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CMV in Pregnancy — RACP Adult Medicine MCQ

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HardInfectious DiseasesCMV in PregnancyRACP Adult Medicine

A 35-year-old pregnant woman at 28 weeks presents with a mononucleosis-like syndrome: fever, lymphadenopathy, and hepatitis. Monospot is negative. HIV test is negative. CMV IgM is positive, CMV IgG is negative (primary infection). CMV PCR is positive. What is the most important fetal concern?

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Correct answer: C — CMV mononucleosis

Primary CMV infection in pregnancy (CMV IgM positive, IgG negative = new infection, not reactivation) carries ~30-40% risk of vertical transmission. Congenital CMV is the leading infectious cause of congenital hearing loss and neurodevelopmental disability. Fetal concerns: IUGR, microcephaly, intracranial calcifications, hepatosplenomegaly, SNHL. Valaciclovir may reduce vertical transmission (ongoing trials). Serial fetal USS monitoring and amniocentesis for fetal CMV PCR may be offered. Refer to maternal-fetal medicine.

Reference: RANZCOG – 2024 – CMV in Pregnancy; eTG Antibiotic 2025