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Re: Pregnant and positive for Mono
Posted By NL HFH MD on November 30, 1998 at 13:41:19:

In Reply to: Pregnant and positive for Mono posted by Debbie on November 10, 1998 at 17:35:29:

I am currently  5 weeks pregnant with my thrid child and I have just been told that my sore throat is actually Mono. I am very worried.............My doctor has admitted that he has never had a similar case or actually studied it in school adn does not what action to take???
He wants me to call his office in  a few days. DO you know of any complications that may arrise or possible damage to the baby? SInce I am in my first trimester I am sleeping alot anyways....is there anything else I can do  to help get over this.
How long does it last? WIll pregnancy help or hurt the duration of Mono.

Enclosed you will find the information available on "mono" and pregnancy. I have attached a list of relevant medical articles that you can retrive through the net by looking on MEDLINE on the WEB. AS you can learn from the repot the risk is low but not zero.
Epstein-Barr virus (EBV) is an infectious agent that has been
associated with infectious mononucleosis, hepatitis, and
lymphoproliferative disorders.  There have been case reports of
infants with various anomalies born after first trimester maternal
mononucleosis (1-3); however, no studies identifying the etiologic
agent of the maternal infection were included in these reports.
There are also reports of normal births after documented first
trimester infections with EBV (4).  There have been uncontrolled
reports of infants with multiple anomalies who had serologic or
virologic evidence of EBV infection (5-8), although in at least
one of these there was simultaneous infection with
cytomegalovirus (6).  A group of Slovak investigators reported in
abstract finding evidence for an increased incidence of infection
with Epstein-Barr virus (associated with infectious mononucleosis)
in infants born with facial clefts and their mothers (9).  There
were insufficient data and analysis presented in the abstract for
an adequate evaluation of these findings.
     In a prospective evaluation of more than 12,000 pregnancies,
serologic evidence of EBV susceptibility was unusual, suggesting
that most pregnant women will not contract primary EBV infections
(10).  In a series of 500 pregnancies, no association was observed
between serologic evidence of active EBV infection in mothers and
major or minor malformations, prematurity, or growth retardation
among their infants (11).  Seroconversion was documented in three
women during pregnancy and one of these three pregnancies resulted
in an infant with congenital cardiac abnormalities (12).  With the
available data, it is not possible, however, to determine whether
there is an increased risk of abnormal pregnancy outcome if
maternal EBV seroconversion or illness occurs during gestation.
In a small group of 37 seropositive women who demonstrated
serologic evidence of reactivation of EBV infection during
pregnancy, all babies were healthy at birth (7).  
     One study of breast milk donated to a milk bank found
evidence of EBV genetic material in about 40% of the samples
tested (13).  It was not determined if the virus was present in a
latent or transmittable form.  EBV infection is infancy is
believed to be commonplace (14), but this study was not adequate
to demonstrate that breast milk is a route for this infective
Selected References

1. Miller HC et al: Study of the relation of congenital
malformations to maternal rubella and other infections:
preliminary report. Pediatrics 3:259-70, 1949.

2. Belfrage S et al: Infectious mononucleosis: age, civil state,
and pregnancy - an epidemiological study. Scand J Infect Dis
1:57-60, 1969.

3. Brown ZA, Stenchever MA: Infectious mononucleosis and
congenital anomalies. Am J Obstet Gynecol 131:108-9, 1978.
4. Fleisher G, Bologonese R: Infectious mononucleosis during
gestation: Report of three women and their infants studied
prospectively. Pediatr Infect Dis 3:308-311, 1984.

5. Goldberg GN et al: In utero Epstein-Barr virus (infectious
mononucleosis) infection. JAMA 246:1579-81, 1981.

6. Joncas JH et al: Simultaneous congenital infection with
Epstein-Barr virus and cytomegalovirus. N Engl J Med 304:1399-403,

7. Costa S et al: Detection of active Epstein-Barr infection in
pregnant women. Eur J Clin Microbiol 4:335-6, 1985.
8. Ornoy A, Dudai M, Sadovsky E: Placental and fetal pathology in
infectious mononucleosis. A possible indicator for Epstein-Barr
virus teratogenicity. Diagn Gynecol Obstet 4:11-16, 1982.
9. Molnarova A, Brozman M, Fedeles J et al: Possible Epstein-Barr
virus infection during pregnancy and orofacial clefts. Teratology
51:27A, 1995.
10. Icart J et al: Prospective study of Epstein-Barr virus (EBV)
virus infection during pregnancy. Biomedicine 34:160-3, 1981.
11. Fleisher G, Bolognese R: Persistent Epstein-Barr virus
infection and pregnancy. J Infect Dis 147:982-986, 1983.

12. Fleisher G, Bologonese R: Epstein-Barr virus infections in
pregnancy: a prospective study. J Pediatr 104:374-9, 1982.

13. Junker AK, Thomas EE, Radcliffe A et al: Epstein-Barr virus
shedding in breast milk. Am J Med Sci 302: 220-3, 1991.
14. Biggar RJ, Henle W, Fleisher G et al: Primary Epstein-Barr
Virus infections in African infants. I. Decline of maternal
antibodies and time of infection. Int J Cancer 22:239-43, 1978.

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