Chickenpox and Pregnancy

How to manage Chickenpox during pregnancy? - Dr. Sangeeta Gomes (October 2018).


What causes chickenpox?

Chickenpox is caused by a virus called varicella zoster. The main symptom is an itchy rash that develops blisters or bumps. These then form scabs and fall off as the infection nears its end. Chickenpox is contagious 1-2 days before the rash occurs, and it remains so until all the bubbles are encrusted. (NHS 2013a, RCOG 2008)

Can it harm my baby if I get chickenpox?

If you contract chickenpox during pregnancy and have never had the disease, it can be dangerous for you and the baby. That is very unlikely. Nine out of ten adults have had chickenpox as a child. This makes them immune, because once you have the infection, you will not get it again (PHE 2014, RCOG 2008).

If you are unsure if you are already immune, you should go to the doctor immediately if you have become infected or even suspected. Luckily, the odds are that mother and child will be fine. (NHS 2014a)

Unfortunately, there is the risk - albeit minor - that chickenpox in pregnant women leads to so-called congenital varicella syndrome (CVS). Babies with CVS are born with serious problems. These include scars, eye problems, brain, bowel and bladder problems and shortened limbs (Sinha 2012, HPA 2011).

The risk of CVS depends on the stage of pregnancy: in the first half of pregnancy, one to two out of 100 children whose mothers have chickenpox are affected by CVS. The risk is therefore very low. (HPA 2011)

  • There is no risk of CVS in the second half of pregnancy. But it may be that it develops a herpes zoster in its first years of life (HPA 2011).
  • To check your baby's health, the doctor will perform a detailed ultrasound scan (Shrim et al 2012). It will check if your baby's vital organs are healthy. (RCOG 2007)

    Ultrasound can also show whether the limbs and brain develop as they should. However, such an examination can not show all birth defects, so it is not a complete guarantee that the baby has not been harmed by the virus.

    If you get chickenpox within five days or three days after birth, your baby may also become seriously ill. For newborns, chickenpox can be a serious or even life-threatening disease (NHS 2014a, PHE 2014).

    Chickenpox can be dangerous for both mothers and babies during pregnancy. The disease can cause serious complications that can lead to serious illnesses for you. For example, one in ten pregnant women who develop chickenpox develop pneumonia. Your liver and brain may also be affected (NHS 2014b).

    It is therefore very important to tell your doctor immediately if you have any rash during your pregnancy. In addition to chicken pox, there are other illnesses that manifest themselves in a rash and some of these can harm your baby or make you very ill yourself (MacMahon 2012).

    Even if you do not have a rash, you should tell your doctor or midwife if you have had contact with chickenpox and have not had one yourself. If you are not sure, it is better to talk to the doctor than to do nothing.

    I am pregnant. Should I avoid contact with people who have chickenpox?

    If you've had chickenpox as a kid, there's no reason for it. Your body has the antibodies against the virus, which means you're immune and can not get chicken pox (RCOG 2008).

    If you are unsure if you are immune, talk to your doctor or midwife immediately for advice (NHS 2014c). The virus spreads very quickly through small droplets in the air and through direct human-to-human contact (PHE 2014).

    If you have not had chickenpox yourself, the risk of getting infected with the virus is very high as soon as you are in the same room with a patient. For example, a face-to-face interview is often enough to get infected with the virus (Fox 2010, PHE 2014, RCOG 2008).

    You may also be infected by someone who has shingles, as both chickenpox and shingles are caused by the same virus (NHS 2013a). More information can be found in our article shingles during pregnancy.

    How do I know if I'm immune to chickenpox?

    If you had chickenpox as a child, you do not have to worry. Because chickenpox is less common in other parts of the world, you should tell your doctor if you grew up outside Germany (RCOG 2008). The doctor can then do a blood test to see if you are immune or not (RCOG 2008).

    There is a vaccine against chickenpox (PHE 2014). Unfortunately, you can not get vaccinated during pregnancy because it could harm your unborn baby (RCOG 2008). You need to wait for your baby to give birth before you can get vaccinated against chickenpox (PHE 2014, RCOG 2008).

    How to Treat Chickenpox in Pregnancy

    You can safely take acetaminophen to treat pain and fever.You can use anti-pruritic lotions such as Lotio alba to relieve the itching of your blisters (NICE 2012).

    Your doctor may recommend an injection with VZIG (RCOG 2008, UKTIS 2011). This stands for Varicella zoster immunoglobulin, it is a blood product that contains antibodies to chickenpox (PHE 2014).

    VZIG can attenuate and shorten the infection (RCOG 2008). Ideally, you should get the injection within 72 hours after you have been exposed to the virus, but it should be injected no later than ten days after that. (RCOG 2008)

    Maybe the doctor will also give you aciclovir, which is a drug to fight viruses (RCOG 2008, UKTIS 2010, UKTIS 2011). Treatment should be given swiftly after the onset of the first chickenpox symptoms (EMC 2013).

    How to Treat Chickenpox in Newborns?

    If you get chickenpox a few days before or after delivery, you will be given Varicella zoster immunoglobulin to your baby to prevent or mitigate the onset of the disease. However, if your baby suffers from chickenpox, it will be given acyclovir because its own immune system is not yet well developed.


    Cohen A, Moschopoulos P, Stiehmet RE, et al. 2011. Congenital varicella syndrome: the evidence for secondary prevention with varicella zoster immune globulin. CMAJ 183 (2): 204-208.

    EMC. 2013. Summary of product characteristics: Zovirax. Electronic Medicines Compendium. www. beta. medicines. org. uk

    Fox G, Hoque N, Watts T. 2010 (reprinted 2013). Oxford handbook of neonatology. Oxford University Press.

    HPA. 2011. Guidance on viral rash in pregnancy. Health Protection Agency. Public health management and guidance. www. hpa. org. uk

    Lissauer T, Fanaroff AA. 2011. Neonatology at a glance. Second edition. Chichester: John Wiley & Sons

    MacMahon E. 2012. Investigating the pregnant woman exposed to a child with a rash. BMJ 344: e1790

    NHS Choices. 2013a. Chickenpox - introduction. Health A-Z. www. nhs. uk

    NHS Choices. 2013b. Chickenpox - complications. Health A-Z. www. nhs. uk

    NHS Choices. 2014a. What are the risks of chickenpox during pregnancy? Common health questions: infections during pregnancy. www. nhs. uk

    NHS Choices. 2014b. How rare is chickenpox during pregnancy? Common health questions: infections during pregnancy. www. nhs. uk

    NHS Choices. 2014c. What should I do if I'm pregnant and I've been near someone with chickenpox? Common health questions. www. nhs. uk

    NICE. 2012. Clinical knowledge summary: Chickenpox. National Institute for Health and Care Excellence. www. cks. nice. org. uk

    PHE. 2014. Varicella. In: Immunization against infectious disease: The green book. Chapter 34. Public Health England

    Patient UK. 2011th Chickenpox contact and pregnancy. Health information. www. patient. co. uk

    RCOG. 2007. Chickenpox in pregnancy. Royal College of Obstetricians and Gynecologists. Green-top Guideline no. 13. www. rcog. org. uk

    RCOG. 2008. Chickenpox in pregnancy: what you need to know. Patient information. Royal College of Obstetricians and Gynecologists. www. rcog. org. uk

    Srim A, Koren G, Yudin MH, et al. 2012. Maternal Fetal Medicine Committee. Management of varicella infection (chickenpox) in pregnancy. J Obstet Gynaecol Can 34 (3): 287-92

    Sinha S, Miall L, Jardine L. 2012. Essential neonatal medicine. Chichester: John Wiley & Sons

    UKTIS. 2011. Chickenpox (varicella zoster) in pregnancy. UK Teratology Information Service. www. uktis. org

    UKTIS. 2010. Use of acyclovir in pregnancy. UK Teratology Information Service. www. uktis. org

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