Chickenpox is a highly contagious rash disease that increases in severity with age. This virus has a high incidence among children, but adults who did not experience the disease as children or were not vaccinated are not immune to it, and in case of contagion the complications and morbidity are greater. This group also includes pregnant women.
Although it is rare to contract chickenpox during pregnancy – as most women of childbearing age have already passed the disease in their childhood or were vaccinated – if contagion occurs it could be very serious for the mother and the baby. We will explain it to you in more detail.
What is chickenpox?
Chickenpox is an infectious disease of viral origin, which although it usually has a benign course in childhood, complications increase with age , and can become especially serious if contracted during pregnancy.
The disease is caused by the varicella-zoster virus (VZV) and is highly contagious , both by air and by contact, causing between 80 and 90 percent of the people who are in contact with a sick person to contract it as well.
After healing, the virus remains latent in the body and at any time in life could reactivate and produce herpes zoster (something that occurs in 15-30% of cases), with grouped vesicular lesions that cause itching, stinging, pain and even fever and general malaise.
The distribution of the chickenpox virus is universal . In European and North American countries with temperate climates, its incidence is usually seasonal, with peaks at the end of winter and in spring. In these countries, 90% of the population contracts the disease before the age of 15. But in tropical countries, the spread of the virus is hampered by its instability in the face of heat, which is why chickenpox usually occurs at later ages.
Vaccination is the most effective way to protect yourself against this virus . Therefore, it is recommended to administer a first dose of the varicella vaccine between 12-15 months of age and a second dose between three and four years.
What is the incidence of the disease in pregnancy?
Infection during pregnancy is rare because 80-95% of women of childbearing age had chickenpox as girls or were vaccinated. The overall incidence of chickenpox during pregnancy is estimated to be 0.7-3 per 1,000 pregnancies.
The incidence of chickenpox is not higher in pregnant women than in the rest of the adult population, however the symptoms it causes can be very serious, both for the mother and the baby.
Chickenpox complications during pregnancy
If the mother contracts chickenpox during pregnancy, the most frequent risk for her is varicella pneumonia , a complication that appears in 5-20% of cases. Up to 40% of the time the woman will need mechanical ventilation.
The risk of suffering from this pneumonia increases with gestational age due to the relative immunosuppression of the mother and the pressure of the uterus on the diaphragm. There are also other risk factors associated with varicella pneumonia such as tobacco use and having more than 100 vesicles .
But in addition, infection by the varicella-zoster virus during pregnancy can cause vertical transmission of the virus through the placenta, causing various conditions in the newborn whose severity will depend on the exact moment of pregnancy when the maternal infection occurs. :
- Fetal chickenpox syndrome
It is a rare group of birth defects in babies. A baby who has fetal chickenpox syndrome can develop scars on the skin and changes in the eyes, brain, digestive system, extremities (atrophy of a limb), muscular and skeletal alterations, delayed development …
It is a very serious clinical form with high morbidity and mortality, although fortunately its incidence is very infrequent, standing at 0.06 cases per 100,000 live births. It occurs when the mother contracts chickenpox in the first 20 weeks of pregnancy , especially between weeks 13 and 20.
- Early neonatal chickenpox
It occurs when the mother contracts the disease between 21 and five days before delivery . Its incidence is 0.16 cases per 100,000 live births; about 34% of babies who get chickenpox occur this way.
In these cases, the baby usually presents early and generally mild chickenpox , as it has given time for the mother to pass antibodies to the disease to the baby. It is characterized by the appearance of a rash in the first week of life, and the appearance of herpes zoster in childhood is also frequent.
- Late neonatal chickenpox
This infection occurs in 17-30% of cases. It occurs when the mother contracts the disease between five days before delivery and 48 hours after it. In these cases, the symptoms of chickenpox in the baby are severe and begin between the fifth and the 15th day of life. Pulmonary complications and mortality of up to 30% can occur.
Therefore, if the mother is infected with chickenpox at the end of her pregnancy, care should be taken to delay delivery for at least five days from the onset of the disease. If not, the baby should receive specific varicella-zoster immunoglobulin and be monitored for possible signs of infection for 14-16 days. In case of infection, the baby will be treated with intravenous acyclovir.
What treatment does a pregnant woman who contracts chickenpox receive?
As we read in this document from the Virtual Library of the Murcian Health Service, if a woman contracts chickenpox while pregnant, the treatment offered will be symptomatic , with paracetamol being the painkiller of choice. If the skin lesions itch, an oral antihistamine compatible with pregnancy could be used.
In pregnant women over 20 weeks of pregnancy, oral acyclovir could also be recommended within 24 hours after the appearance of the rash, but if complications derived from the disease occur, and regardless of gestational age, it may be necessary to start treatment with intravenous acyclovir.
A pregnant woman with chickenpox should receive a thorough medical control , especially if any of the following circumstances arise:
- Respiratory and / or neurological symptoms
- Bleeding
- Intense rash with or without lesions
- If the woman has a chronic lung disease, is on corticosteroids, smokes or is in the final stretch of pregnancy, admission to hospital should be assessed, even in the absence of complications
The chickenpox vaccine is the most effective measure to prevent contagion
Adolescents older than 12 years and adults who did not receive this vaccine or did not pass the disease as children have a higher risk of suffering from severe chickenpox, with higher rates of complications, hospital admissions and fatality.
Therefore, if your doctor considers it so and with exceptions in which this vaccine would not be indicated, you can not only vaccinate in the adult stage but you must do it, especially if you are part of any of the risk groups contemplated in this information of the Centers for Disease Control and Prevention (CDC).
With regard to women of childbearing age who are planning pregnancy, it is very important to check the status of the vaccination record to know what vaccines were received during childhood. In case of doubts or ignorance of this information, the doctor should be consulted, who through a serological analysis will determine if the woman has antibodies against chickenpox, either because the disease has passed or because she has received the vaccine.
The chickenpox vaccine is contraindicated during pregnancy. Likewise, it is important to know that the woman who is vaccinated against chickenpox should not become pregnant during the three months after being vaccinated, as we read on the Mayo Clinic website.
During lactation, this vaccine could be administered (according to what we read on the E-lactancia website, its risk is low), but on rare occasions it is associated with the presence of a contagious rash in the area of the puncture. If this occurs, it is enough to cover the rash with a dressing or clothing to avoid direct contact with the baby.
I am pregnant but I have not had chickenpox and I am not vaccinated: what precautions should I take?
If you are pregnant and through a blood test the doctor determines that there is no presence of antibodies against the varicella-zoster virus , you will receive a series of instructions to protect yourself against this disease, especially if you have young children or work in contact with them.
The basic recommendations – common when it comes to preventing any other infection during pregnancy – are frequent hand washing with soap and water and staying away from those with chickenpox or shingles.
In the event of significant contact with an infected person (contact in the same room as the patient for 15 minutes or more, face-to-face contact, or contacts within the home) it may be necessary to give the pregnant woman varicella-zoster immunoglobulin as as soon as possible, bearing in mind that this treatment is most effective in the first 10 days after contact. The goal of receiving this treatment is to reduce the risk of maternal infection and, consequently, also avoid the risk of having a baby with congenital chickenpox syndrome.
On the other hand, it should be mentioned that when the chickenpox vaccine is received, the vaccinated person can spread the disease for a period of six weeks, although the risk of transmission of the vaccine virus is remote. In this sense, if you are pregnant and you live with someone who is going to be vaccinated against chickenpox, you should be careful especially if a vaccine rash appears, since in that case the vaccine virus could be transmitted to the pregnant woman and the fetus.
For this reason, and although the frequency of this fact is exceptional, the Spanish Association of Pediatrics recommends the separation of the vaccinated person and the pregnant woman until the lesions heal.
Photos | iStock
Via | AEP, Mayo Clinic, Vall d’Hebron University Hospital
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