Two percent of pregnant women will develop primary cyto-megalovirus (CMV) infection, obtained by direct contact or respiratory aerosol from an infected individual. They will most often be asymptomatic or have mild generalized symptoms such as fatigue, malaise, fever, lymphadenopathy, and pharyngitis. Approximately 50% of fetuses whose mothers seroconvert during pregnancy will develop CMV infection, but only 10 to 15% of these will have damage from the infection. Hearing loss is the most common manifestation.

Fetal infection and damage are more likely in the first and second trimesters. Although hearing loss is the most common presentation, congenital CMV can also present with microcephaly or hydrocephalus, microphthalmia, mental retardation, and brain calcifications. Overwhelming fetal infection at birth, known as cytomegalic inclusion disease, is uncommon, is most often caused by maternal primary infection late in gestation, and is often fatal.

Recurrent CMV infection in pregnancy can also cause infection of the fetus, but rarely fetal damage (Stagno, 1982).

Thus, documented immunity to CMV with serologic studies performed before a pregnancy can be reassuring to women at risk of exposure, such as child care providers or health care workers. General screening for CMV in pregnancy is not recommended at present. Suspected CMV infection should be documented by serology or cultures of the cervix, amniotic fluid, or maternal urine.

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