EBV Transmission and Pregnancy
Primary EBV infection during pregnancy is rare, and management is entirely supportive with no specific interventions required, as there is no evidence that antiviral therapy improves outcomes. 1
Epidemiology and Risk
- Primary EBV infection occurs infrequently during pregnancy, with studies showing only 3.4% of pregnant women are susceptible (lacking EBV antibodies), and none acquired infection during pregnancy in prospective follow-up 2
- The majority of adults have already been exposed to EBV before pregnancy, providing natural immunity 2
Transmission Considerations
Maternal-Fetal Transmission
- Vertical transmission of EBV from mother to fetus is possible but extremely rare, with only scattered case reports documenting in utero transmission 3
- When transmission does occur, it has been associated with severe outcomes including symmetric fetal growth restriction and stillbirth, though these cases are exceptional 3
- The actual risk of congenital infection remains poorly defined due to the rarity of documented cases 2
Reactivation in Pregnancy
- EBV reactivation can occur during pregnancy due to physiological immune modulation, though this is typically asymptomatic 4
- Pregnant women may shed virus in saliva during reactivation, which represents a potential source of transmission to young children in the household rather than to the fetus 4
- High-titer maternal IgG antibodies that develop during reactivation cross the placenta and provide passive protection to the infant for several months postpartum 4
Clinical Management
Diagnosis
- Primary EBV infection is diagnosed by detecting IgM and IgG antibodies against EBV viral capsid antigen (VCA) with negative EBNA1 IgG 1
- Clinical assessment should include full blood count, blood film, and liver function tests 1
Treatment Approach
- Management is entirely supportive, as aciclovir therapy does not ameliorate the course of infectious mononucleosis 1
- Corticosteroids may be indicated specifically for airway obstruction but should be used judiciously 1
- No specific antiviral therapy is recommended for EBV infection in pregnancy 1
Important Clinical Caveats
- Routine screening for EBV in asymptomatic pregnant women is not recommended given the rarity of primary infection during pregnancy 2
- Unlike CMV or HSV, there are no established protocols for fetal monitoring or intervention when maternal EBV infection is diagnosed 3, 2
- The risk-benefit profile does not support aggressive intervention, as most infections are self-limited and fetal transmission is exceedingly rare 1, 2
- Fatal lymphoproliferative disorders have been reported in immunosuppressed patients with EBV, but this is not relevant to otherwise healthy pregnant women 1
Contrast with Other Viral Infections
It is critical to distinguish EBV management from other viral infections in pregnancy that require active intervention, such as CMV (where valaciclovir reduces transmission risk) or HSV (where antiviral therapy and cesarean delivery may be indicated) 5, 6. EBV requires only supportive care without specific preventive measures for vertical transmission 1.