Exposure to shingles during pregnancy can be a concern for expectant mothers. Understanding how shingles spreads, its potential risks, and protective measures is important. While developing shingles during pregnancy is uncommon, knowing the necessary steps can help manage concerns.
What is Shingles and How It Spreads
Shingles, also known as herpes zoster, is caused by the varicella-zoster virus (VZV), the same virus responsible for chickenpox. After chickenpox, VZV remains dormant in nerve cells. Shingles occurs when this inactive virus reactivates, typically presenting as a painful, blistering rash.
Shingles is not directly transmissible as shingles. However, an individual with active shingles can transmit VZV to someone who has never had chickenpox or is not immune, causing them to develop chickenpox. The virus primarily spreads through direct contact with fluid from shingles blisters. Less commonly, if blisters are widespread, airborne transmission may occur. The infection remains contagious until all blisters have crusted over.
Potential Risks to the Pregnant Woman
For most pregnant women, shingles typically manifests as a localized rash and is generally not more severe than it would be in non-pregnant individuals. The symptoms of shingles can include pain, burning, numbness, or tingling, followed by a characteristic stripe of blisters. While the rash can be uncomfortable, developing shingles during pregnancy is rare.
Serious complications for the pregnant woman are uncommon. A rare but possible complication is postherpetic neuralgia, which involves persistent nerve pain in the area where the rash occurred, even after the blisters have healed. Prompt medical attention upon the appearance of a rash can help reduce the pain and duration of the illness.
Potential Risks to the Developing Baby
The risk to a developing baby depends on whether the pregnant woman contracts chickenpox (especially if not immune) or shingles, and the stage of pregnancy. Shingles during pregnancy carries a much lower risk to the fetus compared to chickenpox infection in the mother. This is because the virus in shingles is usually contained locally within the mother’s body.
A primary concern is Congenital Varicella Syndrome (CVS), a rare condition arising if a pregnant woman contracts chickenpox, not shingles, during early pregnancy (within the first 20 weeks). The risk of CVS is highest if maternal chickenpox infection occurs between 8 and 20 weeks of gestation. CVS can lead to developmental issues in the baby, including skin scarring, underdeveloped limbs, eye abnormalities, and neurological problems.
Another concern is Neonatal Varicella, which can occur if a pregnant woman develops chickenpox or, rarely, shingles around the time of delivery (five days before to two days after birth). In such cases, the newborn may develop severe chickenpox because there hasn’t been sufficient time for maternal antibodies to transfer for protection. The severity of neonatal varicella links to the timing of maternal infection relative to delivery, with earlier infection during this window leading to more severe outcomes.
Immediate Actions After Exposure
If a pregnant woman believes she has been exposed to shingles or chickenpox, immediate consultation with a healthcare provider is important. The doctor will assess her immunity to the varicella-zoster virus, often through a blood test for existing antibodies. This assessment determines if she is protected against chickenpox.
For non-immune pregnant women with significant VZV exposure, post-exposure prophylaxis (PEP) may be recommended. Varicella-Zoster Immune Globulin (VZIG), an injection containing antibodies against the virus, can reduce the severity of a potential chickenpox infection. VZIG is most effective when given within 10 days of exposure. Oral antiviral medications, such as aciclovir or valaciclovir, are also considered a first-choice option for PEP in susceptible pregnant women. Following exposure, monitor for symptoms like rash or fever and report them promptly to the healthcare provider.
Protecting Against Shingles During Pregnancy
Preventive measures are important for protecting against shingles and chickenpox during pregnancy. For individuals planning a pregnancy, confirm immunity to chickenpox prior to conception. If not immune, the chickenpox (varicella) vaccine can be administered before trying to conceive. It is recommended to wait at least one month after the final dose of the varicella vaccine before attempting to become pregnant.
The shingles vaccine (Shingrix) is generally not recommended during pregnancy due to limited safety data. Avoiding direct contact with individuals who have active shingles or chickenpox is a practical step to prevent exposure, especially for non-immune pregnant women. The virus can spread until all blisters on an infected person have crusted over.