Management of Infectious Mononucleosis in Pregnancy
Infectious mononucleosis during pregnancy requires supportive care only, as no specific antiviral therapy exists and the infection is typically self-limiting with minimal risk to the fetus.
Clinical Approach and Diagnosis
Primary EBV infection is diagnosed by detecting IgM and IgG antibodies directed against the EBV viral capsid antigen (VCA) with negative EBNA1 IgG. 1 The Paul-Bunnell and monospot tests are suboptimal for diagnosis in pregnancy and should not be relied upon. 1
Key Diagnostic Features:
- Classic triad: Fever, tonsillar pharyngitis, and cervical lymphadenopathy 2
- Laboratory findings: Peripheral blood leukocytosis with lymphocytes comprising at least 50% of the white blood cell differential count, and atypical lymphocytes constituting more than 10% of total lymphocytes 2
- Hepatosplenomegaly: Occurs in approximately 50% and 10% of cases, respectively 2
- Periorbital/palpebral edema: Present in one-third of patients, typically bilateral 2
Treatment During Pregnancy
Management is entirely supportive, as aciclovir therapy does not ameliorate the course of infectious mononucleosis. 1 Treatment focuses on:
- Rest and activity modification: Bed rest as tolerated with reduction of physical activity 2
- Symptomatic relief: Supportive care for fever, sore throat, and fatigue 3, 4
- Corticosteroids: May be indicated specifically for airway obstruction, but should be used judiciously 1, 5
Critical Safety Considerations
Pregnant women must avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly persists to prevent splenic rupture, which occurs in 0.1 to 0.5% of cases and is potentially life-threatening. 2
Monitoring Requirements:
- Clinical assessment: Careful evaluation with full blood count, blood film, and liver function tests 1
- Splenic monitoring: Serial assessment for splenomegaly resolution before resuming normal activity 6, 2
Maternal-Fetal Implications
There is no evidence of significant vertical transmission or teratogenic effects from EBV infectious mononucleosis during pregnancy. The available evidence suggests:
- Minimal fetal risk: Unlike other viral infections in pregnancy, EBV does not appear to cause congenital abnormalities 3, 4
- No special obstetric interventions required: Standard prenatal care continues 2
Important Caveats
Fatal infectious mononucleosis-associated lymphoproliferative disorders have been reported in patients on immunosuppressive therapy (particularly thiopurines), but this is not relevant to otherwise healthy pregnant women. 1
Recovery timeline: Fatigue may be profound but typically resolves within three months, though it may take longer for complete recovery. 2 Pregnant women should be counseled about this protracted course to set appropriate expectations.
Complications requiring urgent evaluation: Severe upper airway obstruction, signs of splenic rupture (left upper quadrant pain, referred left shoulder pain, hemodynamic instability), or neurologic symptoms warrant immediate specialist consultation. 2, 5