Shingles, or herpes zoster, is a painful, blistering rash caused by the reactivation of the varicella-zoster virus (VZV), the same virus responsible for chickenpox. After a chickenpox infection, VZV remains dormant in the nervous system and can re-emerge as shingles, especially when the immune system is weakened. While shingles can cause discomfort at any time, its occurrence during pregnancy often prompts concerns for expectant parents.
Impact on Mother and Baby
Shingles during pregnancy typically poses a lower risk to the developing baby compared to a primary chickenpox infection. The virus usually stays localized and does not commonly spread throughout the body or cross the placenta. However, the pregnant individual may experience significant discomfort, including burning or shooting pain, tingling, and an itchy rash, often on one side of the body.
Complications for the mother can include post-herpetic neuralgia (PHN), persistent nerve pain that can last for months or even years after the rash heals. Sometimes, the rash might become infected with bacteria. While rare, shingles on the face, especially near the eyes, can lead to serious complications like vision damage.
In contrast, a primary chickenpox infection during pregnancy carries more substantial risks, such as early delivery, miscarriage, or complications like pneumonia. If a pregnant individual develops chickenpox during the first 20 weeks of pregnancy, there is a small risk (less than 1% before 13 weeks, up to 2% between 13 and 20 weeks) of the baby developing congenital varicella syndrome. This rare condition can lead to birth defects affecting limbs, eyes, or the brain.
Neonatal varicella can occur if the pregnant individual contracts chickenpox immediately before or shortly after delivery. This timing is particularly risky because the baby might be exposed to the virus without protective antibodies from the mother, potentially leading to a severe infection. However, maternal shingles around the time of delivery does not typically indicate a need for neonatal prophylaxis, as the mother’s existing immunity usually provides protection to the baby.
Managing a Shingles Infection
If shingles is suspected during pregnancy, seek medical advice promptly. Healthcare providers typically diagnose shingles based on the characteristic painful rash appearing on one side of the body. Sometimes, a skin culture from a blister may be taken to confirm the diagnosis.
Treatment for shingles during pregnancy often involves antiviral medications, such as acyclovir, valacyclovir, or famciclovir. These medications are considered safe during pregnancy and work best when started within 72 hours of the rash’s appearance to reduce its severity and duration. Acyclovir is frequently the first choice due to extensive clinical experience in pregnancy.
Pain management strategies are also an important part of treatment. Acetaminophen is a common pain reliever that can be used safely during pregnancy. Other comfort measures include applying cool compresses, taking oatmeal baths, or using calamine lotion to relieve itching. Keeping the rash clean and covered with loose clothing aids healing and prevents secondary infections.
Reducing Your Risk
Proactive measures can help reduce the risk of shingles during pregnancy. The shingles vaccine (Shingrix) is recommended for eligible individuals before pregnancy. This vaccine is given in two doses, typically two to six months apart, and is highly effective at preventing shingles and its complications, such as post-herpetic neuralgia.
The Shingrix vaccine is not a live vaccine, meaning it cannot cause shingles. However, it is generally not recommended during pregnancy due to limited safety studies in this population. If inadvertently received during pregnancy, there is no known risk associated with this type of vaccine.
Avoiding exposure to individuals with active chickenpox or shingles is also important, especially if the pregnant individual has not had chickenpox or is not immune. The virus can spread through contact with fluid from blisters. If exposure occurs, particularly to chickenpox, consult a healthcare provider immediately to discuss potential preventative treatments like varicella-zoster immunoglobulin, which can provide temporary protection.