Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point of care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

For more information, click below.


Subscribers log in here


Varicella-zoster virus infection in pregnancy

INTRODUCTION

Varicella-zoster virus (VZV) is one of eight herpesviruses known to cause human infection worldwide. Varicella infection in children is generally a mild disease, while infection in adults can lead to significant morbidity and mortality. During pregnancy, varicella pneumonia can be particularly severe and maternal infection can lead to congenital abnormalities with devastating consequences [1].

This topic will address the epidemiology, infectious complications, management and prevention of varicella in the pregnant female. The clinical manifestations, treatment and prevention of VZV infection in the nonpregnant adult are discussed elsewhere. (See "Clinical features of varicella-zoster virus infection: Chickenpox" and "Treatment of varicella-zoster virus infection: Chickenpox" and "Prevention of varicella-zoster virus infection: Chickenpox".)

Management of the newborn who has been exposed to varicella is discussed elsewhere. (See "Varicella-zoster infection in the newborn".)

GENERAL BACKGROUND

VZV infection causes two clinically distinct forms of disease: varicella (chickenpox) and herpes zoster (shingles).

Varicella — Primary VZV infection results in the diffuse vesicular rash of varicella, or chickenpox. Primary infection with VZV during pregnancy has significant implications for maternal and fetal health:

                                           

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: Apr 2013. | This topic last updated: May 30, 2012.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. Lamont RF, Sobel JD, Carrington D, et al. Varicella-zoster virus (chickenpox) infection in pregnancy. BJOG 2011; 118:1155.
  2. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5604a1.htm (Accessed on July 08, 2011).
  3. Enders G, Miller E, Cradock-Watson J, et al. Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases. Lancet 1994; 343:1548.
  4. Cohen A, Moschopoulos P, Maschopoulos P, et al. Congenital varicella syndrome: the evidence for secondary prevention with varicella-zoster immune globulin. CMAJ 2011; 183:204.
  5. Stagno S, Whitley RJ. Herpesvirus infections of pregnancy. Part II: Herpes simplex virus and varicella-zoster virus infections. N Engl J Med 1985; 313:1327.
  6. Gershon AA, Raker R, Steinberg S, et al. Antibody to Varicella-Zoster virus in parturient women and their offspring during the first year of life. Pediatrics 1976; 58:692.
  7. Watson B, Civen R, Reynolds M, et al. Validity of self-reported varicella disease history in pregnant women attending prenatal clinics. Public Health Rep 2007; 122:499.
  8. Plans P, Costa J, Espuñes J, et al. Prevalence of varicella-zoster antibodies in pregnant women in Catalonia (Spain). Rationale for varicella vaccination of women of childbearing age. BJOG 2007; 114:1122.
  9. Koren G. Congenital varicella syndrome in the third trimester. Lancet 2005; 366:1591.
  10. Alanen A, Kahala K, Vahlberg T, et al. Seroprevalence, incidence of prenatal infections and reliability of maternal history of varicella zoster virus, cytomegalovirus, herpes simplex virus and parvovirus B19 infection in South-Western Finland. BJOG 2005; 112:50.
  11. Harger JH, Ernest JM, Thurnau GR, et al. Risk factors and outcome of varicella-zoster virus pneumonia in pregnant women. J Infect Dis 2002; 185:422.
  12. Schutte TJ, Rogers LC, Copas PR. Varicella pneumonia complicating pregnancy: a report of seven cases. Infect Dis Obstet Gynecol 1996; 4:338.
  13. Pastuszak AL, Levy M, Schick B, et al. Outcome after maternal varicella infection in the first 20 weeks of pregnancy. N Engl J Med 1994; 330:901.
  14. Harger JH, Ernest JM, Thurnau GR, et al. Frequency of congenital varicella syndrome in a prospective cohort of 347 pregnant women. Obstet Gynecol 2002; 100:260.
  15. Jones KL, Johnson KA, Chambers CD. Offspring of women infected with varicella during pregnancy: a prospective study. Teratology 1994; 49:29.
  16. Tan MP, Koren G. Chickenpox in pregnancy: revisited. Reprod Toxicol 2006; 21:410.
  17. Marin M, Güris D, Chaves SS, et al. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007; 56:1.
  18. Higa K, Dan K, Manabe H. Varicella-zoster virus infections during pregnancy: hypothesis concerning the mechanisms of congenital malformations. Obstet Gynecol 1987; 69:214.
  19. American Academy of Pediatrics Committee on Infectious Diseases. Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule. Pediatrics 2007; 120:221.
  20. Marin M, Watson TL, Chaves SS, et al. Varicella among adults: data from an active surveillance project, 1995-2005. J Infect Dis 2008; 197 Suppl 2:S94.
  21. Khandaker G, Marshall H, Peadon E, et al. Congenital and neonatal varicella: impact of the national varicella vaccination programme in Australia. Arch Dis Child 2011; 96:453.
  22. Chaves SS, Gargiullo P, Zhang JX, et al. Loss of vaccine-induced immunity to varicella over time. N Engl J Med 2007; 356:1121.
  23. VariZIG for prophylaxis after exposure to varicella. Med Lett Drugs Ther 2006; 48:69.
  24. Enright AM, Prober CG. Herpesviridae infections in newborns: varicella zoster virus, herpes simplex virus, and cytomegalovirus. Pediatr Clin North Am 2004; 51:889.
  25. Paryani SG, Arvin AM. Intrauterine infection with varicella-zoster virus after maternal varicella. N Engl J Med 1986; 314:1542.
  26. Gnann JW Jr. Varicella-zoster virus: atypical presentations and unusual complications. J Infect Dis 2002; 186 Suppl 1:S91.
  27. Martin KA, Junker AK, Thomas EE, et al. Occurrence of chickenpox during pregnancy in women seropositive for varicella-zoster virus. J Infect Dis 1994; 170:991.
  28. Suga S, Yoshikawa T, Ozaki T, Asano Y. Effect of oral acyclovir against primary and secondary viraemia in incubation period of varicella. Arch Dis Child 1993; 69:639.
  29. Nikkels AF, Delbecque K, Pierard GE, et al. Distribution of varicella-zoster virus DNA and gene products in tissues of a first-trimester varicella-infected fetus. J Infect Dis 2005; 191:540.
  30. Straus SE, Ostrove JM, Inchauspé G, et al. NIH conference. Varicella-zoster virus infections. Biology, natural history, treatment, and prevention. Ann Intern Med 1988; 108:221.
  31. Heininger U, Seward JF. Varicella. Lancet 2006; 368:1365.
  32. Pahud BA, Glaser CA, Dekker CL, et al. Varicella zoster disease of the central nervous system: epidemiological, clinical, and laboratory features 10 years after the introduction of the varicella vaccine. J Infect Dis 2011; 203:316.
  33. Smego RA Jr, Asperilla MO. Use of acyclovir for varicella pneumonia during pregnancy. Obstet Gynecol 1991; 78:1112.
  34. LAFORET EG, LYNCH CL Jr. Multiple congenital defects following maternal varicella; report of a case. N Engl J Med 1947; 236:534.
  35. Mazzella M, Arioni C, Bellini C, et al. Severe hydrocephalus associated with congenital varicella syndrome. CMAJ 2003; 168:561.
  36. Mouly F, Mirlesse V, Méritet JF, et al. Prenatal diagnosis of fetal varicella-zoster virus infection with polymerase chain reaction of amniotic fluid in 107 cases. Am J Obstet Gynecol 1997; 177:894.
  37. Siegel M. Congenital malformations following chickenpox, measles, mumps, and hepatitis. Results of a cohort study. JAMA 1973; 226:1521.
  38. Siegel M, Fuerst HT, Peress NS. Comparative fetal mortality in maternal virus diseases. A prospective study on rubella, measles, mumps, chicken pox and hepatitis. N Engl J Med 1966; 274:768.
  39. Balducci J, Rodis JF, Rosengren S, et al. Pregnancy outcome following first-trimester varicella infection. Obstet Gynecol 1992; 79:5.
  40. Cuthbertson G, Weiner CP, Giller RH, Grose C. Prenatal diagnosis of second-trimester congenital varicella syndrome by virus-specific immunoglobulin M. J Pediatr 1987; 111:592.
  41. Isada NB, Paar DP, Johnson MP, et al. In utero diagnosis of congenital varicella zoster virus infection by chorionic villus sampling and polymerase chain reaction. Am J Obstet Gynecol 1991; 165:1727.
  42. Essex-Cater A, Heggarty H. Fatal congenital varicella syndrome. J Infect 1983; 7:77.
  43. Alkalay AL, Pomerance JJ, Rimoin DL. Fetal varicella syndrome. J Pediatr 1987; 111:320.
  44. Wallace MR, Bowler WA, Murray NB, et al. Treatment of adult varicella with oral acyclovir. A randomized, placebo-controlled trial. Ann Intern Med 1992; 117:358.
  45. Stone KM, Reiff-Eldridge R, White AD, et al. Pregnancy outcomes following systemic prenatal acyclovir exposure: Conclusions from the international acyclovir pregnancy registry, 1984-1999. Birth Defects Res A Clin Mol Teratol 2004; 70:201.
  46. Pickard RE. Varicella pneumonia in pregnancy. Am J Obstet Gynecol 1968; 101:504.
  47. Broussard RC, Payne DK, George RB. Treatment with acyclovir of varicella pneumonia in pregnancy. Chest 1991; 99:1045.
  48. Cox SM, Cunningham FG, Luby J. Management of varicella pneumonia complicating pregnancy. Am J Perinatol 1990; 7:300.
  49. Al-Nakib W, Al-Kandari S, El-Khalik DM, El-Shirbiny AM. A randomised controlled study of intravenous acyclovir (Zovirax) against placebo in adults with chickenpox. J Infect 1983; 6:49.
  50. Reiff-Eldridge R, Heffner CR, Ephross SA, et al. Monitoring pregnancy outcomes after prenatal drug exposure through prospective pregnancy registries: a pharmaceutical company commitment. Am J Obstet Gynecol 2000; 182:159.
  51. Pacifici GM. Transfer of antivirals across the human placenta. Early Hum Dev 2005; 81:647.
  52. McGregor JA, Mark S, Crawford GP, Levin MJ. Varicella zoster antibody testing in the care of pregnant women exposed to varicella. Am J Obstet Gynecol 1987; 157:281.
  53. Koren G, Money D, Boucher M, et al. Serum concentrations, efficacy, and safety of a new, intravenously administered varicella zoster immune globulin in pregnant women. J Clin Pharmacol 2002; 42:267.
  54. Gershon AA, Steinberg S, Brunell PA. Zoster immune globulin. A further assessment. N Engl J Med 1974; 290:243.
  55. Rouse DJ, Gardner M, Allen SJ, Goldenberg RL. Management of the presumed susceptible varicella (chickenpox)-exposed gravida: a cost-effectiveness/cost-benefit analysis. Obstet Gynecol 1996; 87:932.
  56. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5604a1.htm.
  57. Centers for Disease Control and Prevention (CDC). A new product (VariZIG) for postexposure prophylaxis of varicella available under an investigational new drug application expanded access protocol. MMWR Morb Mortal Wkly Rep 2006; 55:209.
  58. Evans EB, Pollock TM, Cradock-Watson JE, Ridehalgh MK. Human anti-chickenpox immunoglobulin in the prevention of chickenpox. Lancet 1980; 1:354.
  59. Centers for Disease Control and Prevention (CDC). FDA approval of an extended period for administering VariZIG for postexposure prophylaxis of varicella. MMWR Morb Mortal Wkly Rep 2012; 61:212.
  60. Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention. MMWR Recomm Rep 1996; 45:1.
  61. Marin M, Güris D, Chaves SS, et al. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007; 56:1.
  62. Troughton JA, Crealey G, Crawford V, Coyle PV. Management of varicella contacts in pregnancy: VZIG or vaccination? J Clin Virol 2009; 46:345.
  63. Coonrod DV, Jack BW, Boggess KA, et al. The clinical content of preconception care: immunizations as part of preconception care. Am J Obstet Gynecol 2008; 199:S290.