Chickenpox and shingles

Most pregnant women are immune to the viral illness chickenpox (varicella) because they had it or were vaccinated as a child. Once you've had the disease, you're immune for life. So if you had chickenpox or have been vaccinated against it, there's no need for concern if you're exposed to it during pregnancy.

If you haven't had chickenpox, it poses risks to you and your fetus if you get the disease while pregnant. That's why during a preconception or prenatal visit your health care provider will likely ask whether you've already had chickenpox. If you haven't or if you don't know, he or she may recommend a blood test to determine whether you're immune. Although a vaccine is available to prevent chickenpox, pregnant women shouldn't be vaccinated.

If you're not immune to chickenpox and haven't been vaccinated, you'll want to take steps to avoid exposure and prevent complications for you and your baby. In rare cases, chickenpox early in pregnancy can result in birth defects. If you develop chickenpox the week before giving birth, your newborn is at risk of developing a severe and potentially fatal chickenpox infection. A chickenpox infection in a baby is rare. Chickenpox in a pregnant woman also is a cause for concern. Pregnant women are much more likely to have severe infections, including varicella pneumonia.

Shingles (herpes zoster) is caused by a limited reactivation of the chickenpox virus, usually years after you were infected. Shingles causes painful clusters of blisters. If you develop shingles while pregnant, there's little cause for concern. There is no risk of birth defects caused by shingles in the mother.

■ Prevention and self-care for chickenpox

If you're not immune to chickenpox, avoid contact with anyone who has the disease, which is highly infectious. Children are most infectious from two days before the rash appears until three days after the rash appears. Stay away from other susceptible people who've been in recent contact with an infected person.

In rare instances, a child who has recently been vaccinated against chickenpox may pass the virus on to others if he or she develops sores around the injection site. If you're not immune, talk to your health care provider about whether to postpone vaccination of any children at home until after you deliver.

■ When to seek medical help for chickenpox

Notify your health care provider if you're not immune to chickenpox and you suspect that you've been exposed to it. In pregnancy, you'll likely receive an injection of anti-chickenpox antibodies (varicella-zoster immune globulin, or VZIG). VZIG is safe for both you and your baby. When given within 96 hours after exposure, VZIG helps prevent chicken-pox or at least lessens its severity. This can help prevent complications such as pneumonia, which seems to occur more commonly in pregnant women than in other adults with chickenpox. Researchers have not determined whether taking VZIG will help protect your fetus from infection.

If you develop chickenpox the week before giving birth, your newborn is at risk of developing severe chickenpox infection. The severity of the infection can usually be reduced if the baby is treated promptly after birth with VZIG. If serious symptoms develop despite use of VZIG, antiviral drugs can help.

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