[Varicella-zoster virus and pregnancy]
Caroline Charlier1, Delphine Le Mercier2, Laurent J Salomon2
1Université Paris Descartes Sorbonne Paris Cité, AP-HP, hôpital Necker-Enfants-Malades, service de maladies infectieuses et tropicales, centre d'infectiologie Necker-Pasteur, institut Imagine, 149, rue de Sèvres, 75015 Paris, France; Institut Pasteur, Unité de biologie des infections, Inserm U1117, centre national de référence Listeria, Centre collaborateur OMS Listeria, 75015 Paris, France.
Presse Medicale (Paris, France : 1983)
|May 28, 2014
Summary
Varicella (chickenpox) in pregnancy is rare but serious. Prompt post-exposure prophylaxis and antiviral treatment are crucial for preventing severe maternal and congenital varicella complications.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Pediatrics
Background:
- Varicella (chickenpox) incidence in pregnancy is approximately 1 in 1000 pregnancies.
- Varicella infection poses increased severity risks for pregnant women, including VZV-associated pneumonia.
- Vaccination is key for prevention but is contraindicated during pregnancy.
Purpose of the Study:
- To outline management strategies for varicella exposure and infection in pregnant women.
- To detail prophylaxis and treatment protocols to mitigate maternal and fetal risks.
- To emphasize timely interventions for optimal outcomes.
Main Methods:
- Review of current clinical guidelines and evidence regarding varicella management in pregnancy.
- Analysis of risks associated with gestational varicella exposure (0-20 weeks) and peripartum infection (D-5 to D+2).
- Evaluation of post-exposure prophylaxis (anti-VZV immunoglobulins) and antiviral treatments (valaciclovir, acyclovir).
Main Results:
- Maternal varicella infection carries risks of congenital varicella syndrome (2% for 0-20 weeks gestation) and severe neonatal infection.
- Post-exposure prophylaxis with anti-VZV immunoglobulins is recommended within 4-10 days of exposure for non-immune pregnant women.
- Antiviral treatment with valaciclovir or intravenous acyclovir is recommended within 24 hours of varicella onset, with both drugs demonstrating safety in pregnancy.
Conclusions:
- Early administration of anti-VZV immunoglobulins and prompt antiviral therapy are critical for managing pregnant women exposed to or infected with varicella.
- Specific management protocols are essential to reduce the risk of congenital varicella syndrome and severe neonatal varicella.
- Continued vigilance and adherence to treatment guidelines are necessary for optimizing outcomes in pregnancy complicated by varicella.
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