Cytomegalovirus (CMV) is a common herpesvirus that poses risks during pregnancy, potentially leading to congenital CMV infection and severe complications for the fetus. High seroprevalence in India necessitates increased awareness and education among healthcare providers and pregnant women regarding CMV transmission, diagnosis, and management. New developments emphasize the importance of antiviral therapy for high-risk mothers and highlight the need for greater focus on CMV screening and maternal serology in clinical practice.

1. CMV
UPDATE
Few solid facts about
cytomegalovirus (CMV)
Infection & New
development from France
for Indian Gynaecologists &
public to know
Dr Sharda Jain

2. CMV is a common herpesvirus that can infect
people of all ages, including pregnant women.
CMV is not the same as HSV (herpes simplex
virus), although they belong to the same viral
family.

3. PREVALENCE
Emery, Vincent & Lazzarotto, Tiziana. (2017).
Cytomegalovirus in pregnancy and the neonate.

4. Lets be clear of Definitions
Primary
Infection for the first time during pregnancy
Risk of Vertical Transmission is more
Risk of baby born with symptoms is 3.9-5.2.%.
Non Primary Infections
Reactivationof the latent virus
Reinfection with a new strain of virus
Risk of vertical transmission is less
Risk of baby born with symptoms is 1-2 %.
Fowler KB, Stagno S, Pass RF, Britt WJ, Boll TJ, Alford CA. The outcome of congenital 507 cytomegalovirus infection in relation to
maternal antibody status. N Engl J Med 1992;326(10):663–7.

5. • Congenital CMV infection is a
leading cause of birth defects.
• Pregnant women can transmit CMV to their unborn
child, which is known as congenital CMV infection.
• CMV infection during pregnancy can lead to
complications like hearing loss, intellectual
disabilities, and developmental delays in infants.

6. Remember
CMV : Major cause of non genetic
sensorineural hearing loss and a
cause of neurodevelopmental
abnormalities
Liveborn infants
• High Income countries : 0.5%
• Low and Middle Income countries
: 1.5%
Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital 482
cytomegalovirus (CMV) infection. Reviews in Medical Virology 2007;17(4):253–76.

7. Primary Infection
Cytomegalovirus#
Likelihood of vertical transmission
after maternal primary infection
Likelihood of severe symptoms at
birth in an infected fetus after
maternal primary
infection
Preconception 0-10% Negligible
Periconception (< 4-11 week before
LMP)
25-45% 70%
First trimester 25-45% 20%
Second trimester 45% 5%
Third trimester 47-78% Negligible
)
Adapted from: Khalil A, Sotiriadis A, Chaoui R, da Silva Costa F, D’Antonio F, Heath PT, Jones C, Malinger G, Odibo A,
Prefumo F, Salomon LJ, Wood S, Ville Y. ISUOG Practice Guidelines: role of ultrasound in congenital infection.
Ultrasound Obstet Gynecol 2020. DOI: 10.1002/uog.21991

8. PLEASE NOTE
Hearing and neurological sequalae are similar in infants following
Primary and non primary infections
50-60% of infants with CMV are born to mothers with non-primary
infection

9. INDIA
By 20 Yrs  90 % of Indians
are exposed to CMV.
CMV is often asymptomatic or
causes mild flu-like symptoms
in healthy adults, but it can
lead to severe illness in
immunocompromised
individuals.

10. Diagnosis for CMV based
on Maternal History /USG
findings

11. • Maternal History (only seen in about a 10% of cases )
• mild fever
• joint aches
• asthenia, myalgia,
• flu-like syndrome.
• Lymphocytosis greater than 40%
• elevated liver enzymes
• Majority are asymptomatic
Clinical Features

12. Hepatomegaly Splenomegaly Echogenic bowel
Ultrasound findings

13. CMV
Primary infection ,
maternal serology is
important.
Non – primary infection
maternal serology is not
important.

14. Diagnosis
• Primary Infection:Maternal serology is reliable
• The appearance of CMV-specific IgG in a woman who was previously
seronegative.
• The detection of CMV IgM antibody with low IgG avidity
• Non –Primary infections :Maternal serology is not reliable
• IgM may persist for several months after primary infection
• Cross-reactivity of IgM with another virus
• A rise in IgG levels may not confirm non-primary infection as this may be due to
nonspecific polyclonal stimulation of the immune system

15. IGM may persist for several
months after primary infection.
Timing of infection is
difficult to ascertain
Diagnostic test for non primary is
PCR -CMV

16. Routine prenatal testing does not typically
screen for CMV, so it's important to discuss
potential risk factors and symptoms with
pregnant patients.

17. Management
• Antiviral medications may be considered for
pregnant women who are at high risk for
transmitting CMV to the fetus.
• Gynecologists can educate pregnant patients
about the risks of CMV and preventive
measures.

18. • CMV can be transmitted through bodily fluids
such as saliva, urine, and breast milk.
• Infection control measures, such as good hand
hygiene, can help prevent CMV transmission to
pregnant women.
• There is no vaccine for CMV, so prevention is
key.

19. Early detection and monitoring of CMV in
pregnant women are crucial to providing
appropriate care & decrease Neonatal Sequele

20. New developments in CMV
-Europe

21. EXPERTS Found
Significant neonatal sequalae only tend to develop
following first trimester CMV infections
• If given In-utero medical Therapy
(valacyclovir )
has been shown to be effective in preventing
serious neonatal sequalae except HEARING loss
Which could easily handled by ENT Surgeons
New developments in CMV
- France

22. France experts requested that
Gynecologists can discuss the potential risks
of CMV and benefits of Anti-viral therapy
for mothers who have CMV.

23. • Women considering pregnancy should
undergo CMV antibody IGM testing to
assess their risk.
• Not possible to test for all PREGNANT
Patients in india

24. What would we could do differently in PRIVATE
practice in INDIA ?
Maternal serology IgG /IgM /IgG Avidity
We anticipate that the risk of fetus affected is low
( India has high seroprevalence)
Treat all patients as primary CMV unless otherwise proven
Medical Therapy --VELACYCLOVIR
FU in a Fetal Medicine EXPERTS

25. Should we be do screening at Booking ?
• No Indian Guidelines in INDIA
• NO Newborn screening programmes in place .
• 87% of CMV infected fetuses are
undetectable at birth
Fowler KB, Boppana SB. Congenital cytomegalovirus (CMV) infection
and hearing deficit
. J 535 Clin Virol 2006;35(2):226–31.

26. CMV reactivation can occur in
immunocompromised pregnant women
and may require antiviral therapy.

27. • CMV infection can be managed with supportive
viral therapy –VELACYCLOVIR.
• care and close monitoring during pregnancy.
• Do counselling that close follow up is needed by
Fetal Medicine Experts .
• ENT specialist take care of Hearing loss which is
invariably present at BIRTH.

28. Pregnant women who are diagnosed with CMV
should work closely with their Fetal Medicine
healthcare providers to ensure the best NEONATAL
outcomes for their pregnancies.

29. For the Public:

30. • Cytomegalovirus (CMV) is a common virus
that can infect people of all ages.
• CMV is typically harmless in healthy , often
causing no symptoms.
• CMV can be transmitted through close
contact, especially with young children who
may carry the virus.

31. Pregnant women should be aware of the potential risks of CMV
infection and practice good hand hygiene to reduce the risk of
transmission.
There is no vaccine for CMV, so it's important for pregnant
women and those planning to become pregnant to be informed
about the virus and its potential bad effects on pregnancy

32. Gynecologists can discuss the potential
risks and benefits of breastfeeding for
mothers who have CMV.