CMV and herpes in pregnancy: toddler hygiene, tests and birth plans

CMV and herpes are common viruses, and most babies are fine. The NHS says CMV in pregnancy causes no problems in most cases. You lower your CMV risk at home, with hand washing and by not sharing cups or spoons with a young child. For herpes, the step that counts is telling your gynae if you or your partner have ever had it. The RCOG says a first genital infection late in pregnancy is the case that needs a birth plan.

How to protect your baby from CMV and herpes, step by step

1. Wash your hands with soap and water after you change a nappy, feed your child or wipe their nose. The NHS puts this first on its list for lowering CMV risk in pregnancy.
2. Keep your own cup and spoon. The CDC says not to share food, cups or pacifiers with a child, so skip finishing your toddler's porridge.
3. Kiss your toddler on the head, or give a hug. The NHS advises against kissing young children on the face while you're pregnant.
4. Wash toys that end up in little mouths. The NHS suggests washing items that may have a young child's saliva or pee on them.
5. Mention it at your first gynae visit if you or your partner have ever had genital herpes. The NHS asks you to tell your doctor about recurring herpes in either of you.
6. Skip sex during your partner's flare-ups if you've never had herpes. The RCOG suggests condoms through pregnancy too, especially in the last three months.
7. See a doctor straight away about new blisters or sores around your genitals. HealthHub tells pregnant women with an active infection to see their doctor immediately.
8. Ask your gynae about CMV screening if you have a toddler in preschool or work with young children. KKH lists first trimester CMV screening among its antenatal services.
9. Get a cold sore treated through a pharmacist who knows you're pregnant. HealthHub says pharmacists can supply antiviral creams such as aciclovir, and the UK's bumps service says aciclovir can be used in pregnancy.
10. Send your family our newborn visitors rules before the birth. The NHS says anyone with a cold sore shouldn't kiss your baby.

How CMV spreads, and why a toddler at home matters

CMV is short for cytomegalovirus. The NHS says it belongs to the herpes group of viruses, and it passes through body fluids such as saliva and pee, and through sex. Most adults don't notice it, though some get a flu-like illness with a fever, tiredness and a sore throat. The NHS says that usually clears in about 3 weeks.

Young children are the usual source. The CDC says 1 in 3 children has had CMV by age 5, mostly without symptoms, and the virus can stay in their saliva and urine for months. The NHS says pregnant women with a young family, or who work closely with children, are more at risk.

The risk to your baby is highest if you haven't had CMV before, the NHS says. The virus can cross the placenta. In the US, the CDC counts about 1 in 200 babies born with CMV, and about 1 in 5 of those have long-term problems such as hearing loss, while most never show signs at all.

Other infections have their own guides: HFMD in Singapore, toxoplasmosis in pregnancy and flu while pregnant.

CMV testing in Singapore: what's routine and what's on offer

CMV isn't on the routine list. The blood tests HealthHub lists for 6 to 12 weeks cover blood count, hepatitis B, syphilis, HIV, rubella immunity and blood group. The CDC doesn't recommend routine CMV testing in pregnancy, because lab tests can't predict which babies will be infected or have long-term problems.

You can still ask for it. KKH's Antenatal Risk Assessment Unit lists first trimester CMV screening, and its KK Fetal Centre assesses babies for infections including CMV. If you do catch CMV, the NHS says there's no treatment for it in pregnancy yet.

After birth, a test of your baby's urine, saliva or blood can confirm CMV. Timing matters here. The CDC says the test must be done within 2 to 3 weeks of birth, so if you had CMV in pregnancy, tell your baby's doctor before you leave hospital. The NHS says babies who have it get regular checks until about age 5, and antiviral medicine can be used once they're born.

SingHealth says your baby's hearing is screened in the first few days, usually before you go home. Keep using the hearing checklist in your baby's Health Booklet afterwards. The CDC notes CMV hearing loss can show up later, even after a passed newborn test.

Genital herpes in pregnancy: what your gynae may offer

Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus. HealthHub says the cold sore type can reach the genitals through oral sex. Many people have mild or no symptoms, so they don't know they have it.

The risk to your baby comes at birth. HealthHub says a mother with open sores can pass the infection on during a vaginal birth, and in a newborn that can be serious. Your gynae's plan depends on when you first caught it.

If you had herpes before pregnancy, the RCOG says your antibodies cross the placenta and protect your baby. Even a flare-up in labour carries an extremely low risk, and most women can have a vaginal birth. In the UK they're offered antiviral treatment from 32 weeks until birth.

If it's your first time in pregnancy, you'll be offered antiviral tablets, the RCOG says, and it shouldn't affect your baby's growth. The worry is labour within six weeks of a first episode, before your body has made antibodies to protect the baby. So for a first episode after 28 weeks, especially within six weeks of your due date, a planned caesarean is usually recommended.

That guidance is from the UK, so ask your gynae what they'd advise here. Bumps names aciclovir as the first choice for genital herpes in pregnancy. Itching or discharge has other causes too: see pregnancy vaginal discharge.

Cold sores in pregnancy and after the birth

A cold sore is herpes simplex too. HealthHub says it's contagious from the first tingle or itch, and spreads through skin contact and saliva. HealthHub also notes that hormone changes in pregnancy can bring on a flare.

While you have one, don't kiss anyone or share towels or lip balm, and wash your hands after touching it. Bumps says aciclovir cream doesn't reach your blood at levels that could affect the baby. Some women leave a simple cold sore to heal by itself. For other medicines, see safe medicine during pregnancy.

After birth, the NHS says babies are most at risk from herpes in their first 6 weeks. If you get a cold sore then, wash your hands before you touch or breastfeed your baby, and keep the sore covered.

CMV and herpes compared

Group B strep is a bacterium with its own check late in pregnancy: see group B strep in pregnancy. Mosquito-borne viruses are in Zika and dengue in pregnancy.

When to see a doctor

These signs don't tell you what you have. They're reasons to call your gynae's clinic, or see a GP or polyclinic doctor.

• A flu-like illness with fever, sore muscles or swollen glands. The NHS says to see a doctor if you're pregnant with CMV symptoms, and they may arrange tests.
• New blisters, sores or pain around your genitals. HealthHub says to see your doctor immediately if you're pregnant.
• Your toddler has been diagnosed with CMV. The NHS says a young family raises your risk, and KKH offers first trimester CMV screening.
• Herpes sores near your due date or when labour starts. Tell your gynae, and tell the delivery suite staff when you arrive. The NHS asks you to tell your doctor if you develop sores.
• Any rash. HealthHub asks you to see your doctor about any type of rash in pregnancy.
• After birth, a baby who won't settle, isn't feeding as well as usual, or has a rash or sores on the skin, eyes or mouth. A fever of 38 degrees C or more counts too. The NHS calls these early warning signs that need a doctor straight away.

At KKH, the Urgent O&G Centre is a 24-hour walk-in centre for urgent problems under 22 weeks. From 22 weeks, KKH asks you to go straight to its Delivery Suite on Level 2 of the Women's Tower if you're bleeding, your water bag leaks or labour starts. For urgent and emergency cases, KKH says to call 995 or go to an emergency room. Our premature labour signs guide lists the SGH and NUH routes.

Frequently asked questions

Is CMV in pregnancy dangerous for my baby?

Usually not. The NHS says it causes no problems in most cases, and the CDC says most babies born with CMV never have health problems. The risk is highest when you catch it for the first time while pregnant.

Should I get a cytomegalovirus pregnancy test?

It isn't part of routine care, and the CDC says a result can't predict how the baby will do. KKH does offer first trimester CMV screening. If you have a toddler in preschool, or you work with young children, raise it with your gynae.

Can I have a normal delivery with genital herpes in pregnancy?

Usually, yes, if you had herpes before you got pregnant. The RCOG says most women with recurring genital herpes can have a vaginal birth. A first episode after 28 weeks is different, and a planned caesarean is often advised then.

Can I treat a cold sore in pregnancy?

Yes. Bumps says aciclovir can be used in pregnancy and is the first choice for cold sores, and HealthHub says pharmacists can supply the cream. Tell the pharmacist you're pregnant. Once your baby is born, the NHS says people with a cold sore shouldn't kiss them, so keep it covered until it heals.

Is CMV a type of herpes, and does that change anything in pregnancy?

Yes, the NHS says CMV is part of the herpes group. They still spread in different ways. CMV comes mostly from young children's saliva and pee, while genital herpes spreads through sex and skin contact, so each needs its own steps.