Commentary Maternity and Birthing

CMV: The Little-Known Virus That May Endanger Your Pregnancy

Nicole Bromfield

Although most of the general public, as well as some in the medical profession, are unaware of the dangers of a CMV infection to the fetus of a pregnant woman, CMV causes more birth defects and congenital disabilities in children than all other well-known diseases.

When I was 22 weeks pregnant with my son, I tested positive for a primary cytomegalovirus (CMV) infection. I had most likely contracted CMV during my second trimester of pregnancy, after spending time with some young children.

CMV causes more birth defects and congenital disabilities in children than all other well-known diseases, including spina bifida, Down syndrome, fetal alcohol syndrome, and pediatric HIV infection. Nonetheless, awareness of the dangers of CMV infections in pregnancy is low in the United States, even among some medical professionals.

The Centers for Disease Control and Prevention (CDC) estimates that in the United States about one in every 150 babies is born with congenital CMV. Although most of these babies will be born without symptoms, one in five will have significant birth defects, including hearing loss, blindness, neurological abnormalities, cerebral palsy, and/or enlarged organs. If contracted during the first trimester, CMV can cause fetal death. Some babies may be born with asymptomatic congenital CMV, but develop problems later in life, the most prevalent being hearing loss. In fact, CMV is the most common environmental cause of hearing loss.

Although not well-known, CMV is a common virus, and between 50 to 80 percent of the U.S. population has contracted it by midlife. Once contracted, the virus remains dormant in one’s body for life. For most healthy people, CMV is harmless, with few, if any, symptoms. It is, however, a danger for pregnant women who contract it for the first time while pregnant, because the virus can cross over the placenta and infect the developing fetus

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According to the nonprofit organization STOP CMV, only about 13 percent of U.S. women are aware of CMV and its dangers to pregnant women, although the people most likely to contract CMV are those working with young children, such as daycare and pre-school professionals, a labor force dominated by women. The most common carriers of active CMV are children under the age of six, who can spread the virus through their tears, saliva, or urine. Although congenital CMV can cause significant problems in infants, children contracting CMV after birth usually have no symptoms beyond those of the common cold, but they can actively shed and spread the virus for several years.

In the United States, there is no routine screening for CMV in pregnant women and little awareness or education. On the STOP CMV website, heart-wrenching stories are featured, written by families affected by congenital CMV. Many include accounts of a lack of awareness by medical professionals—including cases in which pediatricians were unfamiliar with CMV—and the refusal of insurance companies to cover “experimental treatment,” which has been found to lessen the impact of congenital CMV on unborn babies. Almost all of the women featured had never heard of the virus before they were affected by it, even though some of them worked in childcare settings, and many of them contracted CMV during their second or third pregnancies, most likely acquiring it from their own young children.

Unlike in the United States, CMV screening is routine for all pregnant women in eight European countries and in Israel, and is conducted as early as possible in pregnancy. If a pregnant woman is found to carry CMV antibodies, but has no active CMV infection, she has already contracted the virus at some point in her life before the pregnancy and is considered mostly “safe” from CMV, as there is low risk that a secondary infection would affect a developing fetus.

However, if a pregnant woman does not carry CMV antibodies, she has never contracted CMV in her lifetime and is at risk for contracting a primary infection during pregnancy. In these cases, and in countries including Italy, the pregnant woman at risk for a primary CMV infection is educated about the dangers of CMV and is given guidance to avoid infection, including thorough hand washing when in contact with young children, and avoiding kisses on the mouth from any children, including her own. There is currently no vaccination for CMV.

In these countries, a pregnant woman who has not previously contracted CMV will be tested monthly for primary CMV infection, and if she should contract a primary CMV infection at any point during the pregnancy, she has the option of receiving CMV-specific intravenous immunoglobulin therapy, which has been shown to reduce or reverse the impact of CMV on the fetus. These treatments have been met with significant success, but are still considered to be experimental in the United States.

After finding out that I contracted a primary CMV infection during my pregnancy, my insurance company refused coverage of the $10,000 per treatment intravenous immunoglobulin therapy on the grounds that it was experimental. I was lucky enough to be included in a study taking place in Italy, and flew twice to Italy late in my pregnancy, to receive generalized intravenous immunoglobulin therapy treatments. My precious son was born at full-term, healthy, and without congenital CMV.

Like many women, during my pregnancy I avoided alcohol, took folic acid daily, stayed away from litter boxes, didn’t eat lunch meat or rare steak, and did everything else in my power to ensure a healthy pregnancy. But I didn’t know that the potential penalty for not washing my hands after handling toddlers’ toys or not avoiding their sweet little kisses was a potential death sentence for my developing fetus. It also never occurred to me to visit the doctor after I had flu-like symptoms about 14 weeks into my pregnancy.

Surprisingly, despite the progressive actions taken in Europe, the CDC explicitly recommends against screening for CMV in pregnant women in the United States. Dare I suggest that this is due to the powerful health insurance lobby, which doesn’t want to cover routine CMV screening and possible costly treatments for pregnant women?

Analysis Law and Policy

Supreme Court Ruling on Texas Law Reverberates Around the Country

Teddy Wilson

"To the extent that similar state laws have different provisions, like those that contain transfer agreements for example, those laws will need to be litigated individually to fall," said Jessica Mason Pieklo, vice president for law and the courts at Rewire. "The good news is that the Supreme Court's decision in Whole Woman's Health provides advocates with a solid foundation to begin those next fights."

The U.S. Supreme Court struck down Monday two provisions in Texas’ anti-abortion omnibus law known as HB 2, and with that ruling the dominos began to fall. Similar anti-abortion laws in Wisconsin and Mississippi were blocked Tuesday by the Supreme Court, and Alabama’s attorney general announced he would drop an appeal to a legal challenge of a similar law.

However, significant obstacles remain to ensure access to reproductive health care throughout the country. A number of states have in place slightly different variations of the requirements struck down by the Court, which means it remains to be seen how lower courts may apply Monday’s ruling to restrictions that aren’t exactly like those included in Whole Woman’s Health v. Hellerstedt.

Monday’s decision is a significant victory for patients and providers, but it doesn’t guarantee that targeted regulation of abortion providers (TRAP laws) across the country will start to fall immediately, explained Jessica Mason Pieklo, vice president for law and the courts at Rewire.

“To the extent that similar state laws have different provisions, like those that contain transfer agreements for example, those laws will need to be litigated individually to fall,” Pieklo said. “The good news is that the Supreme Court’s decision in Whole Woman’s Health provides advocates with a solid foundation to begin those next fights.”

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Dozens of states in recent years have passed TRAP laws, which single out abortion clinics and providers and subject them to regulations that are more stringent than those applied to clinics and physicians in other medical fields.

Many anti-abortion measures introduced around the country resemble copycat legislation drafted by Americans United for Life (AUL), an anti-choice organization that distributes proposals to state lawmakers as part of a strategy to flood state legislatures with anti-choice bills.

As Rewire previously reported, key players in the development of HB 2 were deeply connected to AUL and other conservative lobby groups.

The Supreme Court ruled in Whole Woman’s Health v. Hellerstedt that two TRAP provisions under HB 2 placed “a substantial obstacle in the path of women seeking an abortion,” and constituted “an undue burden on abortion access.”

Specifically, the Court struck down the requirement that physicians who provide abortion care must have admitting privileges at a hospital within 30 miles of the facility where the physician will provide abortion services. The Court also struck down the requirement that facilities providing abortions meet ambulatory surgical center (ASC) requirements, which involve prohibitively expensive medically unnecessary building renovations.

There are 16 states that have passed laws mandating that physicians who provide abortion care have admitting privileges or similar requirements. In addition to laws that have been struck down in Alabama, Mississippi, Texas, and Wisconsin, courts have also blocked similar laws in Louisiana, North Dakota, and Oklahoma.

Laws requiring abortion providers have admitting privileges remain in effect in Arizona, Arkansas, Florida, Indiana, Kansas, Missouri, South Carolina, Tennessee, and Utah.

These laws typically require physicians have admitting privileges at a hospital near the facility where they provide abortion care. Some of these laws require that the hospitals provide OB-GYN services, and some require the physician to be board certified in OB-GYN medicine.

Other laws require that the hospital be no more than 30 miles from the facility where the abortion is performed, or have varied in defining the geographic boundary.

The law that was struck down in Mississippi required the admitting privileges be obtained at a “local hospital.” And Utah’s current law requires the hospital be within a “travel time of 15 minutes or less,” while Florida’s recently passed law requires the hospital be within a “reasonable proximity.”

There are 24 states that have passed laws requiring facilities in which surgical abortion services are performed to meet ambulatory surgical center standards that go beyond what is needed to ensure patient safety, and another 17 states require clinics that may only provide medication abortion to meet these same standards, according to the Guttmacher Institute.  

As Nick Bagley, an assistant professor at the University of Michigan School of Law, told Vox, similar laws that have been passed in other states may face legal challenges in the wake of Whole Woman’s Health, but the details of those challenges may vary. “The Supreme Court only applies to Texas,” Bagley said. “Other states will have slightly different laws with slightly different facts to argue over.” 

Florida and Indiana TRAP Laws Set to Take Effect 

This year Florida passed its own Texas-style anti-choice omnibus law, which takes effect Friday. However, there are some differences between the two laws, including differences in the types of regulations of physicians who provide abortion care.

Clinics that offer abortion services in Florida will be required to have a written patient transfer agreement, which includes the transfer of the patient’s medical records, with a hospital within “reasonable proximity” to the facility. Physicians also will be required to have admitting privileges at a hospital within “reasonable proximity” to their clinic.

The law also mandates annual inspections of all licensed abortion clinics, requires any medical facility in which abortions are performed to submit a monthly report, and prohibits state or local governments from entering into contracts with organizations that provide abortion services.

State Sen. Kelli Stargel (R-Lakeland), who voted for the bill, expressed concern after the senate vote that the bill’s language could become an issue in the courts. “Those clauses gave me concern that it would make it as though our intent was to close down all abortion clinics in the state,” Stargel told the Tampa Bay Times. “That was not the intent of this bill.”

After the Supreme Court’s ruling on Monday, Stargel reiterated that despite the bill’s similarities to the Texas law, it was not lawmakers intent to restrict access to abortion. “In Florida, we passed [the law] to safeguard women’s health, not to close abortion clinics,” Stargel said in a statement, reported the Florida Sun Sentinel.

Laura Goodhue, executive director of the Florida Alliance of Planned Parenthood Affiliates, told the Miami Herald that the language of the bill may be different, but that Florida lawmakers had the same intent as Texas lawmakers: to shutter abortion clinics.

“It’s definitely different language,” said Goodhue. “But the intent is the same.”

Planned Parenthood has filed a lawsuit challenging the law, however, the organization is not challenging the admitting privileges requirement. 

Goodhue told the Florida Sun Sentinel that the organization will determine if there are grounds for other lawsuits in the future. “Right now, we’re seeking emergency relief on the other three provisions, but we’ll make sure that access to care is protected,” Goodhue said.

Gov Rick Scott (R), who signed the bill into law in March, said during a press conference Monday that his administration is reviewing the Supreme Court’s decision, reported the Miami Herald

Lawmakers in Indiana have in recent years passed multiple laws to restrict access to abortion, including laws that have provisions mandating that physicians have admitting privileges and other reporting requirements

Mike Fichter, president and CEO of Indiana Right to Life, said in a statement that the Supreme Court showed “utter disregard for women’s health and safety,” and defended a similar law passed state lawmakers this year.

“We will be reviewing the Supreme Court’s decision thoroughly to see how this legal precedent could affect Indiana’s laws on admitting privileges and abortion facility building standards,” Fichter said. 

An omnibus abortion bill passed in 2011 contained multiple abortion restrictions, including a provision that a physician performing an abortion must have admitting privileges at a hospital located in the county where abortions are provided or a contiguous county.

The law also allowed for a physician to meet the requirement by entering into an agreement with a physician who has admitting privileges at a hospital in the county or contiguous county.

Another similar law was passed by Indiana lawmakers this year, which made numerous changes to state laws, including requiring forced counseling and mandatory ultrasounds for abortion patients, creating regulations on physicians who provide abortion care, and banning fetal tissue donation that has led to the development of vaccines and other public health benefits

The law created a requirement that a written agreement between a physician performing an abortion and a physician who has written admitting privileges at a hospital in the county or contiguous county be renewed annually.

The law also requires the state department of health to submit copies of admitting privileges and written agreements between physicians to other hospitals in the county and contiguous counties where abortions are performed.

Gov. Mike Pence (R) signed the bill into law in March, and it will go into effect on Friday.

Ali Slocum, spokesperson for Planned Parenthood of Indiana and Kentucky, told the Indianapolis Star that the organization does not have any immediate plans to challenge the law in court. “We are focused on what is currently in the pipeline. It is possible that the standard that the court set [Monday] could be used to challenge restrictions in other states,” Slocum said.

Efforts in State Legislatures to Repeal Laws

In some states lawmakers and advocacy groups may push to repeal similar laws following the Whole Woman’s Health decision.

Arizona lawmakers have passed several anti-choice laws in recent years and, like Texas and Florida lawmakers, justified those regulations as necessary to ensure the health and safety of women in the state.

Jodi Liggett, vice president of public affairs for Planned Parenthood Arizona, said in a statement that the Supreme Court made a “clear statement” that laws that restrict access to abortion care are unconstitutional.

“Arizona is a large state, with population spread across many rural areas. Laws that delay care, require travel over great distances and overnight stays certainly place real-life burdens on women seeking our care,” Liggett said.

Arizona Senate Minority Leader Katie Hobbs told the Arizona Republic that she will lead the effort in the legislature to repeal similar laws. “No woman or doctor should be punished for receiving or providing essential medical care,” Hobbs said. “These restrictions have never truly been about women’s health.”

However, repealing anti-choice laws in the GOP-dominated Arizona state legislature may prove difficult.

Republicans hold an 18-12 majority in the state senate and a 36-24 majority in the state house, and they have introduced dozens of anti-choice bills in the past several years. There have been seven laws to restrict access to abortion passed by Arizona lawmakers, including a law similar to Texas’ HB 2 which requires abortion providers to have admitting privileges.

Those efforts have been spearhead by the Center for Arizona Policy, a conservative think tank that promotes anti-choice, anti-LGBTQ, and so-called religious freedom legislation.

Cathi Herrod, president of the Center for Arizona Policy, said in a statement that the Supreme Court’s decision eliminated “common-sense safety precautions” for women seeking abortion care. “To give the abortion industry a blanket exemption from laws applicable to every other medical facility is unconscionable,” Herrod said.

Josh Kredit, general counsel for the Center for Arizona Policy, told the Arizona Republic that the Supreme Court’s decision suggest that abortion providers should be treated differently that other health-care providers.

“They are arguing they should be exempt from garden-variety health and safety regulations,” Kredit said. “It was clear that Texas, when it passed these, was focusing on protecting women, just like many of our laws that we pass in Arizona.”

Dr. Thomas M. Gellhaus, president of the American College of Obstetricians and Gynecologists, said in a statement that the Court’s decision made it clear these laws do not improve the health and safety of patients seeking abortion. Said Gellhaus: “As the court found, it was clear that the ambulatory surgical center and admitting privileges requirements at the heart of Texas law HB 2 did not improve the safety of women, and served only as a barrier to women’s ability to access safe, legal abortion when needed.”

“Of course, this is not the end of the battle when it comes to abortion access,” Gellhaus added. “In dozens of states, women are living under laws that impede access in a variety of ways, for example banning certain abortion procedures, setting gestational limits, mandating that medically inaccurate information be provided to patients, and more. None of these have a basis in medicine, and all of them represent political interference in the patient/physician relationship. We will continue to oppose these laws and to promote safe access to legal abortion for our patients.”

News Abortion

Anti-Choice Governors Face Twitter Backlash

Jenn Stanley

Kentucky Gov. Matt Bevin has made anti-choice laws a key part of his agenda, so Kentucky women are fielding their reproductive health questions to #AskBevinAboutMyVag.

The social media world has exploded this week with hashtags like  and , with which Kentuckians and Ohioans field their reproductive health questions to their anti-choice governors.

Both Ohio Gov. John Kasich (R) and Kentucky Gov. Matt Bevin (R) have made passing anti-choice legislation a key part of their respective agendas, with Kasich proving to be among the nation’s most effective in attacking reproductive rights.

Louisvillian Molly Shah last week created the hashtag #AskBevinAboutMyVag, after Bevin signed into law a Republican-backed bill forcing women to sit through a real-time counseling session 24 hours before an abortion procedure.

Shah and co-authors Emily Van Bogaert and Jamie Yeager wrote a commentary in Insider Louisville condemning the anti-choice legislative agenda that inspired the social media campaign. They explained that while Bevin was signing the “informed consent” bill, another anti-choice bill passed through a Kentucky state senate subcommittee consisting of only men. 

SB 152 landed in the (all-male) Senate Veterans, Military Affairs & Public Protection Committee, which is charged with handling “matters relating to veterans, including veterans’ rights, benefits and education; veterans’ nursing homes; military affairs and civil defense; national guard; retention of military bases; safety of citizens and security of public buildings and property; military memorials and cemeteries” — and, of course, every woman’s private parts.

We appreciate that Kentucky’s lawmakers consider our birth cannons to be American heroes, but why didn’t the bill start out in the Health and Welfare Committee? Was it because that committee actually includes female senators?

The authors are referring to a bill that would require doctors to perform an ultrasound and describe the image to people seeking abortion care. If SB 152 were to pass, doctors who failed to follow the mandate would be forced to pay a $100,000 penalty for the first offense and $250,000 for subsequent offenses.

“Despite the fact that men feel welcome to regulate our vaginas, they squirm upon hearing us discuss them in public,” the commentary reads. The social media campaign caught on fast and garnered international attention.

Shah later urged women to tweet at Kasich, who has been in the national spotlight due to his 2016 Republican presidential campaign.

Kentucky’s social media campaign will step into the real world on February 23 at 1 p.m., when the ACLU of Kentucky and Planned Parenthood Advocates of Indiana and Kentucky host a reproductive rights rally at the state capitol. Until then, Shah, Bogaert, and Yaeger used their commentary to remind women where to go if they have any questions about their vaginas:

Oh, and don’t forget — you can always call (502) 564-2611 to schedule an appointment at Dr. Bevin’s clinic, or (502) 564-8100 to consult your triage nurses in the Kentucky Legislature.