Infectious Mononucleosis, often called Mono, is a common illness usually caused by the Epstein-Barr Virus (EBV), which is a member of the herpesvirus family. The virus is easily spread through saliva, earning Mono the nickname “the kissing disease.” Most adults have already been exposed to EBV and developed immunity, meaning the virus remains dormant in their bodies. Consequently, contracting a primary EBV infection for the first time is uncommon during pregnancy. The primary concern for expectant mothers is understanding the implications if a new infection or a symptomatic viral reactivation occurs while carrying a baby.
Differentiating Mono Symptoms During Pregnancy
Identifying Mononucleosis during pregnancy can be challenging because its typical symptoms often overlap with normal pregnancy discomforts or other common illnesses. The classic presentation of Mono includes profound fatigue, fever, a sore throat, and swollen lymph nodes, especially in the neck and armpit.
The constellation of symptoms can easily be mistaken for conditions like Strep throat, the flu, or other viral infections such as Cytomegalovirus (CMV). A key differentiator in Mono is the duration of the symptoms, as the lethargy often persists for weeks or months after other signs have subsided. Healthcare providers must rely on specific testing to accurately determine the cause of the illness, particularly to rule out infections like CMV or Toxoplasmosis, which carry different fetal risks.
Potential Risks to the Mother and Fetus
Mononucleosis can lead to specific complications for the mother, mainly related to organ involvement, though these are rare. The virus commonly causes the spleen to enlarge, requiring careful management. An enlarged spleen is susceptible to rupture, a life-threatening event that necessitates immediate medical attention. Affected individuals must strictly avoid contact sports or heavy lifting.
Mono can also affect the liver, leading to mild inflammation (hepatitis). This liver involvement may occasionally cause jaundice, a yellowing of the skin and eyes. Less common but serious maternal complications include severe tonsillar swelling that could obstruct the airway, requiring urgent medical intervention.
Regarding the developing baby, EBV is generally not considered a major teratogen, meaning it is unlikely to cause birth defects. Studies show that the rate of congenital anomalies in pregnancies exposed to EBV is similar to the baseline rate. Vertical transmission from mother to fetus is possible but occurs extremely rarely, and newborns are often asymptomatic even if transmission occurs.
However, a significant EBV infection or reactivation in the mother may be associated with adverse pregnancy outcomes. Specifically, this includes a shorter duration of pregnancy and the baby having a lower birth weight.
Testing, Monitoring, and Supportive Care
The diagnostic process for Mono begins with a clinical evaluation of symptoms, often followed by a Monospot test, though this test can sometimes yield false negative results early in the illness. To confirm an EBV infection and determine its timing, specific blood tests measuring EBV-specific antibodies are necessary. The presence of viral capsid antigen IgM (VCA-IgM) antibodies indicates a current or very recent infection, while the presence of VCA-IgG and EBNA-IgG antibodies suggests a past infection and immunity.
The distinction between a primary infection and a reactivation is important. In addition to antibody testing, a full blood count, blood film, and liver function tests are typically ordered. This comprehensive testing assesses the severity of the infection, checks for organ involvement, and helps differentiate EBV from other infections that pose a higher risk to the fetus.
Management of Mononucleosis during pregnancy is entirely supportive, as there is no specific antiviral medication recommended. Rest and maintaining adequate hydration are the most important components of care. For fever and body aches, Acetaminophen is the recommended medication, while non-steroidal anti-inflammatory drugs like Ibuprofen should be avoided during pregnancy.
A pregnant woman with a severe EBV infection requires frequent monitoring, including for liver function and persistent high fever. The healthcare provider may recommend additional measures, such as ultrasounds, to ensure the baby’s growth and well-being remain on track. Following recovery, maternal antibodies developed during the infection provide passive protection to the newborn for several months.