>>>>>I just spoke with the mother of a 5wk old baby boy. The mother contracted
CMV when she was
20wks pregnant and was hospitalized for a week. She was told that she would
not be able to
nurse her baby because the virus would always be in her milk. With great
regret, she started
to bottlefeed her new baby, but has now discovered that he has tested positive
to CMV,
although it is inactive. She would very much like to relactate.
I do not know a great deal about CMV and am seeking some guidance. Would you
compare this to
a mother and baby who are both HIV positive? Riordan and Auerbach say that
*all infected
infants shed cytmegalovirus: however no infant had any sequelae.* Any further
thoughts on
this?
Please reply to me personally as well as to the list as I am waaaaaay behind
on reading
digests right now.
TIA>>>>>>>
ARRRGGHHHH!!!!!! I also contracted CMV while pregnant and was hospitalized. My
baby contracted congenital CMV and was born shedding the virus. No one *ever*
suggested to me that I should not breastfeed. CMV is quite benign in the
newborn except in a small percentage of congenitally infected newborns (1% of
all newborns in the US are born infected. 90% of these have no sequelae) or in
those newborns with underlying immune problems. Passing CMV in breastmilk does
not represent a risk to a healthy newborn. Once this mother finds out how
dead-wrong her HCP's advice was, I hope she gets hopping mad and raises hell.
If she isn't able to relactate, she has been robbed of her breastfeeding
relationship for no reason. Even if she is able to relactate, she has been
unecessarily subjected to hassle and worry.
I wrote an article on CMV for a parenting magazine (I'll e-mail it to anyone
who is interested and who e-mails me) from which I quote:
>>>>>>
According to Dr. Gail Demmler of the National CMV Registry at Baylor College
of Medicine, CMV is the most common congenital viral infection in this
country. Each year in the United States, 30,000 to 40,000 infants are born
prenatally infected with the disease, meaning that the virus was transmitted
from mother to unborn baby.This constitutes approximately 1% of all babies
born. Of these infected newborns, 3,000 to 4,000 are symptomatic at birth and
up to 10% of this group die. An additional 4,500 to 6,000 babies with
Congenital CMV, while seemingly without health problems at birth, go on to
develop significant disabilities as they grow into early childhood.
Anyone seeking more information about CMV will soon discover the puzzling
contradictions of this disease. Most Americans, both male and female, have
been infected with CMV by the time they reach adulthood, with no ill effects.
Some medical texts refer to CMV as "the silent virus" because for the vast
majority of those persons who contract the illness, including those who are
pregnant, there will be no symptoms to alert the carrier that she has an
active infection. Instead, the virus will come and go without any signs of its
presence. A minority of persons who catch CMV will suffer from a mild to
severe mononucleosis-like syndrome which can last for months. Still, for the
average, otherwise healthy infant, child or adult, CMV presents no serious
threat and a full recovery can be expected. The exceptions to this positive
prognosis are immunocompromised individuals, such as persons infected with
HIV, those undergoing chemotherapy, or transplant patients, for whom CMV can
be deadly.
Pregnant women are, however, the primary group for whom CMV offers a
significant threat. The disease is not dangerous to the woman who becomes
infected, but to her fetus. Women who develop a CMV infection for the first
time during pregnancy will pass that infection on to their unborn children
approximately forty percent of the time.Women who have already had CMV prior
to becoming pregnant are at little to no risk of becoming re-infected.
Therefore, prior exposure to the virus is a woman's best defense against
giving birth to a child with Congenital CMV.
The odds of a woman reaching her childbearing years without natural immunity
to this disease
vary, depending on age, race and economic status. The older a woman is when
she becomes pregnant, the more likely she is to have already had CMV.
Economically disadvantaged women are, in general, more likely to have had
CMV prior to adulthood. Only approximately 50-60% of college-educated, white
women of childbearing age in this country currently carry protective immunity
to CMV. Thus, it is this group which is most vulnerable to contracting a
primary CMV infection while pregnant and passing the disease on to an unborn
baby.
According to Dr. Martha D. Yow of Baylor College of Medicine, a primary reason
that young, American women of the middle and upper socio-economic classes
have lower rates of natural CMV immunity is because many have had minimal
contact with small children prior to becoming pregnant themselves . It is
estimated that up to 80% of toddlers in the United States are shedding the CMV
virus at any given time. Lack of contact with children prior to pregnancy can
mean that a young woman has not had the opportunity to become exposed to the
virus and obtain important immunologic protection prior to starting
her own family. On the other hand, a pregnant woman who does not already carry
CMV immunity should carefully avoid exposure to young children, particularly
those in group care, where the disease is of almost epidemic proportions.
Daycare centers and nursery schools provide an ideal environment for the
spread of CMV, since the virus lives in bodily fluids such as feces, urine,
saliva and mucous. Avoidance of the disease can be difficult if a pregnant
mother without CMV immunity has other young children in group care.
The issue of whether pregnant women should be routinely tested for CMV
immunity is not a settled one. Most experts believe that evaluation would be
too costly to implement on a wide scale. Others, such as Dr. Martha D.Yow,
disagree and recommend CMV screening for women who are planning a pregnancy,
or as early in pregnancy as possible. Any woman who wishes to determine
whether she is at risk of exposing her fetus to Congenital CMV can request
that her doctor administer the blood test. Because the level of understanding
and knowledge of CMV and its role in pregnancy is so poor among much of the
United States health care community, a woman who seeks CMV testing may find
that her health care provider is resistant to the idea.
Researchers and physicians have been focusing most of their energy in the
fight against CMV on
development of a vaccine to prevent the disease. With an effective vaccine,
women could be immunized against CMV before becoming pregnant. The National
CMV Registry estimates that an effective vaccine could prevent severe, life-
long disabilities for as many as 4,000 congenitally infected infants in the
United States each year. Unfortunately, an acceptable vaccine is presently
years away from general use.
In the absence of an effective testing program or a vaccine, old-fashioned
preventive measures are critical in the fight against Congenital CMV. An
increase in the U.S. rate of naturally acquired immunity to the disease could
play a very important role. Since breastmilk is a bodily fluid through which
CMV is frequently passed, more breastfed babies would ensure a greater number
of CMV-immune individuals in the general population. Healthy babies who
contract CMV through breastfeeding are at no risk from the virus and are then
immune from the disease for life.
"It (breastfeeding) is nature's way of affording passive-active
immunization:The infant receives small doses of CMV while being protected by
antibody acquired from the mother," explains Dr. Yow.
Women of childbearing age who are concerned about contracting CMV should
practice excellent hygiene around all young children, since such a high
proportion of little people excrete the virus. Needless to say, avoiding
exposure to virus in one's own children can be tricky. CMV experts recommend
to pregnant women or women who plan to become pregnant that they avoid kissing
toddlers and preschoolers on the mouth, wash their hands after changing
diapers, sterilize toys which have been "mouthed" and avoid sharing food or
utensils with anyone. Pregnant women whose occupations involve working with
young children are advised that studies have shown that the rate of CMV
infection among daycare center employees is up to five times greater than in
the general population. For a non CMV-immune pregnant woman who is employed
in a child care center or preschool, her workplace can be a hazardous
environment for her unborn baby.
Because CMV is carried in blood and body fluids, it is considered a sexually
transmitted disease. Women of childbearing age should be aware that
unprotected sex with a partner who is shedding the virus can easily lead to
infection. Considering the prevalence of the disease in the community at large
and the commonly asymptomatic etiology of the virus, a woman has no reliable
way of knowing whether her partner is infected. Women with new or multiple
partners should be especially cautious.
Parents, doctors or others with a desire to learn more about Congenital CMV
can contact The National CMV Registry in Houston, TX. The Registry offers
information on the disease and physicians who specialize in its treatment, a
CMV Newsletter and a Parent-to-Parent national network for families with
children affected by Congenital CMV. This organization is also at the
forefront of tracking the disease and its spread across the United States.
To contact the Registry:
The National CMV Registry
Clinical Care Center, Suite 1150
1102 Bates Street, MC 3-2371
Houston, TX 77030
Phone-(713)770-4387
Fax-(713) 770-4347
>>>>>>>>>>>>>>>>>>>>>
Please feel free to have this mother contact me if I can answer any further
questions.
Katie Allison Granju
Knoxville, TN
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