The information in this podcast is provided for education and research information only. It is not a substitute for professional health advice.
If you're trying to get pregnant, or you are pregnant and you feel a little bit overwhelmed by all you need to know, then this is the right podcast for you. Welcome to the show. I'm Bridget Maloney.
And I'm obstetrician doctor Patrick Maloney, and this is the kick your expert led podcast that delivers the essentials of growing a baby. Make sure you head to our website grown mybaby dot com dot au to get some moreesome free tools like our pregnancy knowledge checker to help you feel like you got this.
Welcome everyone, I'm Bridget Maloney.
And I'm obstetrician doctor Patrick Maloney.
And today we've got an episode that I can't believe we haven't done PAM on CMV.
Yeah, definitely time we talked about CMV.
Yeah, we got a question ages ago about this, oh gosh, like years ago, and we did do a couple of social media posts on it. But I think there's enough information for us to do an episode, and it's such an important thing for people to know about.
Yeah, and I think in our in our sort of preparation for this episode, one of the most interesting stats is that people don't know about.
Oh that's it. Yeah, so let's go talk about that. All right, it's cyto megalovirus. If I pronounced that correctly, that is right?
Good?
Yeah, what is it?
Pat? So CMV is a virus. It's common virus in our community. It's often spread around by well, it's spread it's spread through through close contact, and it's often spread around by asymptomatic normal children through saliva and close touch and urine. And the problem with that is that that's what children do, and that virus is easily spread around. Now, the relevance to us is that it is an important virus in pregnancy. It can cause significant problems for the
developing baby. And it's not that rare. A little over a baby a day is born in Australia with a significant outcome from CMV.
And we're going to talk about why that is a problem in a minute. But I just you've already raised so many points there. It's most virulent, isn't it in kids under the age of two?
Yes, So it's bad to get it as a fetus, and it's bad to get it as a newborn. But and it can cause a significant sort of flu like illness in children. But it can also be spread around relatively well people in settings like child cares.
Kindergartens and parents with toddlers that then happen to be pregnant.
That's the problem.
Yeah, Yeah, So it's part of the herpes virus family.
Yeah, big family of viruses with some similar characteristics.
And we know that, you know, I have a little bit of herpes. Can I say that? You know I get my cold sauce every now and then you know it lies dormant in my system and then just reactivates. That's the same thing with CMV, isn't it.
It can be. Yeah. So the classic cold saw picture, where you get the saw on the corner of your mouth when you're tired, run down, burn the candle at both ends it comes out again. There is a sort of a version of that with CMV. See lots of by the time someone gets to the age of having a baby, about half the community have already had CMV, and they get some lifelong immunity to it, which is
a little incomplete. In that one. There is a capacity to be reinfected, so you might not have complete immunity. And two there's there's a phenomenon of reactivation where the old CMV virus might have been alive in your body but dormant, and it reactivates in pregnancy because you're a bit immunosuppressed. Yea, possibly due to the demands on your body of being pregnant. So you might be a little bit I mino suppressed, a little bit sleep deprived.
So farth Yeah right, I want to add it's not relevant actually to CMV, but costs come when I get a sun burnt on my lip too. If anyone also has that, then I want to hear from.
You, because yeah, that's definitely a thing.
Yeah, that's my issue. So I read a study that only one in six pregnant people have even ever heard of CMV.
Yeah, and this is this is definitely somewhere where we can improve. I've got a theory on this. I think. I think one of the reasons why we don't sort of talk to people about CMV as much as we should is there's a fear feeling amongst obstetricians, midwives, obstetric care give is that there's not tons that can be done about it, and Firstly, that's not entirely true, because there is some evidence that the preventative things that can stop be catching it do work or at least improve
the odds in your favor. And the other thing is just because like for example, there isn't a vaccine, then that doesn't mean there's nothing we can do. We're don't throw our arms up and say, well, we can't do anything about CMV. By contrast, if you look at rebella used to be a cause of serious infection in pregnancy people in our community this day with the natal rebella, blindness, deafness, intellectual disability, pretty much fixed by an effective vaccine that
really works. So vaccinated as a child, potentially have a booster before you have a baby, you're not going to catch rebella in pregnancy. You'll be fine c MV. Unfortunately, we don't have the same we don't have the same weapons to fight it.
And interestingly, I did see a graph that showed people's knowledge about the different diseases and things like rebella. Nearly one hundred percent of pregnant people know about the impact of rebella or why they should even be tested for rebella. Yes, but you know, I don't know this. It's interesting why I know you said that. It's because we feel like, as you know, you feel like as medical people that you can't do much about it. But one in six
people not knowing about it. I find that really a shocking statu.
Yeah, we should be doing better than that. And I think it starts with the fact that it isn't actually one of the tests that's recommended in early pregnancy. And that's because you know, if someone's got CMV immunity or they don't, the advice we would give them would be the same. It's about preventing transmission. That there isn't something special we could do for the person who's non immune
versus immune. Yeah, whereas the person who early pregnancy testing shown they didn't have any rubella immunity, we could we give that person a booster before they're pregnant again and at least reduce risk that way. So it's it's it's sometimes it is tested for in early pregnancy opportunistically, but it's not actually an official recommendation in Australia, and I think that's where it's where it's where it starts, that we don't talk about enough.
Yeah, right, I want to really highlight that CMV is the most common infectious cause of disabilities in newborn babies.
Yeah, yeah, yeah, so presumably it came to number one as rubella dropped away.
Yeah, so CMV effects one in one hundred and fifty babies down, syndrome one in six hundred and sixty, spina biffitter six point three in ten thousand, and toxoplasmosis is zero point zero one seven in one thousand. Yeah, So interesting, isn't it?
That is interesting data because you know, it's certainly it's turned its place in things we should be discussing. The we can get We can talk today easily about about you know, how how detection works and so forth. But you know, in our preparation for today, the thing I found most interesting was that there's quite good data behind the relatively simple things that you can do to prevent CMV transmission that actually shows that it really does prevent it.
All. Right, now, we've talked about that we want to raise awareness, but let's talk about why, Like why is CMV an issue?
Why is it an issue in pregnancy? In pregnancy, Well, if if the most significant CMV infection in pregnancy would be somebody with no previous immunity catching CMV while they're pregnant, and then having that c MV virus cross the placenta
into the developing baby. And that's a potentially very serious situation where the baby can develop a large number of significant abnormalities that could resate result in long term health troubles for that baby, long term disability, or even still birth or nanatal death.
I don't want to scare people, but maybe we could talk about some of those disabilities that are noted to be caused by CMB.
Yeah, so I guess in the most serious situation, you might get a CMV picture in the developing baby. That's a very serious and multi system. It can lead to a problem in babies called hydrops, which is where there's abnormal fluid develops right throughout the the baby's body cavities and that and that can be a cause of pregnancy
loss or nanatal death. And then more subtly, but the CMV infection can affect various organs within the baby's body, causing you know, potentially very long term dysfunction of those organs. And among the more serious outcomes scene our problems with hearing intellectual disability, learning difficulties, have failed to thrive as newborn, those sort.
Of things, and eye diseases, yes, possibly, yeah, And it can be a cause of prematurity and growth restriction.
Yeah, that's right. And these are some of the ways that it can be picked up. For example, sometimes it's it's quite obvious the woman has a really severe flu like illness, which is sometimes just mistaken for seasonal flu. And then but maybe she winds up sick enough for somebody to be looking into that she's tested for CMV and it's found that she's got a CMV infection at that time, and that she didn't used to have any
old immunity. And then this is somebody who who suddenly has developed antibodies for CMV which they didn't previously have, and that is and that proves that this is a new infection in this person, and that might lead to that woman being referred to a specialist center where with expertise in the management of infectious diseases in pregnancy, where her baby would be monitored for signs of CMV infection in the in the fetus, and that's done using ultrasound
and occasional occasionally MRI and they and an amniosynthesis can be taken from the fluid around the baby to also look for evidence of the virus in the water around the baby.
Can I ask you know you mentioned that the that sometimes the woman will feel unwell and that will be thought of it that it's just the cold or a flu. Would from a patient's perspective, would it be best for them to go I would like to be tested for CMV.
I think that's quite reasonable, especially for someone with a significant flu like illness where they had had a vaccine for seasonal flu, which I think would mean it was less likely to be seasonal flu, then a CMV test would be quite reasonable. And the other one would be a situation where it had features that were more in
keeping with CMV rather than seasonal flu. For example, significant what we call limp hat anopathy, big lymph nodes in the neck core, the armpits or the groin, and you're thinking, hang on a minute, this is a bit not very much like seasonal flu. Could this be CMV? When you're go and have those first trimester bloods, when you're first pregnant, you have HIV and hepatitis and hemoclover and all that are the blood from those that first set of bloods.
They keep that in the laboratory for a year so that if you later developed something that might be CMV and they say, yep, you've got some CMV antibodies, they can then go back to the stored blood from the start of the pregnancy, see whether you had antibodies then.
But would CMV be looked for back then?
No, but the blood still there, and they just test again.
Oh they can, Okay, they keep the actual blood. Yeah, yeah, how big of these storage units?
Yeah, it must be big, right, and so they keep it. They keep it all for a year, so you can go back then and say, just find the tube of blood from seven months ago, plase, wow, and then they'll test that for CMV. And I guess the most I guess the most concerning would be that there were zero antibodies back then and fresh antibodies now.
Yeah.
Yeah, proves that the infections new.
And that's also called a primary infection. If anyone then goes and reads up, yeah, that's.
That's what's called a primary infection. And then there's also secondary infections where you've always had CMV and you've got it again, And then there's a reactivation where you've got it years ago and it was never quite killed off inside your body and it comes.
Back, and you're more interested in their primary infection because the transmission rate is higher, isn't it.
The transmission from mother to baby is highest. Yes, that right, But more people have secondary or reactivations, so we're interested in both.
Yeah, And I want to go back just in case anyone's panicking right now, when we said that one in one hundred and fifty babies are found with CMV. There's some that are infected. Yep, And there are some that are affected exactly.
So lots of those babies are fine and have no problems then and no problems later. Yeah, But the most severe scenario is a baby that becomes quite sick inside. So when we talk about it as a cause of prematurity, some of that prematurity will be caused by us. We'll be watching a baby with CMV and thinking, this baby is not going to make it to full term unless we interfere.
Now, yeah, the old better out than in scenario.
Sometimes that applies.
Yeah. Now, the baby can also get during delivery and post natally through breast milk, is that right?
Yeah, So that's a significant situation as well, So we want to know about mums that are sick with CMV even if there's no Even if there's no immediately obvious evidence of fetal infection.
You've talked about how we can test for it during pregnancy, but if it's suspected after birth, what sort of tests would a parent expect for their baby to have.
So after birth, when we've got the baby right there in front of us, we can try and sample and culture multiple body fluids, urine, a saliva, pooh, and get swabs and viral cultures off the baby to try and make a quick diagnosis of whether the baby appears to have CMV at birth, because there is a role for anti viral medication, but you need to give it quickly, So we'd.
Want to get a diagnosis right at the start, and that baby then would be referred to a pedutrition or yeah, that's in the hand of aped, isn't it.
Yes, So the pediatricians would then be looking at that baby for any signs of an acute illness. So the baby got sick as a newborn, and then long term, if CMV was proven for the development of any you know, neurodevelopmental things vision, hearing, and so forth.
It must be so hard because you know, jaundice is one symptom as well, but jaundice can be caused by so many different things like it do people say, well, how about CMV? Like is that what you hear?
That's right? So we rely on these neonatal pediatricians. They're pretty clever men and women, and they and we and we rely on them to take a broad look at a newborn. And the new one can't tell you what's wrong. It must be a really hard job. So they do take a really broad look. And sometimes we would say, well, well, here's a baby with some significant jaundice, and yet there were no real obstetric risk factors for that obstetric for that jaundice, like a mismatch between blood groups or anything
like that, or significant prematurity. Why is this baby jaundice? And the clever pedutrition will often say, well, let's let's rule out infection, So they test the baby for something called a torch screen, which is any evidence of infections that could be making a baby.
See right, What about the placenta do they do? The peds also say hey, can we hey, obstetrician, what do you do with the placenta. Can we test it?
Yeah? They do. Yeah, so you can swap the placenta for any signs of infection and then for other problems. You can analyze the placenta microscopically for any for signs of problems that might have led to an unexpected pregnancy outcome.
All right, so you mentioned that the baby needs you know, it's best if they get their antiviral treatments within twenty one days. That's that's a pretty tight frame, isn't it.
Yeah. I think I think that's the The important thing we need to have about CMV is an index of suspicion. Could this be CMV? And the opportunities for early treatment might be lost by just not being thought of. But if we're on the ball about CMV, then then you know there's a there's a clear protocol of of how to a manager suspected their natal infection.
I imagine that in one in six people knowing about CMV, listening to this podcast will be kind of shocking and it will be kind of terrifying.
Yeah, that's that's sort of the risk, isn't it, Because information is good, but it also worries people potentially So I'm encouraging people, if they're hearing about CMB for the first time and have never heard of it, to talk to their cares and say, what can I do to prevent this? Is there any value in me being tested? I had a shock and flu like illness a month ago which is pasted. Is there any chance that was CMV? And encourage discussion of it.
Hopefully, our next portion of the podcast, we're really going to hone in on how to prevent getting CMV. So everyone take a big breath.
Because that I think is the most is the best way to respond. If this is causing people anxiety, We'll say, right, what what can we do? What's been shown to help reduce transmission?
Let's do that, all right? What has been shown to help stop transmission? Yeah, you asked your own question.
Then look, I think you might get it off your own children who are older and two or three year old, say in daycare or kindergarten or something, And you won't get it from just giving that child a hug or just usual parenting care, but you could get it from sharing saliva. So there are a couple of things that parents do that that maybe we shouldn't if we if we knew about CMV. And one is that if a toddler drops their dummy on the ground, I've done.
This, I've done this.
We pick it up and there's no tap or anything around, so we put in our own mouth to wash the dirt off, and then we put back in the baby's mouth. And that's probably a high risk activity for CMV transmission. And then you know, the other thing that that it's nice to do when you've got when you've got really little ones, is you want to kiss them all the time. But it's presumably a lot safer to kiss the baby anywhere but on the mouth, and and that's something that
people could consider. And the other thing is contact with urine. So the virus is spread heavily in urine. There's a lot of virus in the urine. So when you have to clean up we your baby or somebody else's that, you know, proper hand wash towards.
I want to further explore where we might share saliva with our children. I remember being on holidays and one of the kids has forgotten their toothbrush, and I've loaned my toothbrush, which in hindsight is disgusting.
But also that's why I'm hesitating because it all sounds a bit gross, But when it's your baby, doesn't feel gross. Kissing a little baby on the math you think it's other people baby on the mouth, but you mike's your own baby in the mouth and there they might.
Kiss you like you know, the the open mouth kiss of a six month old is hilarious.
Hilarious, and but they've definitely got saliva again out there and then and then you know, things like contact with urine. You would wash your hands if you had just cleaned up somebody else's urine, but we had, But with our own children in our own household, we're probably a bit slack.
Yeah, so it's back to That's one thing COVID did teach us is proper and washing routine, which is good. I'm stuck on the saliva sorry. But toddlers their slobbery people, so they sobber over everything, so you know you've got to make sure you're cleaning their toys properly. Sometimes you want to feed your baby off your own utensils, you know, put a mouthful in their mouth and then back in yours.
Or do what I used to do and take food from their.
Play Yeah, you're a shocker at doing that. That is so bad.
Used to go what are you doing? Yeah, yeah, that would have been like, no, they just left it them and you're like, we'll come to what.
I'm back now, slob it all over it.
Yeah, So this is I'm serious, like like we should be we should be rethinking these behaviors, and I guess things that we can do to reduce cm FEA transmission might be our best defense in the absence of a vaccine.
I want to read where this all sort of you know, came back to me and I thought, oh, well, we better get to it. I want to read this from a It's a written question, this person said. I just wanted to know whether you could do a podcast or congenital CMV getting tested for exposure when pregnant or before. Context is I am a physio. I worked with children with congenital CMV, and my boss checked that at the time,
I wasn't pregnant or planning to be. I'm no longer seeing this child and I will check with my GP. But maybe interesting if others have also asked about it, I've got to say, no one has ever asked about it. That's the only question we've ever got on CMB.
Yeah, yep, which is interesting in itself, but in that setting of healthcare or childcare, you know, this is not standard practice. But there's a potential argument that somebody with no CMV protection at all, no evidence of prior infection, no antibodies, maybe within the child care environment, the room with the babies where they are cleaning up a vomit pool and we all the time, might not be the
perfect job for that person. Certainly that person should be practicing a very active personal protection and hand washing.
Yeah, and maybe you know, if there's some flexibility about where they work from the childcare, maybe they could go to the older.
Kids rooms exactly jobs, but maybe the older kids rooms.
Yeah, because I did read that risks of getting of kids getting CMV is two to threefold in childcare.
We know that about That's just the nature of the environment, isn't it.
Yeah. It is tricky though, because, like you know, often the age gap between kids in families too is two years two and a half years. That's the prime infection time for that toddler as well. So you know, we say that people should be careful in childcare, but I suppose anybody the toddler the same.
Absolutely, Yeah, all right.
So let's say somebody has a known CMV infection, should they have any precaution about getting pregnant?
Well, no, it's not a reason not to become pregnant. This is somebody who's had it in the past before they were pregnant.
Are there any sort of special recommendations for somebody that's planning to get pregnant but maybe have just had a primary CMV infection? God, if you know that they've had a CMV infection, I suppose that's that's.
The problem, right, is that is that, apart from a pregnant person, if all woman's had a severe flu like illness, even with some lymph glands up and stuff, it's fairly unlikely to have been identified formally as a CMV infection. So you're not really you don't really get an opportunity to give that person advice, conservative or otherwise because she's
it's not known that that's what it was. Let's say, for example, it is known, so this is a person who's perhaps trying for a pregnancy or in her child bearing years or what have you, and some smart doctor has identified that illness as a c MV infection. Then there is some wisdom in that person waiting perhaps up to a year before becoming pregnant, and blood tests can
be helpful. You can watch the development of that person's antibodies, watch the immune response developed from a preliminary immune response into a mature one, and there are some clever tests that you can do to establish that the more dangerous face of the infection is over and then go for the pregnancy after that. Yeah, well, but the problem is identifying that person in the first place.
This seems to me that as a public health issue, we haven't focused enough on it. You know, if it is one in one hundred and fifty kids are born with CEN, whether they're infected or affected by it, why isn't that up the chain?
I think it comes. It's an excellent question, and I'm sure some of it is we just we just aren't doing enough about CMV. But the other problem is that to justify a public health message, it needs to meet some criteria, and one of the criteria, unfortunately, is that there needs to be roughly something that can be done about it. If we if we make a big public health message out of a problem that doesn't have a
way of detecting it or an obvious solution. Then are we just creating anxiety without actually helping anybody with the with the with the ultimate health outcome.
We could certainly throw a bit more money towards developing a vaccine. I know there's a few in trial, but like.
I'm sure speed that up, yeah, is good. I think speeding that up would make an enormous difference. If we could treat it like rebella, that would be awesome. And then the other thing we could we should probably be doing is definitely doing, is increasing people's knowledge of its existence and of the relatively simple and straightforward things that can be done in your home and in a childcare setting and in a kindergarten and in a pediatric sward to reduce transmission.
All right, I think perhaps we'll call this the kick Public Health Annoyance Announcement.
There's a thing called CMV.
Yes, and we want you to know about it.
Yes.
We hope we've helped you know more about it and what you can do to prevent it and not get it in the first place.
Yes, And then we should return to this in a future a podcast that would be fascinating to speak to someone for example, who's maybe have been affected by n natal CMV, and also if there's if there's developments.
Yeah, yeah, we'll come straight back and tell you if we've got a vaccine that is approved from one of the many trials that apparently are happening.
Yeah, I think that might be a little way off, but the you know, one day, we'll look back this at this as an issue that's been essentially solved. Yeah.
Excellent. All right, everybody, thank you so much for listening. We really appreciate all the love that you give us on our reviews and in our dms. To know that we're helping is something that keeps us motivated and back at the MIC, So keep them coming and other than that, we'll see you next week.
Thanks for listening, everybody, Thanks for listening.
Bye,