Between your growing belly, baby’s kicks and the excitement of new motherhood, it can be easy to overlook a rash — after all, most seem so harmless. But there's good reason to pay attention, especially during pregnancy, since it could be something more serious like chickenpox or shingles.
Here’s what moms-to-be need to know about chickenpox and shingles during pregnancy and in newborns.
What’s the difference between chickenpox and shingles?
Chickenpox and shingles are caused by the same varicella zoster virus. You can only develop shingles if you’ve had chickenpox in the past, because the varicella zoster virus stays around like an uninvited house guest, never entirely leaving your system.
Chickenpox causes telltale red, itchy bumps all over your body, sometimes even inside your mouth. Shingles causes pain, tingling and a blistering rash that usually appears on one side of the body. Although the varicella zoster virus can resurface as shingles at any time, this rarely happens during a person’s childbearing years.
How can I get chickenpox or shingles while I’m pregnant?
Doctors estimate that chickenpox infections happen in only 1 out of every 2,000 pregnancies. About 90 percent of adults today are immune to the disease, either from having had it in childhood or from having been vaccinated against it.
If you’re not immune and you’re exposed to chickenpox as an adult, it’s possible to get it. Chickenpox is highly contagious, spreading through a sneeze or cough of an infected person. That’s why it tends to spread like wildfire through grade-school classrooms and entire families.
Shingles, on the other hand, is much more likely to appear in adults over 50. And most people who develop shingles get it only once, although it is possible for it to recur.
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The chickenpox virus can, in rare cases, recur as shingles. Most often this happens when your immune system is suppressed — as it can be during or after pregnancy, when you’re particularly stressed or as you age.
What are the symptoms of shingles and chickenpox?
The symptoms of a chickenpox infection include:[1]
- Fever
- Fatigue
- Loss of appetite
- Body aches
- Headache
- A rash of itchy, red, fluid-filled bumps that typically appears one to two days after other symptoms; the bumps tend to scab over after about a week
People who have been vaccinated against chickenpox can sometimes still get sick if they’re exposed to the virus, although the symptoms are usually milder (you may not have a rash, for example).
Shingles symptoms include:[2]
- Burning or tingling pain or itchiness on one side of the body, which usually appears a few days before the shingles rash
- A rash of painful or itchy, fluid-filled blisters that break open and crust over after about a week; the rash generally occurs on only one side of your body, often appears as a stripe of blisters, and should clear up entirely within two to four weeks
Can chickenpox or shingles during pregnancy hurt my baby?
If you’re pregnant and you notice a rash that could be chickenpox or shingles, be sure to check in with your doctor right away. (It's always a good idea to ask your practitioner about any unusual rash that crops up while you're expecting.).
The incidence of varicella infection during pregnancy in the United States is estimated to be 1 to 5 cases per 10,000 pregnancies. Although the incidence is low, pregnant mothers may have an increased disease severity.
If you get chickenpox during your pregnancy, it’s unlikely that your baby will be affected, although the risks vary slightly depending on when you’re infected:[3]
- During the first 20 weeks: While the odds are good that your baby will be born healthy, there’s a slight risk that babies may develop a condition called congenital varicella syndrome (a collection of birth defects). Fewer than 2 percent of women who have gotten a varicella infection during the first 20 weeks of pregnancy have subsequently given birth to an infant with congenital varicella syndrome.
- During the second half of pregnancy: If you come down with chickenpox later in your pregnancy, there's little to no danger to the baby. Your main concern will be your own discomfort, thanks to the itchy pox.
- Within a week of giving birth or just after delivery: Babies whose moms catch chickenpox right around delivery are at risk of newborn chickenpox. Typically, a baby exposed to chickenpox at birth is given an infusion of chickenpox antibodies immediately after delivery for their protection— or as soon as it becomes apparent that you've been infected.
If you develop shingles during pregnancy, the risks to a baby are minimal since it doesn’t spread to babies in utero.
Is shingles contagious to babies?
If you have shingles, you can potentially pass the varicella-zoster virus (which causes both chickenpox and shingles) on to your baby after delivery, usually if your baby is in contact with any open shingles sore. In fact, it’s possible to pass the virus on to anyone who hasn’t been infected with chickenpox.
Exposure to the varicella-zoster virus in people who aren’t immune to it causes chickenpox (not shingles), which can be serious in newborns. Although the chickenpox vaccine reduces the severity and complications of chickenpox, your baby won’t get it until he’s 12 to 15 months old.
That said, it’s still rare for a mother with shingles to infect her infant. For one, shingles is much less contagious than chickenpox. Plus, moms who had chickenpox pass on antibodies of the varicella-zoster virus to their babies, and that provides some initial protection.
How can I protect my baby if I get chickenpox or shingles?
It’s important to protect your infant if you have chickenpox or shingles. If you’re exposed to chickenpox or come down with it, your doctor might suggest an injection of varicella-zoster immune globulin (VARIZIG), which can help make the infection less severe. No one knows for sure whether that shot can also protect your baby from infection.
If you have shingles, the best way to protect a newborn is to keep the shingles rash covered — the lesions on the rash contain the active virus — and wash your hands frequently. If your shingles rash is on your breast, talk to your doctor, who might recommend that you avoid breastfeeding until it goes away.
How are chickenpox and shingles treated during and after pregnancy?
A doctor can diagnose chickenpox and shingles and give you an antiviral treatment. This medication is most effective if it’s started within 24 to 72 hours of when the rash first appeared; it can help decrease the duration and severity of the infection. The antiviral drug you'll likely be given (usually acyclovir, the same medication used to treat genital herpes) is safe to take if you’re pregnant or breastfeeding.
Can I prevent chickenpox or shingles?
Not sure whether you're immune to chickenpox? A blood test can check for antibodies.
If you find out that you’re not immune to chickenpox before or after you’re pregnant, talk to your doctor about getting the varicella vaccine. Getting vaccinated against chickenpox is the best way to protect both you and your baby from chickenpox and shingles.
If you find out that you're not immune to chickenpox while you’re pregnant, you can’t get vaccinated because the vaccine contains the live virus. Your best bet is to avoid infected people and hotspots as much as possible. Be proactive: For example, skip your niece's birthday party if her preschool class recently had an outbreak. If you’ve been exposed to the virus, your doctor may recommend a VARIZIG injection, which may help protect you.
The best way to protect against shingles during pregnancy, meanwhile, is to never contract chickenpox in the first place (which is why it’s so important to get vaccinated!). But try not to worry if you had chickenpox before there was a vaccine for it: It’s unlikely that the varicella-zoster virus will come back in the form of shingles while you’re pregnant, since shingles is much more common in people over the age of 50.
Call your doctor if you have a fever or an out-of-the-ordinary rash. This strategy will help to reduce the risks and odds of complications from these diseases (the sooner you get diagnosed, the sooner you can get treated). And if you do come down with chickenpox or shingles, know that good medical care helps ensure both you and your baby will recover before you know it.
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