Epstein Barr Virus Mononucleosis

INFORMATION FOR WOMEN WHO HAVE EPSTEINBARR VIRUS-INDUCED MONONUCLEOSIS DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is EpsteinBarr virus infection?

EpsteinBarr virus (EBV) is a virus that commonly infects people of all ages; in fact, it is estimated to be present in as much as 90 percent of the human population. In some people, typically people in their teens and early 20s, EBV can strike as an acute (powerful, short-term) infection that shows up as a disease called mononucleosis, commonly known as mono.  The name of the condition comes from the fact that the infected people have an increase in the number of blood lymphocytes, a type of white blood cell that has only one nucleus (mononuclear), compared with other blood cells. Lymphocytes are also present in lymph nodes, where they the dominant kind of white blood cell, and mononucleosis is characterized by swollen nodes, particularly in the neck, where there is also a sore throat. Along with this, there are flu-like symptoms, such as headache, fatigue, muscle pains, and swelling in other parts of the body, such as the spleen. Sometimes, there is also a rash. EBV-induced mononucleosis is notorious as the kissing disease because it spreads easily through saliva, but you can get the infection from minimal contact, and are susceptible when your immunity is weak, such as when you are pregnant.

How common is EBV mononucleosis during pregnancy?

EBV mononucleosis has not been studied extensively in the setting of pregnancy.  However, EBV is one of the most common disease-causing viruses to infect humans, and women of childbearing age are typically infected, so it is quite a realistic scenario for mono to strike during pregnancy.

How is EBV mononucleosis diagnosed?

EBV mononucleosis is diagnosed first based on your history, symptoms, and physical signs, such as sore throat, fever, fatigue, swollen lymph nodes in the back of your neck and in the groin areas, purplish-red spots on the palate (palatal petechiae), and an enlarged spleen. Your doctor will have a blood sample drawn from you to conduct either a complete blood count with a differential white blood cell count (CBC with diff) or whats called the heterophile antibody test.

Does EBV cause problems during pregnancy?

The fever of EBV can cause dehydration, the most common complication of EBV mononucleosis. There is some evidence that when a previous EBV infection that the body has suppressed is reactivated that pregnancy can be shortened slightly, meaning that the infection may slightly increase the risk of premature birth. A small amount of anemia is fairly common, due to the breakage of red blood cells in some patients. In a very small fraction of patients more serious complications can develop, including inflammation of the connective tissue layers surrounding the brain and inflammation of the brain itself, other neurological problems such as a condition called Guillain-Barré syndrome, breathing problems, and rupture of the spleen. There also are rare long-term complications, such as an on-going EBV active infection (chronic infection), chronic fatigue syndrome, and some conditions in which certain cells of the lymphatic system are produced in excessive quantities, including certain types of cancer, such as Burkitt lymphoma and Hodgkin lymphoma.

Does EBV during pregnancy cause problems for the baby?

As noted above, there may be a slight effect of EBV in shortening pregnancy such that the baby would be born early. The real problem, however, is the fever. Some studies have suggested that fever during pregnancy can increase a babys risk of having congenital defects involving the heart and other organs. Also, a recent study identified maternal fever as a possible risk for the baby developing autism spectrum disorder.

What to consider about taking medications when you are pregnant or breastfeeding:

  • Any risks to yourself and your baby if you do not treat EBV
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat EBV during pregnancy?

Medication is used to treat the fever and body aches of EBV mononucleosis. The best drug for this in a pregnant patient (and non-pregnant patients too) is acetaminophen (in the United States) and paracetamol (in Europe). You should avoid non-steroidal anti-inflammatory drugs (such as ibuprofen), not only because these drugs may harm the developing baby if used in the third trimester, but also because they may possibly provoke bleeding in the spleen.

Who should NOT stop taking medication for EBV during pregnancy?

Nearly every pregnant woman with EBV mononucleosis should take acetaminophen or paracetamol to reduce fever, since fever can be dangerous for the developing baby, and these drugs are thought to be safe during pregnancy. The only exceptions are women who have certain liver disorders.

What should I know about choosing a medication for EBV during pregnancy?

You may find Pregistrys expert reports about the individual medications used to treat EBV here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for EBV when I am breastfeeding?

First of all, you should know that EBV is transferred between people through body fluids, and there is evidence that EBV can get into breastmilk. Acetaminophen and paracetamol, which are given to treat the fever that can result from EBV, are thought to be relatively safe in mothers who breastfeed.

What alternative therapies besides medications can I use to treat my EBV during pregnancy?

Rest, maintenance of good hydration, and avoidance of types of physical activity that potentially could result in trauma to, or near, the spleen, are the most important therapies. A pregnant woman who becomes very dehydrated will likely require hospitalization to receive intravenous fluids along with monitoring, as would a woman who develops neurological complications. In the event of spleen rupture, the woman would be admitted to the intensive care unit.

What can I do for myself and my baby when I have EBV during pregnancy?

Cooperate with your healthcare providers in order to minimize risk to yourself and the child.

Resources for EBV in pregnancy:

For more information about EBV during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following links:

 

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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