Abstract
Pregnant women in the tropics like India are more susceptible to varicella zoster infection due to the lower seroprevalence of varicella as compared to temperate regions. Seronegative pregnant women are highly susceptible following a significant exposure owing to the high secondary attack rate of the virus. Fetal transmission could happen transplacentally while neonatal transmission occurs through close contact post partum. Maternal VZV infection could be severe (particularly varicella pneumonia) with high mortality if untreated. Congenital varicella syndrome has an incidence of about 1–2% and is more likely if maternal symptoms occur between 5th and 24th week of pregnancy. Susceptible pregnant women with a significant contact should be administered VZIG not later than 10 days of exposure. Women presenting with the typical rash of VZV infection should be prescribed oral aciclovir. The mainstay of diagnosis of fetal varicella syndrome is detailed ultrasound scanning starting 4 weeks after the onset of maternal rash. Prenatal diagnosis of varicella can be achieved by varicella PCR of the amniotic fluid at least 6 weeks after maternal infection. However, presence of the virus in the amniotic fluid does not necessarily imply progression to fetal varicella syndrome. If the mother contracts primary infection at term, her delivery should be delayed by at least 5–7 days after the onset of the rash if possible. Neonatal varicella zoster immunoglobulin should be administered to prevent neonatal infection if delivery cannot be postponed. Obstetrician should be aware of the prophylactic and treatment strategies in the event of exposure/infection.
Similar content being viewed by others
References
Varicella and herpes zoster vaccines: WHO position paper, June 2014.
Arunkumar G, Vandana KE, Sathiakumar N. Prevalence of measles, mumps, rubella, and varicella susceptibility among health science students in a University in India. Am J Ind Med. 2013;56:58–64. https://doi.org/10.1002/ajim.22046.
Miller E, Marshall R, Vurdien JE. Epidemiology, outcome and control of varicella-zoster infection. Rev Med Microbiol. 1993;4:222–30.
Zhang HJ, Patenaude V, Abenhaim HA. Maternal outcomes in pregnancies affected by varicella zoster virus infections: population-based study on 7.7 million pregnancy admissions. J Obstet Gynaecol Res. 2015;41(1):62.
Hall S, Maupin T, Seward J, Jumaan AO, Peterson C, Goldman G, Mascola L, Wharton M. Second varicella infections: are they more common than previously thought? Pediatrics. 2002;109(6):1068–73.
Harger JH, Ernest JM, Thurnau GR, Moawad A, Thom E, Landon MB, National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units, et al. Frequency of congenital varicella syndrome in a prospective cohort of 347 pregnant women. Obstet Gynecol. 2002;100(2):260.
Jones KL, Johnson KA, Chambers CD. Offspring of women infected with varicella during pregnancy: a prospective study. Teratology. 1994;49(1):29–32.
Pastuszak AL, Levy M, Schick B, Zuber C, Feldkamp M, Gladstone J, et al. Outcome after maternal varicella infection in the first 20 weeks of pregnancy. N Engl J Med. 1994;330(13):901–5.
Siegel M. Congenital malformations following chickenpox, measles, mumps, and hepatitis. Results of a cohort study. JAMA. 1973;226(13):1521–4.
Sauerbrei A, Wutzler P. Varicella-zoster virus infections during pregnancy: epidemiology, clinical symptoms, diagnosis, prevention and therapy. Curr Pediatr Rev. 2005;1:205–15.
Chickenpox in pregnancy, greentop guideline; 2015.
Lamont RF, Sobel JD, Carrington D, Mazaki-Tovi S, Kusanovic JP, Vaisbuch E, Romero R. Varicella zoster virus (chickenpox) infection in pregnancy. BJOG. 2011;118(10):1155–62. https://doi.org/10.1111/j.1471-0528.2011.02983.
Schutte TJ, Rogers LC, Copas PR. Varicella pneumonia complicating pregnancy: a report of seven cases. Infect Dis Obstet Gynecol. 1996;4(6):338–46.
Nathwani D, Maclean A, Conway S, Carrington D. Varicella infections in pregnancy and the newborn. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. J Infect. 1998;36(Suppl 1):59–71.
Management of varicella infection (chickenpox) in pregnancy, SOGC clinical practice guidelines, no. 274, March 2012.
La Foret EG, Lynch LL. Multiple congenital defects following maternal varicella. N Eng J Med. 1947;236:534–7.
Srabstein JC, Morris N, Larke RP, DeSa DJ, Castelino BB, Sum E. Is there a congenital varicella syndrome? J Paediatr. 1974;84:239–43.
Higa K, Dan K, Manabe H. Varicella zoster virus infections during pregnancy: hypothesis concerning the mechanisms of congenital malformations. Obstet Gynecol. 1987;69(2):214–22.
Sauerbrei A, Wutzler P. Varicella-zoster virus infections during pregnancy: epidemiology, clinical symptoms, diagnosis, prevention and therapy. Curr Pediatr Rev. 2005;1:205–15.
Prober CG, Gershon AA, Grose C, McCracken GH Jr, Nelson JD. Consensus: varicella-zoster infections in pregnancy and the perinatal period. Pediatr Infect Dis J. 1990;9(12):865–9.
Ahn KH, Park Y-J, Hong S-C, Lee EH, Lee J-S, Oh M-J. Congenital varicella syndrome: a systematic review. J Obstetr Gynaecol. 2016;36(5):563–6. https://doi.org/10.3109/01443615.2015.1127905.
Schulze A, Dietzsch HJ. The natural history of varicella embryopathy: a 25-year follow-up. J Pediatr. 2000;137(6):871–4 [PubMed: 11113846].
Enders G, Miller E. Varicella and herpes zoster in pregnancy and the newborn. In: Arvin AM, Gershon AA, editors. Varicella-zoster virus virology and clinical mangement. Cambridge: Cambridge University Press; 2000. p. 317–47.
Mattson SN, Jones KL, Gramling LJ, Schonfeld AM, Riley EP, Harris JA, et al. Neurodevelopmental followup of children of women infected with varicella during pregnancy: a prospective study. Pediatr Infect Dis J. 2003;22:819–23.
To M, Kidd M, Maxwell D. Review prenatal diagnosis and management of fetal infections. Obstet Gynaecol. 2009;11:108–16.
Maternal immunization, ACOG committee opinion, number 741, June 2018.
Enders G, Miller E, Cradock-Watson J, Bolley I, Ridehalgh M. Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases. Lancet. 1994;343(8912):1548–51.
Mouly F, Mirlesse V, Meritet JF, Rozenberg F, Poissonier MH, Lebon P, 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;177:894–8.
Wallace MR, Bowler WA, Murray NB, Brodine SK, Oldfield EC III. Treatment of adult varicella with oral acyclovir. A randomized, placebo-controlled trial. Ann Intern Med. 1992;117(5):358–63.
Haddad J, Simeoni U, Paira M, Lokiec F, Messer J, Willard D. Transplacental passage of acyclovir. Presse Med. 1987;16(37):1864.
Ogilvie MM. Antiviral prophylaxis and treatment in chickenpox. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. J Infect. 1998;36(Suppl 1):31–8.
Palasanthiran P, Starr M, Jones C, Giles M (eds) Management of perinatal infections. Sydney: Australasian Society for Infectious Diseases (ASID); 2014. http://www.asid.net.au/resources/clinical-guidelines.
Pretorius DH, Hayward I, Jones KL, Stamm E. Sonographic evaluation of pregnancies with maternal varicella infection. J Ultrasound Med. 1992;11:459–63.
To M, Kidd M, Maxwell D. Review prenatal diagnosis and management of fetal infections. Obstetr Gynaecol. 2009;11:108–16.
Paulman PM, McLellan R. Varicella during pregnancy: the timing of effective treatment. J Am Board Fam Pract. 1990;3(2):121–3.
Zieger W, Friese K, Weigel M, Becker KP, Melchert F. [Varicella infection at birth]. Z Geburtshilfe Perinatol. 1994;198(4):134–7.
Brown NW, Parsons AP, Kam PC. Anaesthetic considerations in a parturient with varicella presenting for caesarean section. Anesthesia. 2003;58(11):1092–5.
McIntosh D, Isaacs D. Varicella zoster virus infection in pregnancy. Arch Dis Child. 1993;68(1Spec):1–2.
National Health and Medical Research Council (NHMRC). The Australian immunisation handbook. 10th ed. Canberra: Australian Government Publishing Service; 2013. http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home.
Health Protection Agency. Guidance on viral rash in pregnancy: investigation, diagnosis and management of viral rash illness, or exposure to viral rash illness, in pregnancy. London: Health Protection Agency; 2011. https://www.gov.uk/government/publications/viral-rash-in-pregnancy.
South Australian perinatal practice guidelines: varicella-zoster (chickenpox) in pregnancy; 2015.
Huang YC, Lin TY, Lin YJ, Lien RI, Chou YH. Prophylaxis of intravenous immunoglobulin and aciclovir in perinatal varicella 22. Eur J Pediatr. 2001;160(2):91–4.
Mori T, Komori S, Fukuda Y, Naito S, Tanaka H, Koyama K. The primary varicella infection near term: a case report 13. Arch Gynecol Obstet. 2003;268(2):128–30.
Akisu M, Yalaz M, Aksu G, Arslanoglu S, Genel F, Kutukculer N, et al. Maternally acquired varicella-zoster virus antibodies disappear at 6 months of age in prematurely born children. Panminerva Med. 2003;45(2):155–6.
Gershon AA, Raker R, Steinberg S, Topf-Olstein B, Drusin LM. Antibody to Varicella-Zoster virus in parturient women and their offspring during the first year of life. Pediatrics. 1976;58(5):692–6.
Cytomegalovirus, Parvovirus B19, Varicella Zoster, and Toxoplasmosis in Pregnancy, ACOG Practice Bulletin, Number 151, June 2015.
Balasubramanian S, Shah A, Pemde HK, Chatterjee P, Shivananda S, Guduru VK et al. Indian Academy of Pediatrics (IAP) advisory committee on vaccines and immunization practices (ACVIP) recommended immunization schedule (2018–19) and update on immunization for children aged 0 through 18 years.
Acknowledgements
We would like to thank Dr. Anita Kaul, Director, Apollo Centre for Fetal Medicine for her guidance and Prof. S. Suresh, Mediscan Systems, Chennai for permitting the use of images in this article.
Funding
No financial support or funding to declare.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Vivek Krishnan and Akshatha Sharma equally contributed to this study.
Rights and permissions
About this article
Cite this article
Krishnan, V., Sharma, A. Chickenpox in Pregnancy. J. Fetal Med. 7, 65–71 (2020). https://doi.org/10.1007/s40556-019-00234-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40556-019-00234-6