Guidelines Revised on Chicken Pox in Pregnancy

Laurie Barclay, MD

January 22, 2015

The Royal College of Obstetricians and Gynaecologists (RCOG) issued their revised, fourth edition Green-top guideline on chicken pox (primary varicella-zoster virus; VZV) in pregnancy on January 21. The new recommendations describe prevention of chicken pox in pregnancy, management and treatment of pregnant women with chicken pox, mode of delivery, infant risks, and advice regarding breast-feeding.

"[C]hickenpox can be serious for your health during pregnancy and complications can arise," coauthor Professor Patricia Crowley, MB, FRCOG, from University College Dublin, said in a RCOG news release.

"It is vital that pregnant women with symptoms of the virus should contact their [general practitioner] as soon as possible and avoid contact with potentially susceptible individuals, such as other pregnant women and babies."

VZV infection is a common, usually mild childhood disease typically resulting in persistent immunity. However, VZV infection affects three of every 1000 pregnancies.

"Chickenpox is very contagious so it is important that women are aware of the symptoms and the necessity to seek medical attention promptly," RCOG Guidelines Committee Co-Chair Dr Manish Gupta said in the news release.

"Women may worry about passing the virus onto their baby however this is quite rare and depends on what stage of pregnancy the virus was transmitted," he continued.

He added, "It is also vital that clinicians are aware of the increased morbidity associated with chickenpox in pregnant women and ensure that the woman receives the best possible care."

Specific best practice recommendations include the following:

  • Clinicians should ask women presenting for antenatal care about previous chicken pox or shingles infection.

  • Pregnant women who have not had chicken pox, or who are known to be seronegative for chicken pox, should avoid contact with persons who have chicken pox or shingles and should promptly inform their clinician of potential exposure.

  • Clinicians should confirm potential exposure by careful history to confirm the significance of the contact and the susceptibility of the patient, as well as by blood test to determine VZV immunity or nonimmunity.

  • Pregnant women may need a second dose of varicella-zoster immunoglobulin if there is further exposure and 3 weeks have elapsed since the last dose.

  • Pregnant women who develop the characteristic rash should immediately inform their clinician, and they should be isolated from other pregnant women and neonates until the lesions have crusted over (usually about 5 days after rash onset).

  • Symptomatic treatment and hygiene are helpful to prevent secondary bacterial infection.

  • Aciclovir is not licensed for use in pregnancy. Clinicians should advise their patients of the risks and benefits.

  • Clinicians should consider hospital assessment of women at high risk for severe or complicated chicken pox, regardless of clinical status.

  • Clinicians should refer pregnant women who develop chicken pox to a fetal medicine specialist, virologist, and neonatologist for decision regarding treatment.

  • Clinicians should individualize the timing and mode of delivery of the pregnant woman with chicken pox.

  • Women with chicken pox should breast-feed if they so desire and are in sufficiently good health.

The gynecology oncology practice of the husband of one of the authors is run as a company, and she is also chair of the Specialist Research and Education Committee and a member of the Executive Council of the Institute of Obstetricians and Gynaecologists in Ireland. The other authors have disclosed no relevant financial relationships.

"Chickenpox in Pregnancy." RCOG. Published online January 21, 2015. Full text

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