothers were initially infected with CMV. In second place are those whose mothers received immunosuppressive therapy. On the third - cases of reactivation of CMV during pregnancy, not detected and not treated. At the last, cases of reactivation in pregnant women not receiving immunosuppressive therapy, in whom reactivation was detected and who received treatment in the form of intravenous infusion of immunoglobulins.

Management of pregnancy, childbirth and the postpartum period in women with CMV infection. Necessary tests for CMV in pregnant women

In conditions of a risk of exacerbation of CMV, it is necessary to carry out a quick and, most importantly, reliable diagnosis in order to start using the necessary drugs in time and prevent the virus from spreading in the body. The method for detecting antibodies is not suitable, since antibodies are formed with a long delay. The PCR method gives an answer almost instantly, but cannot distinguish between a live virus and a dead one. The only way out is sowing, although it takes a long time.

At the same time, it is worth doing blood cultures at least twice - at the beginning and at the end of the first trimester, since infection of the fetus during this period is most dangerous.

The duration of pregnancy has a significant impact on the frequency of infection in the mother. In the early stages of pregnancy, cytomegalovirus production is suppressed, but this suppression decreases as pregnancy progresses, and the likelihood of cytomegalovirus isolation as a result of infection reactivation increases. Therefore, it is a good idea to do a blood culture both in the second and in the third trimester, since intrauterine infection is possible at any time.

Activation of CMV in the body of a pregnant woman does not yet mean intrauterine infection of the fetus. Carefully selected powerful therapy and strict implementation of the doctor's recommendations can significantly reduce the risk of transmitting the infection to the child, which directly depends on the activity of the virus in the mother's body. I must say right away that the only cure for the virus during pregnancy is immunoglobulin.

Against the background of cytomegaly, the fetal weight often exceeds the gestational age, and there are also partial increments of the child's place, premature detachment of a normally located placenta, blood loss during childbirth, reaching 1% of the woman's body weight, a clinic of latent postpartum endometritis with the development of menstrual disorders in the future.

Infection of the child can occur during childbirth when he swallows the cervical mucus and vaginal discharge of the mother. This virus is also found in breast milk, so more than half of the children on breastfeeding become infected with CMV infection in the first year of life. Intranatal or early postnatal transmission of cytomegalovirus occurs 10 times more often than transplacental.

Women who actively shed the virus during pregnancy can give birth on their own because C-section does not provide any benefit in protecting the child from infection in this case.

Obstetricians often face the question: keep a pregnancy in a woman infected with cytomegalovirus or consider it contraindicated? This issue must be resolved on the basis of dynamic monitoring using ultrasound monitoring of fetal development (malformations), prenatal testing of anti-cytomegalovirus IgM antibodies in the fetus during amniotic fluid sampling by amniocentesis.

After delivery, it is important to confirm the diagnosis of congenital CMV infection within the first two weeks, and to differentiate between primary infection during childbirth through the birth canal or infection through milk during the first days of breastfeeding.

Diagnosis of CMV infection in the fetus

The determination of IgM in the blood of the fetus is not a reliable diagnostic method, since the appearance of these antibodies can be greatly delayed. However, the detection of IgM in umbilical cord blood is an unambiguous evidence of infection of the fetus, since these antibodies, due to their significant molecular weight, do not penetrate the placental barrier.

Currently, detection of a virus culture in the amniotic fluid (inoculation) and polymerase chain reaction (PCR) make it possible to make a correct diagnosis in 80-100% of cases. The level of all virological parameters (viremia, antigenemia, DNAemia, etc.) in the blood of fetuses with developmental abnormalities is higher than in fetuses with no abnormalities found. Also, the level of specific IgM immunoglobulins in normally developing fetuses is much lower than the level of these antibodies in children with developmental disabilities. These data suggest that congenital CMV infection in infected fetuses with normal biochemical, hematological, and ultrasound findings, as well as low level virus genome and antibodies to it, has a more favorable outcome.
Determination of viral DNA in amniotic fluid can be a good prognostic factor: its level is lower if the fetus does not have developmental abnormalities.
Negative test results are not a reliable sign that the fetus is not infected.
The risk of transmission of the virus from mother to child during diagnostic procedures in the presence of active virus in the mother is small.

Treatment of cytomegalovirus

CMV infection in a latent state generally does not require treatment.

In certain cases, it is possible to prescribe antiviral drugs. The effect of these drugs on the body of a pregnant woman and the fetus has not been fully studied. The use of antiviral drugs is also limited in pediatrics due to the high toxicity of drugs.

Treatment with immunomodulators usually lasts for several weeks, only a doctor prescribes them.

Specific anticytomegalovirus immunoglobulin is administered intravenously (dropper). It contains 60% CMV-specific antibodies. Intramuscular administration of immunoglobulin is allowed, but this significantly reduces its effectiveness. It should be noted that the use of immunoglobulin only reduces the likelihood of infection of the fetus or reduces the negative consequences of this infection, however, even such an inferior result gives a gain in the health of children, therefore, a specific immunoglobulin should definitely be used, especially given the complete safety of the drug.

Nonspecific immunoglobulins for intravenous administration are prescribed for the prevention of CMVI in immunocompromised individuals. However, their effectiveness is much lower than specific immunoglobulins. However, they can also help in the fight against cytomegalovirus infection.

The cytomegalovirus is almost insensitive to action, which is an important factor in determining the significant frequency of latent cytomegalovirus infection. At the same time, cytomegalovirus prevents the production of interferon under conditions of mixed infection, one of the components of which is a virus that has interferonogenic activity during monoinfection. So, it is known that in patients with cytomegaly, influenza occurs in a more severe form.

Leukocyte interferon, introduced into tissue culture, protects cells from extracellular cytomegalovirus, but does not protective effect from intracellular.

So, the drug of choice during pregnancy is immunoglobulin. The level of fetal damage directly depends on the level of antibodies in the mother's blood.

Pregnancy is a responsible event and you need to take it seriously - do not forget to examine your body and make the necessary tests. What does it mean if it turned out that cytomegalovirus IgG is positive during pregnancy, will this affect its course and the development of the fetus? This infection belongs to the group of herpes, therefore, like all diseases of this group, it is often asymptomatic or the symptoms are not pronounced.

But it is very important to establish if the analysis turned out to be positive, whether there are antibodies to cytomegalovirus in the blood.

After all, any pathological process during pregnancy can lead to a negative effect on the child's body. The main thing in treatment is to remember that you need to consult a doctor in everything, do not self-medicate!

In this article you will learn:

Positive IgG

If the result for cytomegalovirus IgG turned out to be positive, this does not mean that something threatens the patient's health or that a pathological process is actively taking place in the body. In most cases, this means that a person has immunity to this infection, but he is its carrier. Once infected with cytomegalovirus, it persists in the body for life, even after treatment.

In the manifestation of this virus great importance has a state of the immune system, the body's resistance to diseases. If Health and Immunity stays at high level, then the virus may not manifest itself throughout life. It is necessary to test for antibodies to CMV in a pregnant woman, since the child's body is still unable to produce them itself against infections.

Primary infection

During pregnancy, cytomegalovirus can manifest itself both in the form of a primary infection and in the event of a relapse, this is primarily due to a decrease in the woman's immunity, an increased load on her body and a decrease in resistance to antigens.

If the tests turned out to be positive for IgM, this means that a primary cytomegalovirus infection has occurred. After all, this type of immunoglobulin is produced by the body a short time after infection in order to be the first to fight the infection. It is believed that the primary infection is more dangerous, because the body has not yet developed antibodies to the virus that can fight the infection, and for this it needs a lot of energy and high immunity.

The infection is transmitted by airborne, contact, sexual and intrauterine routes, that is, it is possible for a child to become infected even before birth. Unfortunately, this can affect the development of the fetus. Therefore, if antibodies are detected in the first 12 weeks of pregnancy, it is necessary for the doctor to urgently prescribe treatment.

Disease recurrence

The situation when the mother had CMV before pregnancy is most often more favorable. This is due to the fact that the resistance of immunity to a particular type of pathogens is high, antibodies are already circulating in the blood, which are ready to join the fight and protect the body of the mother and fetus.

The presence of a relapse is indicated by the appearance in the blood of IgG, which exists throughout life and is often produced after the infection has been cured.

Deciphering a blood test for TORCH infection

TORCH infections are a group of toxoplasmosis (T), rubella (R), cytomegalovirus infection (C) and herpes (H), the letter "O" indicates other infections that can affect the child. These diseases are combined because of their danger to the fetus during pregnancy. The purpose of their conduct is the calculation of the presence of IgG in a woman. In their absence, the expectant mother should take precautions and be observed by the doctor throughout the pregnancy.

The result of the analysis for cytomegalovirus is obtained after an enzyme-linked immunosorbent assay (ELISA), which detects early (M) and late (G) antibodies. Ideally, a woman should have these tests before a planned pregnancy.

IgG class

A positive result for the developed IgG to cytomegalovirus indicates the presence of immunity to this disease. This the best option during the course of pregnancy, the risk that the woman will get sick is small and the threats to the child are minimal.

They are synthesized by the body itself and protect the human body throughout life. They are produced later, after the course of an acute process and even after treatment.

IgM class

Depending on whether there is an estimated risk of fetal anomalies. These immunoglobulins are produced quickly to fight infection. But they do not have a memory, they die after a while, thus not creating an immune defense against the pathogen.

Avidity of immunomodulins

Avidity characterizes the strength of the bond between antigens and antibodies specific to them. The avidity of IgG increases with time, thanks to which it is possible to assess how long ago the infection with the pathogen occurred.

The results can be evaluated in this way:

A negative test means no infection in the absence of IgG and IgM;
Less than 50% - infection occurred for the first time;
50-60% - you need to repeat the test after a while;
60% or more - there is immunity, the person is a carrier of the infection, or the process proceeds in a chronic form.

Congenital cytomegalovirus infection

This form of CMV occurs as a result of intrauterine infection of the child. In most cases, it does not manifest itself, and children remain carriers of the infection. In some children, symptoms appear in the first years, and even months, of life.

They may appear as:

anemia;
Hepatosplenomegaly (enlargement of the spleen and liver);
Disorders of the nervous system;
Jaundice, that is, liver damage will indicate yellow baby skin;
The appearance of blue spots on the skin.

These characteristics may also indicate other diseases, for this reason it is important to monitor the health of the newborn, examine and study the state of his organs with some frequency. In addition, other damage to the body, the development of developmental anomalies, heart defects, deafness, cerebral palsy or mental disorders.
The presence of a cytomegalovirus lesion in an infant is evidenced by a fourfold increase in IgG titer in analyzes that were made with an interval of one month. In infants, the presence of CMV can be seen with muscle weakness, if they weakly suck milk, they little weight, vomiting, tremors, convulsions, decreased reflexes, and so on often occur. In older children, at 2-5 years old, one can notice a lag in mental and physical development, a violation of sensory systems and speech.

How is CMV infection treated in children and adults

A person who has been ill with cytomegaly for life remains the carrier of its pathogen, because even today medicine can only reduce the manifestation of symptoms.

Therapy is complex and depends on how affected the body is.

Vitamin, immunomodulatory and antiviral drugs are prescribed. Determines which medicine is needed, only the attending physician;
In some cases, symptomatic treatment is carried out to improve general condition the patient;
It is important to eat healthy and keep healthy lifestyle life, to strengthen the immune system;
The doctor should prescribe antiviral drugs only when the patient's condition is serious;
Assign specific antimegalovirus immunoglobulin and interferon;

It is important to establish the presence of the virus in the body in time in order to start the course of treatment as early as possible. By this, the patient will not only take care of her health, but also protect her baby from future health problems and the development of organ defects.

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:

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 aid to strengthen immunity.
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. When the immune system is weakened or favorable conditions for the development of the virus, the symptoms of the disorder will recur. 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 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 infection belongs to the group of herpes. In most cases, it proceeds without any external manifestations or with mild symptoms. People often do not pay attention to this disease and do not take any measures to eliminate it. But CMV during pregnancy is very dangerous, because it can lead to pathologies of fetal development and interruption of the gestation process.

An infection of this kind is difficult to treat, especially during the period of expectation of a child, when taking many antiviral drugs is prohibited. Therefore, diagnostics at the planning stage of conception is of great importance.

The question of what is CMV during pregnancy and how to protect yourself from infection is of interest to many expectant mothers. CMV or cytomegalovirus is a pathogen that belongs to the herpes family. In the human body, it behaves in the same way as the well-known cold on the lips: most of the time it does not manifest itself in any way, but with a decrease in immunity, an exacerbation occurs. After the initial infection, it is no longer possible to get rid of it completely; a person becomes a carrier of the virus for life.

Cytomegalovirus was first identified by scientists in 1956. Now the infection is spread all over the world. In economically developed countries, antibodies in the blood are found in 40% of the population, in developing countries - in 100%. Women are more susceptible to the disease. Among infants, the prevalence of infection ranges from 8% to 60%.

Most carriers of the virus are unaware of its presence in the body. CMV is an infection that exacerbates during pregnancy and other conditions accompanied by a decrease in immunity. Therefore, expectant mothers are at risk.

The source of cytomegalovirus infection is a person with an exacerbated form of the disease. Transmission can be carried out in several ways: airborne, sexual, contact, intrauterine. After infection, the virus enters the cells and destroys their structure. Affected tissues fill with fluid and increase in size.

Causes

CMV during pregnancy can occur both for the first time and recur. The main causes of infection are a natural decrease in immunity, which is necessary to maintain pregnancy, and contact with a carrier of the virus.

After the fertilization of the egg, a lot of changes begin to occur in the woman's body. The main ones are the restructuring of the hormonal background and a decrease in immunity.

At the initial stage, this is necessary for the successful fixation of the embryo in the uterus, then - to maintain the pregnancy. The immune system of a woman becomes less active and due to this, the risk of rejection of the fetus as a foreign body is reduced. But as a result, a woman becomes more vulnerable to any infectious diseases.

If earlier in the body future mother there was no CMV, then its primary infection is possible through contact with a person whose disease is in the acute stage. Transmission can occur through sexual contact, not only through genital contact, but also through oral or anal contact.

Less likely to be infected by household means: through a kiss, the use of dishes and personal hygiene items of the patient. The risk of transmission through blood is very low, and is more likely to occur in people who use intravenous drugs.

Symptoms

A woman carrier of CMV and / or HSV during pregnancy may not show any signs of the disease and may not even know what it is. With a relatively active immune system during this period, the infection is hidden.

If an exacerbation occurs, then most often there are symptoms similar to SARS. The body temperature rises, the woman feels that she has become tired faster, a runny nose appears, headache, salivary glands increase, tonsils can become inflamed. Often, all these manifestations are mistaken for a cold and do not cause much concern. But cytomagelovirus infection lasts longer than the respiratory one (1-1.5 months).

Sometimes the symptoms of cytomegalovirus infection are similar to mononucleosis. The temperature rises sharply to 38-39 ° C, the tonsils and salivary glands become inflamed, the lymph nodes increase, there is pain in the muscles, joints, in the right and left hypochondrium, fever, chills. This condition is called mononucleosis-like syndrome and develops 20 to 60 days after infection. Symptoms continue for 2-6 weeks.

CMVI during pregnancy in some cases proceeds with complications. Pneumonia, arthritis, pleurisy, myocarditis, encephalitis, vegetative-vascular disorders, and lesions of internal organs can join this disease.

It is extremely rare to observe a generalized form of infection, in which the virus spreads throughout the body. IN clinical picture may be present:

inflammation of the kidneys, adrenal glands, spleen, liver, pancreas and brain;
damage to the tissue of the lungs, eyes, digestive organs;
paralysis.

Diagnostics

Since cytomegalovirus infection often occurs in a latent form, and during exacerbations it looks like a common cold, it is impossible to identify it on your own. Analysis for CMV during pregnancy is carried out using laboratory methods research, for this, blood, urine or saliva is taken from the patient. Not only cytomegalovirus is determined, but also pathogens of toxoplasmosis, rubella, herpes simplex (TORCH infection).

Three diagnostic methods are used:

PCR (polymerase chain reaction) - under special conditions, under the action of enzymes, parts of the DNA of the virus are copied.
Cytological examination of sediment in urine and saliva - the study of biomaterial under a microscope to identify virus cells.
Serological examination of blood serum using enzyme-linked immunosorbent assay (ELISA) - the search for antibodies specific to a given virus.

Most often, CMV during pregnancy is determined using ELISA, in which two types of immunoglobulins are detected: IgM and IgG. The first type is produced by the body 4-7 weeks after infection, and when an immune response is formed, its number decreases. Immunoglobulin G in this phase increases.

How does CMV affect pregnancy?

The acute course of cytomegalovirus infection can affect the condition of the fetus and the course of pregnancy. The greatest danger is the primary infection during the period of bearing a child. In this case, antibodies have not yet been formed in the woman's blood, the virus is very active and quickly penetrates the placental barrier. The probability of infection and the appearance of pathologies in the development of the fetus is 50%.

If CMV worsens during pregnancy, then the prognosis is more favorable. The body already has IgG antibodies, the virus is weakened. The probability of its penetration through the placenta is 1-2%. And even in these cases, its damaging effect is reduced.

The shorter the period at which CMV manifested itself, the more serious the complications and consequences. If the infection occurred in the first trimester, there is a high risk of spontaneous abortion. It is also possible the appearance of anomalies in the fetus, including those causing its intrauterine death.

When the disease manifests itself in the second and third trimesters, the danger is lower: the fetus develops normally, but there is a risk of pathologies of its internal organs, premature birth, polyhydramnios, and congenital cytomegaly. It is very important to diagnose CMV at the planning stage, since during pregnancy this disease is difficult to treat and poses a danger to the unborn child.

Norms of CMV during pregnancy

When cytomegalovirus enters the body, it remains in it for life. But if the disease proceeds in a latent form, then it does not bring much harm. Many women have antibodies to CMV when they are tested for TORCH infection. Their level indicates the features of the course of the disease and its stage.

The norm of CMV during pregnancy as such does not exist. Enzyme-linked immunosorbent assay is a complex procedure that uses dilution of blood serum in a certain ratio. The interpretation of the result depends on the test system, its sensitivity and components.

When studying the results of diagnostics, you need to pay attention to the following options:

IgM not detected CMV IgG- the norm (absent) - during pregnancy is the optimal result. This means that there is no pathogen in the body, no complications will arise.
IgM not detected, but CMV IgG positive during pregnancy. The virus is present in the body, the infection occurred a long time ago and the disease proceeds in an inactive form. The chance of passing the infection to the fetus is minimal.
CMV during pregnancy, when IgM is positive, there was a primary infection with CMV or an exacerbation of an infection that had previously been latent. At the same time, the risk of infection of the fetus is high.

How is CMV treated during pregnancy?

As already noted, it is impossible to get rid of the virus completely. Treatment of CMV during pregnancy is reduced to transferring it into an inactive state.

For this apply:

Antiviral drugs. Reduce the number of viruses and suppress their activity.
Human immunoglobulin against CMV. The drug is made from the blood of people who have formed antibodies to the pathogen.
Immunomodulators. Increase the body's resistance to viruses, bacteria and other pathogenic microflora. The effectiveness of drugs in this group has not been fully proven.

All medicines should be selected only by a doctor, taking into account the duration of pregnancy and the characteristics of the course of the disease. In this case, you cannot self-medicate.

Is it necessary to terminate the pregnancy?

The question of whether to terminate the pregnancy is decided individually in each case. Abortion may be recommended (but not prescribed) by a doctor in cases where the risk of infection is high and the likelihood of serious developmental anomalies is high (primary infection occurred at an early stage). The final decision on this matter is made by the woman. Interruption can be carried out up to the 22nd week of pregnancy.

With timely treatment, the risk of transmitting the infection to the fetus is significantly reduced. If infection or reactivation of CMV during pregnancy occurred in the later stages , interrupt is not shown.

Consequences

The earlier the infection or reactivation of the virus occurred during pregnancy, the more serious the consequences will be. In the early stages, this can provoke a miscarriage or abnormal development of the fetus: underdevelopment of the brain, epilepsy, cerebral palsy, impaired mental function, deafness, congenital deformities.

Data 11 Aug ● Comments 0 ● Views

Doctor Maria Nikolaeva

Pregnancy is the most pleasant and beautiful period in the life of every woman. However, not all of the fair sex, it flows in one breath. The body of a pregnant woman is subjected to serious disturbances from the hormonal and immune systems, which makes her vulnerable to all kinds of infectious diseases. One of the most common and dangerous infections for the expectant mother and baby is cytomegalovirus.

Cytomegalovirus belongs to the herpesvirus family. Pathology is very common and for some it poses a serious danger. The harm lies in the fact that many do not suspect the presence of a virus in the body due to the absence of specific symptoms.

For a healthy person with a strong immune system, the disease does not pose a danger. A truly harmful disease is only for those who suffer from a violation in the work of the protective functions of the body. And since the immunity of a pregnant woman is almost always weakened, they are among the first to be at risk of transmitting the virus.

After the penetration of infectious agents - cytomegalia - into the body, they will never leave it again. If the immune system is strong, then the virus is in a dormant state. When the protective functions are weakened, it begins to multiply, destroying the structure of normal cells and leading to their swelling.

Cytomegalovirus spreads with the help of human biological fluids, that is, through saliva, urine, feces, semen, blood, breast milk, sputum.

It should be noted that the disease proceeds in two forms - latent carriage of infection and subclinical manifestation. The disease can also be acquired and congenital.

It is transmitted in the following ways:

to the child through mother's milk;
after sexual contact (orally, anally, genitally);
after using personal items of a sick person;
in the process of blood transfusion or transplantation of donor organs, tissues;
in a transplacental way;
endogenous, that is, by droplet-air way.

Cytomegalovirus: causative agent, transmission routes, carriage, re-infection

Are there any symptoms

If infection has occurred, and the person's immunity is strong, then in most cases there will be no symptoms. Only occasionally in people with strong protective function can be manifested by the so-called mononucleosis-like syndrome. This is when 20-60 days after infection appears heat, headache, general malaise. This condition can last from 2 to 6 weeks.

The virus manifests itself in the body of a pregnant woman quickly. Symptoms resemble SARS - fever, body aches, muscles, joints, headache, weakness. Therefore, often a woman believes that this is a common cold and is treated with completely different medicines. The condition of the pregnant woman worsens.

The main difference between ordinary ARVI and cytomegalovirus is that the latter takes much longer - up to 4-6 weeks.

With immunodeficiency, the infection can cause the development of dangerous diseases in a pregnant woman - pneumonia, encephalitis, pleurisy, myocarditis. In addition, there is a high probability of damage to internal organs and vegetovascular disorders.

If cytomegalovirus occurs in a generalized form (which is very rare), then the infection spreads to almost all organs.

Symptoms of cytomegalovirus

Analysis for cytomegalovirus

It is not possible to find out on your own about the presence of pathology in the body. Even the acute form is difficult to recognize because of its similarity with other diseases. To find out about the presence of cytomegalovirus during pregnancy, you should be tested. The essence of the study is to detect antibodies to CMV - IgG. For this, saliva, blood or any other biological fluid of a pregnant woman is taken.

To be clearer, IgG is an antigen, a protective protein that is formed by the immune system in response to the entry of foreign organisms. "G" means here one of the subtypes of immunoglobulins. In addition to this letter, the letter “M” can also be seen in the abbreviation. It indicates the presence of completely different antibodies. IgM is faster than its counterparts. They are much larger and are produced almost instantly in response to the penetration of the herpes virus into the body of a pregnant woman.

However, these antibodies do not possess immunological memory. This means that the activity of antibodies after 4-5 months is on the decline. What can not be said about IgG. These antibodies to cytomegalovirus are produced, cloned throughout life. They are produced much later than IgM (they are often called late). Therefore, if CMV igM is negative in the tests for antibodies, and CMV IgG is positive, this means that the inflammatory process in the body of the pregnant woman has been stopped.

Cytomegalovirus during pregnancy: consequences for the fetus, diagnosis (tests)

Deciphering the analysis

Unfortunately, cytomegalovirus in a smear during pregnancy is often detected. But this does not always mean that you need to worry.

Here are all the norms and values \u200b\u200bof antibodies to cytomegalovirus that are found in the test results:

If the indicators are “0” or the “-” sign is indicated in the decoding, then the pregnant woman has nothing to worry about. Cytomegalovirus is absent in the body.
If the avidity index (characteristic of the strength of the bond between antibodies and antigens) is 50-60%, regardless of the presence of antibodies, then a second study is required.
If avidity is high, IgG positive during pregnancy, and IgM negative, then the cytomegalovirus is inactive, that is, the virus is dormant. The risk to the fetus is minimal.
If avidity is low - less than 40%, IgMm and IgG are positive, then this means primary infection and a high risk of infection of the fetus.
If antibodies to cytomegalovirus IgG in the analysis are positive, avidity is average, and IgM are marked in this way “+/-”, then the infection is in a subsiding stage. This period is also quite dangerous for the fetus.
If avidity is low, IgG values are positive, IgM is marked as “+/-”, then CMV during pregnancy is in the stage of reactivation and is dangerous to the fetus.

Deciphering the analysis for cytomegalovirus, taking into account the risk to the fetus

Risk to fetus and pregnant woman

If the levels of antibodies to cytomegalovirus IgG are increased in pregnant women, then this indicates an exacerbation of the pathology. That is, the infection recurs. This situation, both for the unborn child and for his mother, is more favorable than in the case of primary infection.

If the pregnant woman caught the virus for the first time, then the level of IgM will increase in the analysis. There is a high risk of transmission of cytomegalovirus to the child. It is especially dangerous when the infection is detected in the first weeks of pregnancy. This threatens the development of serious developmental anomalies in the child, intrauterine death and miscarriage.

If infection occurs in the second and third trimesters, then this threatens congenital, damage to the internal organs of the fetus and other dangerous pathologies. The infection is transmitted during the passage of the child through the birth canal during childbirth.

Treatment and prevention

Unfortunately, it is completely impossible to remove cytomegalovirus from the body. The goal of treatment is to eliminate symptoms and prolong the remission of the infection. Pregnant women are prescribed special antiviral drugs based on acyclovir and immunomodulatory drugs.

are good herbal teas consumed to strengthen the immune system. Herbal preparations for pregnant women are sold in pharmacies. They cannot be taken on their own, as they have contraindications.

As a prevention of cytomegalovirus, it is important to pass all the tests and carry out treatment even at the stage of pregnancy planning. In addition, be sure to eat right, being on fresh air, rest, avoiding stressful situations, observing the rules of personal hygiene.

To prevent primary infection, intimate relationships, any contact with a sick person should be avoided. It is important to follow the rules of personal hygiene, wash your hands more often with soap, avoid public places, etc.

Prevention and treatment of cytomegalovirus during pregnancy

The presence in the blood of antibodies to cytomegalovirus in a pregnant woman does not mean that she and the unborn child are in serious danger. If the disease recurred, then this is the most favorable option for the woman and for the unborn baby. Worse, when infection occurred during gestation. To avoid this, you should take preventive measures.