Anecdotal reports have suggested that embryopathy may occur in very rare cases of primary maternal EBV infection in early gestation (9,10). However, the exact risk of congenital infection with EBV is not known. Various congenital defects have been described in the few reported infants with documented congenital EBV infection or whose mothers had infectious mononucleosis during pregnancy (11). No specific pattern has been recognized. Reported abnormalities include micrognathia, congenital heart disease, cataract, microphthalmia, hip dysplasia, biliary atresia, and central nervous system abnormalities. Other studies of women with infectious mononucleosis or primary asymptomatic EBV infection in early pregnancy failed to document serologic or virologic evidence of EBV infection in their offspring (7). Although intrauterine transmission of EBV has been documented in a study using PCR, none of infants with positive PCR had clinical abnormalities (12). Maternal human immunodeficiency virus infection was not shown to increase the risk of intrauterine transmission of EBV.
The possibility of EBV acquisition by neonates during passage through the birth canal has been raised by the results of a study in which cervical shedding of EBV was demonstrated in 5 out of 28 (18%) seropositive women (13). However, no clear data are available regarding the incidence of perinatal transmission of EBV.
The diagnosis of congenital EBV infection can be established serologically or by attempting virus identification using lymphocyte transformation assays. PCR has been used for the detection of EBV DNA in infants, and this technique could become more useful in the diagnosis of congenital EBV infection. However, the sensitivity and specificity of the PCR assay for the diagnosis of intrauterine transmission of EBV has not been well defined. In addition, the PCR assay has not yet been standardized and thus is not available for routine use in clinical laboratories.
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