Ask Your Doctor

Pregnancy… quite possibly one of the most significant, exciting health experiences that a woman can have, but also one that can cause anxiety, stress, and concern for the welfare of her unborn baby. Whether you’re pregnant with your first or you’ve been down this road a few times, you know that it’s important to make sound, healthy decisions in the coming weeks and months. We’d like to share some important questions as you begin your pregnancy to empower you as a patient and to also help engage your doctor in an effective discussion about CMV and other healthy considerations during pregnancy.

How much weight should I expect to gain during pregnancy?

The average woman should gain approximately two to four pounds during the first three months of her pregnancy, and then about one pound per week for the duration. As a general guideline, women with a normal weight before pregnancy should gain between 25 to 35 pounds in total. Women who are overweight before pregnancy should gain 15 to 25 pounds, while women who are underweight should try to gain 28 to 40 pounds. Be sure to consult with your doctor about a recommendation that’s right for you.

What kind of diet should I follow? What should I avoid eating or drinking during pregnancy?

While you’re pregnant, it is not necessary to “eat for two”. However, there are select foods that are better for your baby’s development. For example, eat plenty of greens, fruits, whole grains, and calcium-rich foods. Try to avoid eating fish with high levels of mercury, including swordfish and shark. Cut back on your consumption of tuna, salmon, and shellfish to 1-2 times a week and avoid raw fish, including sushi and sashimi. Stay away from cold deli meats and soft cheeses, which may contain dangerous bacteria, including listeria. Do not drink any alcohol during your pregnancy and try to steer clear from caffeine, especially during your first trimester. Take daily prenatal vitamins to make sure you are getting your essential vitamins and minerals.

Is there anything that I should be doing more of while I’m pregnant? What actions or activities should I avoid?

If you were active before pregnancy, it is advantageous to do light or moderate exercise throughout. It will help speed your recovery after baby, too. Unless otherwise advised by your doctor, you can have sexual intercourse throughout the duration of your pregnancy, but be sure to avoid laying on your back after the second trimester.

Avoid using saunas, hot tubs, and tanning booths because of the harm that excessive heat can cause to your baby. Solicit help with painting the baby’s bedroom and changing the cat litter box to reduce your exposure to toxic chemicals and infections.

Be diligent about washing your hands to prevent infection. Wash your hands before preparing and eating food, after using the bathroom, changing diapers, or wiping a child’s nose or mouth. Always use your own utensils, straws, and cups to avoid sharing germs with children and adults, even if they don’t have any symptoms of being ill. Kiss babies, toddlers, and small children on the forehead instead of their mouth or cheek to avoid contact with bodily fluids that may contain CMV.

What tests or screenings should I expect during my pregnancy?

Throughout pregnancy, you will have several different routine tests and screenings, including blood and urine labs for HIV/STDs, anemia, diabetes, Hepatitis B, and preeclampsia. Your doctor may also order genetic testing if you are over 35, have previously had a high-risk pregnancy or premature delivery, or if certain genetic or medical conditions run in your family. Other common tests include ultrasound, amniocentesis, triple or quadruple screening, and chorionic villus sampling (CVS). Your doctor may also choose to test you for cytomegalovirus, or CMV, using CMV IgM and IgG antibody testing, which will indicate whether you have been exposed to CMV in the past and if you should require additional screening during pregnancy to monitor the health and development of your baby. If you would like to know your CMV status prior to or during your pregnancy, ask your doctor to order this test, which is relatively inexpensive and is covered by most insurance plans.

What symptoms are expected and normal during pregnancy, and which ones should I contact my doctor about?  

Each woman and pregnancy is different, but there are some common symptoms that you may or may not experience, including nausea and/or morning sickness, light spotting during the first trimester, and breast tenderness due to hormone changes. Women may also experience fatigue, food cravings and/or aversions, heartburn, and frequent urination.

During your pregnancy, you may experience a fever, joint pain, or sore throat, which may seem like a common cold or flu, but could be a CMV infection. If you have any of these symptoms during your pregnancy, ask your doctor to be tested for CMV using IgM and IgG antibody testing.

More severe symptoms that can cause concern and may require a trip to the doctor or ER include severe abdominal pain, significant bleeding, and severe dizziness. Call your doctor and on-call nurse immediately should you experience any of these symptoms.

What kind of symptoms may present if I have acquired an active CMV infection? 

Most children and adults who are infected with CMV do not develop symptoms. However, some people may experience the following: 

• Fever
• Swollen glands
• Exhaustion
• Muscle aches
• Loss of appetite
• Weakness
• Stiff joints

How common is CMV?

• CMV is a member of the herpes virus family. By 40 years of age, up to 80% of all adults have been infected with CMV. Once you have CMV, it stays in your body for life. And there is always a small risk for reoccurence or reinfection.
• While CMV is typically more prevalent in developing countries and in areas of lower socioeconomic conditions, everyone is at risk. Be sure to practice standard hygiene and prevention methods before and during pregnancy.
• The rate of incidence is higher among the following risk groups: babies in utero, people who work directly with children, and in immunocompromised patients (e.g. organ transplant recipients and persons with HIV).

How is the CMV virus transmitted?​

CMV is spread through close, intimate contact with a person excreting or shedding the virus through their saliva, urine, breast milk, or other bodily fluids. 

How is CMV diagnosed?

Most CMV infections are rarely diagnosed because the virus is typically symptomless. An IgG / IgM antibody test can determine if you've ever been exposed to the virus and if you have an active or recent infection.

If a pregnant woman is diagnosed with CMV infection, there are a few ways to understand if the virus has spread through the placenta to the baby in utero. Ultrasound may identify symptoms signaling a possible infection including low amniotic fluid, intrauterine growth restriction (IUGR), echogenic bowel, and/or enlarged tissues in the brain. Amniocentesis can be done to check fetal fluids or blood for signs of infection. Due to the risks associated with amnio, speak with your healthcare provider to understand if this test is appropriate for you.

Once the baby is born, testing can be done to understand if the baby has congenital CMV by saliva, urine, or blood PCR within the first twenty-days of life.

What are some recommendations for pregnant women regarding CMV infection?

• Your doctor can test CMV antibodies to determine if you have already had CMV infection.
• Transmission is often preventable because it is most often transmitted through infected bodily fluids that come in contact with hands and then are absorbed through the nose or mouth.
• If you develop a mononucleosis-like illness, be sure to be tested for CMV infection.
• Breastfeeding benefits outweigh the minimal risk of transmitting CMV postpartum (but discuss with your doctor first).
• Throughout pregnancy, practice diligent hand washing and follow specific prevention tips such as:
  • Do not share utensils, food, straws, drinks, or a toothbrush with anyone.
  • Do not put a pacifier in your mouth.
  • Avoid contact with saliva when kissing a child.
  • Wash your hands immediately after wiping a child's nose or drool, changing diapers, feeding a young child, handling children's toys.