Abstract
Even though varicella is rare in pregnancy, the disease can lead occasionally to disastrous illnesses for both the mother and her neonate. By contrast, normal zoster is not associated with special problems during pregnancy and peri- natal period. Pregnant women, who contract varicella, are at risk of varicella pneumonia which must be regarded as medical emergency. At any stage during pregnancy, chickenpox may cause intrauterine infection. The consequences for the fetus depend on the time of maternal disease. During the first two trimesters, maternal varicella may result in congenital varicella syndrome which may occur in nearly 2%. Typical symptoms are skin lesions in dermatomal distribution, neurological defects, eye diseases, and skeletal anomalies. Maternal infection near term is associated with a substantial risk of intrauterine acquired neonatal chickenpox in the neonate. If the mother develops varicella rash between day 4 (5) ante partum and day 2 post partum, generalized neonatal varicella leading to death in about 20% of the cases has to be expected. The present paper reviews the clinical consequences and the currently available concepts of prevention, diagnosis, and therapy of varicella-zoster virus infections during pregnancy.
Highlights
Even though varicella is rare in pregnancy, the disease can lead occasionally to disastrous illnesses for both the mother and her neonate
Varicella pneumonia during pregnancy must be regarded as a medical emergency
Retrospective studies suggest that varicella pneumonia may be more severe, not more frequent, in pregnant compared to non-pregnant women [9]
Summary
Chickenpox is a rare disease during pregnancy, as more than 90% of women of childbearing age have virus-specific immunoglobulin (Ig) G class antibodies. According to a seroepidemiological study in Germany, the prevalence of VZV-specific IgG class antibodies in women of reproductive age is 96-97% and only 3-4% of women were found to be susceptible to varicella [1]. The clinical course of chickenpox is usually mild, varicella in pregnant women may occasionally lead to serious maternal and fetal diseases (Table 1). Pregnant women who contract varicella are at risk of severe pneumonia associated with life-threatening ventilatory compromise and death. Maternal varicella leading to viremia may transmit the virus to the fetus by either transplacental spread or by ascending infection from lesions in the birth canal. The fetal consequences depend on the time of maternal disease. After maternal varicella between 4-5 days before and 2 days after delivery, generalized neonatal varicella, leading to death in up to 20% of the cases, may occur since these neonates have not acquired protecting antibodies [7]
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