Chickenpox is an unusual infection to occur during pregnancy. The risk of FVS following maternal infection is low, too. However, if VZV infection does occur, it can have disastrous consequences for the pregnant women, fetus and neonate. The question of routine screening of pregnant women for immune status against varicella has been hotly debated. Chapman (42) has advocated that all pregnant women be questioned about immunity to varicella during their first antenatal appointment. Those with negative histories could be advised to avoid contact with individuals with chickenpox. Glantz et al (43) carried out routine antenatal varicella screening of all pregnant women with negative or indeterminate chickenpox histories and concluded that the measure is not cost effective. A highly immunogenic, effective, and safe vaccine against varicella is available. Universal immunization using this vaccine could prevent varicella infections during pregnancy and in fetus and neonates. However, the cost-benefit ratio of this strategy in developing countries is yet to be evaluated.

Table 1 : Potential consequences of maternal varicella infection during pregnancy

Timing of maternal infection	Consequences for fetus neonate or infant
Early pregnancy	Spontaneous abortion, fetal varicella Syndrome.
At any stage	Intra-uterine death, herpes zoster during first  year of life.
Near term	Congenital varicella or neonatal varicella.

Table 2 : Therapeutic modalities used for managing varicella infection or exposure to varicella during pregnancy.

State	Therapeutic Modalities
Exposure to varicella	Administration of VZIG to non-immune pregnant women.
Maternal varicella infection	IV acyclovir for treatment of varicella pneumonia.
	Oral acyclovir to women in second half of pregnancy within 24 hrs. of the onset of the rash.
	Oral / IV acyclovir to all pregnant women.
	VZIG to reduce the risk of fetal varicella  syndrome.
Prevention of neonatal varicella	VZIG to neonate when mother has suffered from varicella around the time of delivery.
	Prophylactic acyclovir to neonate.
	IVIG if VZIG not available.
Treatment of neonatal varicella infection	IV Acyclovir.

References :

1. Keyserling HL. Other viral agent of perinatal importance. Varicella, parvovirus, respiratory syncytial virus and enterovirus. Clin Perinatol 1997, 24: 193-211.
2. Whitley RJ, Kimberlin DW. Treatment of viral infections during pregnancy and the neonatal period. Clin Perinatol 1997, 24: 267-281
3. Wharton M. The epidemiology of varicella-zoster virus infections. Infect Dis Clin N A 1996, 10: 571-581.
4. Enders G. Varicella-zoster virus infections of pregnancy. Prog Med Virol 1984,29:166-196.
5. Stagno S, Whitley RJ. Herpes virus and varicella zoster virus infections. N Engl J Med 1985, 313: 1327-1330.
6. Miller E, Vurdien J, Farrington P. Shift in age in chickenpox. Lancet 1993,341: 308-309.
7. Feldman S. Varicella zoster infection of fetus and neonate and immunocompromised child. Adv Pediatr Infect Dis1986, 99115.
8. Venkitaraman AR, John TJ. The epidemiology of varicella in staff and student nurses of a hospital in the tropics. Int J Epidemiol 1984, 13: 502-505.
9. Venkitaraman AR, Seigneurin JM, Baccard M, Lenoir GM, John TJ. Measurement of antibodies to varicella-zoster virus in a tropical population by enzyme-linked immunosorbent assay. J Clin Microbial 1984, 14: 582-583.
10. Weller THE. Varicella and herpes zoster : Changing concepts of the natural history, control and importance of a not-so-benign virus. N Engl J Med 1983, 1362-1368, 1434-1440.
11. Kjersen H, Jepsen S. varicella among immigrants from the tropics, a health problem. Scan J Soc Med 1990,18: 171-174.
12. Harris RE, Rhoades ER. Varicella pneumonia complicating pregnancy: Report of cases and review of the literature. Obstet Gynaecol 1965, 25:734-740.
13. Paryani SG, Arvin AM. Intrauterine infection with varicella zoster virus after maternal varicella. N Engl J Med 1986, 314: 1542-1546.
14. Enders G, Miller E, Cradock-Watson J et al. Consequences of varicella and herpes zoster in pregnancy: Prospective study of 1739 cases. Lancet1994, 343: 1547-1550.
15. McIntosh D, Isaacs D. Annotations: Varicella zoster virus infection in pregnancy . Arch Disc Child Fetal and Neonatal Edition, 1993, 68:1-3.
16. 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 Infection 1998, 36 (suppl.1): 59-71.
17. Siegel M. Congenital malformations following chickenpox, measles, mumps and hepatitis. Results of a cohort study. JAMA 1973, 226: 1521-1524.
18. Birthistle K, Carrington D. Fetal varicella syndrome - a Reappraisal of the literature. A review prepared for the UK advisory group on chickenpox on behalf of the British Society for the study of infection. J Infection 1998,36(supp 1) : 25-29.
19. Salzman MB, Sood SK. Congenital anomalies resulting from maternal varicella at 25 and a half weeks of gestation. Pediatr Infection Dis J 1992, 11: 504-505.
20. LaForet EG, Lynch CL Jr. multiple congenital defects following maternal varicella. N Engl J Med 1947, 236: 534-537.
21. Strabstein JC, Morris N, Larke RBP. De Sa DJ, Castelino BB, Sum E. is there a congenital varicella syndrome ? J Pediatr 1974, 84: 239-243.
22. Higa K, Dan K, Manabe H. varicella zoster virus infections during pregnancy : hypothesis concerning the mechanism of congenital malformations. Obstet Gynecol 1987, 69: 214-222.
23. Miller E, Marshall R, Vurdien J. Epidemiology, outcome and control of varicella zoster infection. Rev Med Micro 1993, 4:222-230.
24. Alkalay AL, Pomerance JJ, Rimosin DL. Fetal varicella syndrome. J Pediatr 1987, 111: 320-323.
25. Scharf A, Scherr O, Enders G, Helftenbein E. Virus detection in the fetal tissue of a premature delivery with a congenital varicella syndrome- a case report. J Perinatal Med 1990, 18:317-322.
26. Meyers JD. Congenital varicella in term infants: Risk reconsidered J Infect Dis 1974, 129: 215-217.
27. Hermann KL. Congenital and perinatal varicella. Clin obstet Gynaecol 1982, 25: 605-609.
28. Miller E, Cradock-Watson JE, Ridehalf MSK. Outcome in newborn babies given anti-varicella zoster immunoglobulin after perinatal maternal infection with varicella-zoster virus. Lancet1989, ii: 371-373.
29. Varicella zoster infection. In: Report of the Committee on Infectious Diseases, American Academy of pediatrics, 23^rd Ed, pp.514.
30. Recommendations of the Immunization Practices Advisory Committee (ACIP). Varicella-zoster immune globulin for the prevention of chickenpox. MMWR 1984, 33: 84-100.
31. Inocenicon G, Loebstein R, Lalkin A, Geist R, Petric M, Korean G. Managing exposure to chickenpox during pregnancy. Can Fam Physician 1998, 44:745- 747.
32. Prober CG, Gershon AA, Grose C, McCrachen GH Jr, Nelson JD. Consensus : varicella - zoster infections in pregnancy and the perinatal period. Pediatr Infect Dis J 1990, 9: 865-869.
33. Gilbert GL. Chickenpox during pregnancy. Br Med J 1993, 306: 1079-1080.
34. Boyd K, Walker E. Use of acyclovir to treat varicella in pregnancy. Br Med J 1988, 296: 393-394.
35. Andrews EB, Venkashas CB, Cordero JF, Schoefler K, Hampp RN. Acyclovir in pregnancy registry: six years experience. Obstet Gynaecol 1992, 79: 7-13.
36. Eldridge R, Andrews EB, Tilson HH. Pregnancy outcome following systemic acyclovir exposure - June 1, 1984-June 30,1993. Arch Dermatol 1994, 130: 153-154.
37. Brunell PA, Ross A, Miller LH, Kuo B. Prevention of varicella by zoster immunoglobulin. N Eng J Med 1969, 280: 1191-1194.
38. Gershon AA. Prevention and treatment of varicella-zoster virus infection. Pediatr Infect Dis J 1984, 3(supply): 34-36.
39. Bose B, Kerr M, Brookes E. varicella zoster immunoglobulin to prevent neonatal chickenpox. Lancet 1986, I: 449-450.
40. Whitley RJ, Gnann J. Acyclovir: A decade later. N Engl J Med1992,327: 782-789
41. Carter PE, DufftyP, Lloyd DJ. Neonatal varicella infection. Lancet 1986, ii: 1459-1460.
42. Lipton SV, Brunnel PA. Management of varicella exposure in a neonatal intensive care unit. JAMA 1989, 261: 1782-1784.
43. Wang EEL, Prober CG, Arvin AM. Varicella zoster virus antibody titres before and after administration of zoster immune globulin to neonates in an intensive care nursery. J Pediatr 1983, 103: 113-114.
44. Ng PC, Lyon DJ, Wong MY, Fok TF et al. Varicella exposure in a neonatal intensive care unit: emergency management and control measures. J Hospital Infect 1996, 32: 229-236.
45. Chapman SJ. Varicella in pregnancy. Semin Perinatol 1998,22: 339-346.
46. Glantz JC, Mushlin AI. Cost-effectiveness of routine antenatal varicella screening. Obstet Gynaecol 1998, 91: 519-528.

Last created on 23-02-2001
Last updated on 24-05-2007.