Fetal Infections (CMV & Toxoplasmosis)

• Cytomegalovirus (CMV): A common virus that usually spreads through contact with the saliva or urine of young children. If a mother gets CMV for the first time during pregnancy (primary infection), there is a 30-40% chance of transmission to the baby.
• Toxoplasmosis: Caused by a parasite found in undercooked meat, unwashed soil, or cat litter.

Both infections can affect the baby's developing brain, eyes, and hearing. The risk of severe issues is highest if the infection occurs in the first trimester, while the risk of transmission is highest in the third trimester.

You may be at higher risk for these infections if:

• CMV: You work with young children (teachers, daycare workers) or have toddlers at home.
• Toxoplasmosis: You handle raw meat frequently, garden without gloves, or have close contact with cats and their litter boxes.

Standard blood tests at the beginning of pregnancy check for 'antibodies' (IgG and IgM) to see if you have had these infections in the past (which provides protection) or if you have a new infection.

Diagnosis involves a two-step process:

1. Maternal Testing: Blood tests to confirm a 'primary' or 'recent' infection in the mother.
2. Fetal Testing: If the mother is infected, we perform an Amniocentesis (usually after 20-21 weeks) to test the amniotic fluid for the virus's DNA using a PCR test. This is the only way to know for sure if the baby has been infected.
3. Ultrasound Surveillance: We look for 'soft markers' like brain calcifications, ventriculomegaly (enlarged fluid spaces), echogenic bowel (bright bowel), or slow growth.

Management has advanced significantly in recent years:

• CMV Treatment: For a long time, there was no treatment. Now, we use high-dose Valacyclovir for mothers with a recent CMV infection. Clinical trials have shown that this can reduce the risk of the virus passing to the baby by up to 70%.
• Toxoplasmosis Treatment: We use a combination of antibiotics (Spiramycin or Pyrimethamine/Sulfadiazine) to kill the parasite and prevent transmission.
• Monitoring: Babies with confirmed infections are monitored every 2-3 weeks with specialized neuro-ultrasound and sometimes fetal MRI.

Many babies who are infected with CMV or Toxoplasmosis in the womb are born healthy and appear normal.

• CMV: About 80-90% of infected babies have no symptoms at birth. However, some may develop hearing loss or developmental delays later in childhood. Those who show signs on ultrasound are at a higher risk of more significant neurological issues.
• Toxoplasmosis: Without treatment, the risk of eye or brain issues is higher. With early antibiotic treatment, the risk of serious complications is reduced considerably.

If your blood tests show a 'recent CMV infection' or 'positive Toxoplasmosis IgM,' or if a scan shows 'bright spots in the brain or belly,' you should be seen by an MFM consultant immediately.

Our team provides the specialized counseling required to understand the difference between 'maternal infection' and 'fetal disease.' We facilitate the amniocentesis PCR testing and provide access to the latest antiviral protocols to give your baby the best possible protection.