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Maternity information – POSSIBLE COMPLICATIONS
Chickenpox in pregnancy
This patient information sheet is for pregnant women who have had contact
with chickenpox. It will give you information, explains what the condition is
and how the infection is treated. If you have any questions or concerns that
aren't answered in the information, please speak to one of the midwifery staff.
What is chickenpox?
Chickenpox is a highly infectious viral infection caused by virus named Herpes zoster. It is
a common childhood disease causing mild infection with a rash. It generally spreads
through air or if you come into direct skin to skin contact with an infected person or
indirectly through clothing.
Once you have had chickenpox you cannot catch it a second time. This means that 90% of
the general population in UK and Ireland are immune to it because their bodies’ defence
mechanism produces antibodies (fighting bodies) against infection and prevents them from
getting it again. If you are from a tropical or subtropical area you are less likely to have
been exposed to chickenpox than your UK counterparts; this means you are more likely to
catch it in pregnancy.
What are the symptoms of chickenpox?
The symptoms of chickenpox take 10 days to three weeks to appear. The first sign is
feeling unwell and feverish, followed by an itchy rash which appears like watery blisters on
skin, mainly over your trunk and limbs.
After five days of developing a rash, the blisters develop a honey-coloured crust over
them, which eventually lead to complete healing.
How do you catch chickenpox?
You can easily catch chickenpox when you come in contact with an infected person 48
hours before the onset of rash and until the rash crusts over. During this time, you can
catch chickenpox by being in very close skin to skin contact with them, or face to face with
them for at least five minutes, or in the same room with them for at least 15 minutes.
I can’t remember if I’ve had it… how do I know if I’m immune?
This can be checked to see if you have immunity to chickenpox and it is done by a blood
test. If you are immune to it then there is nothing to worry about. But if you are not
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immune, then you are at a risk of catching it while you are pregnant. Because of the
dangers of catching chickenpox while pregnant, it is best to avoid contact with anyone with
chickenpox and, if you had a contact, report it to your GP as soon as possible.
Is there a chickenpox vaccination?
There is a vaccination against chickenpox. However, it cannot be given during pregnancy.
You must avoid getting pregnant for three months after the injection. If you are not immune
to chickenpox during pregnancy, you can have a vaccination after the birth of your child. If
you want to find out more about it, see your GP.
What is shingles? Is it the same as chickenpox?
Shingles is related to chickenpox but the symptoms are different. Shingles occur in people
who had chickenpox in the past. With shingles you get patch of itchy and painful blisters
on the skin. It lasts for few days and gets better without any treatment.
What should I do if develop shingles?
You must see the GP as soon as possible for assessment. There is almost no risk to the
baby since you already have protective antibodies which pass to the baby via the placenta.
You may be offered simple pain relief and sometimes antibiotics to prevent infection.
What should I do if I come into contact with chickenpox or someone with a
rash or with shingles?
You must see your GP or midwife as soon as possible. Your GP will then do a blood test
to check for immunity.
If you are not immune to chickenpox, the GP will give you Varicella zoster immune globulin
injection (VZIG). This is a human blood product which strengthens the immune system and
makes infection milder and not last too long. It does not prevent chickenpox developing. It
can be given within 10 days of contact with chickenpox and before any symptoms appear.
VZIG does not work once you already have blisters.
If you had further exposure with chickenpox, after three weeks of having VZIG then you will
need a second VZIG injection.
What should I do if I think I have chickenpox?
If you develop a rash you must contact your GP as soon as possible. Women should avoid
contact with other people who might be badly affected by the disease such as children and
other pregnant women until the blisters have crusted over. This is usually about five days
after the onset of rash.
Why is chickenpox during pregnancy dangerous?
Chickenpox can be very serious for your health during pregnancy. The main complications
are chest infections and inflammation of the liver and brain. Very rarely, women can die
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from these complications. High risk women are those who smoke, have lung diseases like
COPD (bronchitis/emphysema), those who regularly take medications like steroids and
those who are more than 20 weeks pregnant.
If you develop breathing problems, headaches, vomiting, a severe rash that is bleeding,
you must report it to your GP as soon as possible. These symptoms indicate that you are
developing complications from chickenpox, for which you may require hospital admission.
Can I be treated once I develop chickenpox?
You can be given antiviral medication called Acyclovir within 24 hours of chickenpox rash
appearing if you are more than 20 weeks pregnant. This will reduce the intensity of the
symptoms. No medication is without its risk during pregnancy and this will be discussed
with you by your doctor.
What are the risks to my baby during pregnancy and after birth?
There is no increased risk of spontaneous miscarriage with chickenpox. Risks to the baby
depend on what stage in pregnancy you catch it.
If you are less than 28 weeks gestation, then there is 1 in 100 chance of baby being
affected by the chickenpox while growing. Damage to the baby’s skin, ears, legs, arms,
brain, bladder or bowel is possible. You will be referred to a local specialist in fetal
medicine for further ultrasound scans and discussion about further tests like amniocentesis
(testing the fluid around the baby).
If you are between 28-36 weeks gestation, the virus stays in the body of baby but will not
cause any symptoms. It can be active later and cause ‘shingles’ in first few years of life.
If you are more than 36 weeks, the baby may become infected and could be born with
chickenpox.
If you have chickenpox at the time of delivery and baby is born within 7 days, of your rash
appearing then baby may get severe chickenpox requiring treatment.
If you get chickenpox up to 7 days after birth, the baby may get severe chickenpox so you
will be monitored for 28 days after you become infected.
When should I give birth if I have chickenpox at term (when baby is due)?
It is best to wait until all blisters crust over. This will also give a chance for your natural
immunity to pass to your unborn baby. You can discuss delivery with your obstetrician.
Can I breastfeed with chickenpox?
Yes you can breastfeed even if have had chickenpox during pregnancy.
Will my baby be checked after delivery?
After birth, the baby will have an eye examination and blood tests to check for antibodies.
When the baby is seven months old, we repeat the blood tests for antibodies.
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What medications are advised for the baby following exposure to
chickenpox?
All babies must receive VZIG injection, if the mother develops chickenpox at birth or within
seven days of birth. This injection must be given within first seven days of life.
If the baby develops chickenpox then they can be treated with antiviral like acyclovir
following discussion with specialist doctors. VZIG is of no benefit once baby has
developed chickenpox.
What is the risk to my newborn baby if a sibling has a chickenpox?
If the mother is immune to chickenpox, then the natural immunity will be passed on to your
newborn and the baby will be safe for the first seven days of life. But if you are not immune
then baby will need VZIG, therefore see your GP as soon as possible.
References
1) Royal College of Obstetricians and Gynaecologists, Green Top guideline no: 13 on
chickenpox in pregnancy
2) Chickenpox in pregnancy - what you need to know? Patient information leaflet
published by Royal College of Obstetricians and Gynaecologists
This document can be made available in other languages and formats
upon request.
MAT_0175
Written: Miss Pat Street, Consultant Obstetrician / Dr Sameena Kausar, SpR in Obstetrics &
Gynaecology, September 2011
Reviewed: January 2014 (S Kausar, SpR), June 2016 (M Selinger)
Approved by Maternity Information Group, July 2016
Review due: July 2018
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