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Cytomegalovirus (CMV) and Pregnancy
Dr. Stuart P. Adler M.D. is a board certified pediatrician on the faculty at the Virginia Commonwealth University School of Medicine, who for the last 28 years, has specialized in cytomegalovirus (CMV) infections among women and children. Adler has published over 100 papers on this subject. His research work is supported by grants from National Institutes of Health and the March of Dimes.
In 2004, Adler published data indicating that pregnant women with young children in day care should be able to prevent CMV infections during pregnancy by simple changes in hygienic behavior.
In 2005, in collaboration with Giovanni Nigro and other investigators in Italy, they published encouraging data concerning the use of hyperimmune CMV immunoglobulins to prevent and treat CMV infections in women who have acquired their first CMV infection during pregnancy.
They used Cytoect made by a German company called Biotest and this product is available in Europe. In the United States a similar product called Cytogam distributed by CSL Behring is readily available. Women in the U.S. have also been treated successfully with this product. For a woman who has acquired a CMV infection during pregnancy, the decision by her and her obstetrician on whether to use immunoglobulin during pregnancy and if so, at what dose, is currently a complicated one. This decision depends on many factors including confirmation of the infection, gestational age at the time infection, interval between infection and immunoglobulin administration and the results of amniocentesis and ultrasound exams of the fetus and placenta.
Dr. Adler is available by e-mail or phone to answer questions from women or their physicians, without charge, regarding how to prevent or treat CMV infections in pregnant women.
In Europe, Dr. Giovanni Nigro (nigrogio@libero.it) is also available to answer questions about immunoglobulin therapy.
Some practices for seronegative pregnant women to reduce risk of CMV infection. Assume children under 3 years old, in your care, has CMV in their urine and saliva.
1. Thoroughly wash hands with soap and warm water after:
- Diaper changes and handling child’s dirty laundry.
- Feeding or bathing child.
- Wiping child’s runny nose or drool.
- Handling child’s toys, pacifiers or toothbrushes.
2. Do not:
- Share cups, plates, utensils, toothbrushes or food.
- Kiss your child on or near the mouth.
- Share towels or washcloths with your child.
- Sleep in the same bed with your child.
Suggested reading:
Nigro, G., Adler, S.P., La Torre, R., Best, A.M. Passive immunization during pregnancy for congenital cytomegalovirus infection. New England Journal of Medicine, 2005; 353: 1350-62.
La Torre, R., Nigro, G., Mazzocco, M., Best, A.M., Adler, S.P. Placental enlargement in women with primary maternal cytomegalovirus infection is associated with fetal and neonatal disease. Clin Infect Dis, 2006; 43: 994-1000.
Adler, S.P., Finney, J.W., Manganello, A.M., and Al M. Best. Prevention of child-to-mother transmission of cytomegalovirus among pregnant women, J. of Pediatrics, 2004; 145: 485-91.
Adler, S.P., Finney, J.W., Manganello, A.M., and Al M. Best. Prevention of child-to-mother transmission of cytomegalovirus by changing behaviors: A randomized controlled trial. Pediatric Infectious Disease Journal 1996; 15: 240-6.
Adler, S.P. and Marshall, B.C. Cytomegalovirus infections. Pediatrics in Review, March 2007.
Adler, S.P., Nigo, G., and Pereira, L. Recent advances in the prevention and treatment of Congenital CMV infections. Seminars in Perinatology. February 2007.
Stuart P. Adler M.D.
Medical School: Johns Hopkins University School of Medicine
Residency: Johns Hopkins Hospital
Fellowship: Johns Hopkins Hospital
E-mail: sadler@hsc.vcu.edu
Pediatrics: Infectious Disease
Virginia Commonwealth University
P.O. Box 980163
Richmond, VA 23298
Phone: (804) 828-1807
Fax: (804) 827-0575
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