Epstein-Barr virus (EBV) and pregnancy

Epstein-Barr virus (EBV), or human herpesvirus 4, is a member of the human herpesvirus family and is the most common human virus. Most people will have evidence (antibodies to EBV in their blood) of a previous infection with EBV by age 35. Once infected with the EBV, you carry the virus for the rest of your life, although usually in a dormant state.

After an initial infection with the EBV, the virus can go dormant for many years until something causes it to reappear. Sometimes this can happen during pregnancy.

Does the EBV cause infection or disease?

In healthy infants and adults, there is often no overt infection when first infected with EBV. Teenagers and young adults, as well as patients with a less functioning immune system (people with AIDS and other immune diseases), may experience more severe symptoms and develop infectious mononucleosis ("mono").

Although EBV is not the only virus that can cause infectious mononucleosis, it is the most common cause. In adolescents and young adults, one in four EBV infections results in mononucleosis.

EBV can also cause many other diseases and conditions, including but not limited to:

Viral meningitis
Encephalitis
Transverse myelitis
Optic neuritis
Paralysis of facial muscles or on one side of the body
Acute Cerebellar Ataxia
Guillain-Barre syndrome
Pancreatitis
Myocarditis
Pneumonia
Lung disease
Lymphocytosis
Weakened immune system

How does it spread?

The virus is transmitted primarily through saliva, but can spread through all bodily fluids. Infectious mononucleosis is a common infection that can be caused by the EBV and is often referred to as "kissing disease" in adolescents because of the ease of transmission through saliva.

What are the symptoms of an EBV infection?

Symptoms of an EBV infection may include:

Fever
Sore throat
Exhaustion
Skin rash
Swollen neck lymph nodes
Enlarged liver and spleen

These symptoms should last as long as any other common illness, usually no more than 1-2 weeks. Sometimes fatigue can last longer.

Remember that many healthy children and adults do not have symptoms, or the symptoms may resemble a common childhood illness or a cold. These symptoms are most common in people with weakened or poorly functioning immune systems (people living with HIV/AIDS, some pregnant women, teens, and possibly more pregnant teens).

What are the symptoms of infectious mononucleosis?

The symptoms of infectious mononucleosis are similar to those of the EBV, but more severe. They may include:

Fever
Extreme exhaustion
Sore throat
Skin Rash
Headaches
Body aches
Swollen neck & armpit lymph nodes
Swollen liver and/or spleen

You can get rid of these symptoms in 1-2 weeks, but sometimes it can take longer to restore normal energy levels (from several weeks to 6 months). If your symptoms persist six months or more after diagnosis, you may be diagnosed with a rare chronic active EBV infection. You should see a doctor if your symptoms do not disappear after two weeks and especially after six months.

Keep in mind that although EBV is the most common cause of infectious mononucleosis, it is not the only possible cause. Other causative factors include cytomegalovirus, toxoplasmosis, hepatitis A/B/C, HIV, rubella, or adenovirus.

How is EBV diagnosed?

Because the symptoms of EBV are similar to many other mild illnesses, the best way to detect EBV infection is with a blood test for EBV-specific antibodies. If these antibodies are present, it indicates the presence of the EBV.

How do you know if it's the EBV?

Infectious mononucleosis is usually diagnosed based on symptoms alone; however, sometimes it is necessary to determine the cause. In this case, a test with the following results may indicate infection with the EBV:

Abnormal white blood cells
A higher number of white blood cells than normal
Fewer neutrophils
Fewer platelets
Proteins/enzymes indicative of an atypical liver function

How to treat EBV infection?

Because it is a virus, there are not many treatment options other than symptom reduction. Pain relievers and antipyretics such as ibuprofen or acetaminophen can reduce body pain and control fever. Rest and proper hydration (water, electrolyte drinks) are helpful approaches to managing symptoms.

Pregnant women can take acetaminophen to reduce fever and treat body aches - avoid ibuprofen.

If I get infectious mononucleosis from EBV, is there any other treatment?

The answer depends on the severity of your illness. Your doctor should watch for infectious mononucleosis and take the same steps as above to reduce symptoms, as well as a long period of rest. If the infection is affecting your organs (especially your spleen and/or liver), your doctor may also take steps to treat them. Because infectious mononucleosis can cause the spleen to enlarge, avoid contact sports to avoid rupturing the spleen.

How can I avoid getting or passing on EBV and/or infectious mononucleosis?

Since the virus can be transmitted through saliva and other bodily fluids, avoid kissing and sharing drinks, food, toothbrushes; Also avoid anal, vaginal, or oral sex with someone you know has EBV or if you have EBV.

Will the treatment be the same if I am pregnant and have EBV or infectious mononucleosis?

Generally, yes, the treatment will be the same. Acetaminophen should be used instead of ibuprofen to reduce fever and headaches. Rest and hydration are critical, especially during pregnancy, as the development of the fetus depends on the mother's hydration and good rest.

The main concerns are to minimize any infection or organ damage and to ensure that the mother's body temperature does not rise too high or stay high for too long. Indeed, a developing baby is more sensitive to temperature than the mother's body. High fever can cause miscarriage (first half of pregnancy), birth defects (first trimester), and/or premature birth (if fever is associated with organ infection).

Is there a health risk to my developing baby?

Research since the 1980s has provided varying answers to this question. Some studies show that there is no correlation between EBV reactivation during pregnancy and birth defects or preterm birth/low birth weight. More recently, research has demonstrated an association between significant EBV reactivation and early birth and low birth weight. Another found an association between maternal depressive symptoms at 32 weeks and late activation of the EBV before delivery.

More research is needed on EBV activation and its effects on pregnancy and the fetus. Almost all studies agree that EBV reactivation is not associated with fetal death. Taking heat out of the equation, it is possible that EBV activation or infection during pregnancy is associated with early labor and low birth weight.

Will the virus be passed on to my child?

EBV infection in a newborn born to a mother with EBV has been reported in some studies, although the incidence is low. There is no clear indication as to whether the virus is transmitted in utero or during childbirth. Discuss with your doctor any intervention they think is necessary to prevent transmission.

The good news is that although EBV is passed from you to your baby, EBV is usually asymptomatic during infancy and childhood, and few children have episodes of "infection". Also, most people will have EBV by the age of 35, so there's a good chance your child will still get EBV one day.