Serum
PREGNANCY RECOMMENDATION: Compatible
BREASTFEEDING RECOMMENDATION: No Human Data—Probably Compatible
PREGNANCY SUMMARY
The American College of Obstetricians and Gynecologists recommends that one IM dose of the immune globulin should be given to healthy pregnant women within 96 hours of exposure to varicella to protect against maternal, but not congenital, infection (1). There is no known fetal risk from exposure to immune globulin (2).
FETAL RISK SUMMARY
Varicella-zoster (human) immune globulin (VZIG) is obtained from the plasma of normal volunteer blood donors. In most of the United States, it is available from the American Red Cross Blood Services.
Varicella-zoster immune globulin is indicated for susceptible (seronegative) pregnant women exposed to chickenpox because of the increased severity of maternal chickenpox, including death, in adults compared with children (1,3–14). One reference cited the increased risk of complications in adults as 9- to 25-fold greater than in children (6). It is not known whether administration of VZIG to the mother will protect the fetus from infection or the low risk of defects associated with the congenital varicella syndrome (3,11,13,14). Moreover, VZIG may modify the mother’s infection such that she has a subclinical, asymptomatic infection, but not prevent fetal infection or disease (3,11,12,14).
Congenital malformations following intrauterine varicella in pregnancy are relatively uncommon, but case reports have periodically appeared since 1947 (7–9,11,12,15–19). In addition to cicatricial skin lesions, defects associated with this syndrome involve the brain, eyes, skeleton, and gastrointestinal and genitourinary tracts, with the highest risk occurring if the mother has varicella between the 8th and 21st weeks of gestation (7,9,11,19), although one case occurred when the mother had varicella at 25.5 weeks’ gestation (20). One review (11) found that the incidence of congenital malformations after 1st trimester chickenpox infection was 2.3% (3/131; 95% confidence intervals 0.5–6.5%), but a second review (9) found a lower rate of 1.3% (4/308) if all cases of intrauterine varicella infection were included.
There is no known fetal risk from passive immunization of pregnant women with varicella-zoster immune globulin (1–3). Administration of VZIG to newborns of mothers who develop varicella within a 5-day interval before or 48 hours after delivery is recommended (1,3,7,13,14).
BREASTFEEDING SUMMARY
No reports describing the use of varicella-zoster immune globulin during human lactation have been located.
References
1.American College of Obstetricians and Gynecologists. Immunization during pregnancy. ACOG Committee Opinion. No. 282, January 2003. Obstet Gynecol 2003;101:207–12.
2.CDC. Guidelines for vaccinating pregnant women. Available at www.cdc.gov/vaccines/pubs/preg-guide.htm. Accessed May 16, 2010.
3.Centers for Disease Control and Prevention. Immunization Practices Advisory Committee. Varicella-zoster immune globulin for the prevention of chickenpox. MMWR 1984;33:84–100.
4.Enders G. Management of varicella-zoster contact and infection in pregnancy using a standardized varicella-zoster ELISA test. Postgrad Med J 1985;61(Suppl 4):23–30.
5.McGregor JA, Mark S, Crawford GP, Levin MJ. Varicella zoster antibody testing in the care of pregnant women exposed to varicella. Am J Obstet Gynecol 1987;157:281–4.
6.Greenspoon JS, Masaki DI. Screening for varicella-zoster immunity and the use of varicella zoster immune globulin in pregnancy. Am J Obstet Gynecol 1989;160:1020–1.
7.Sterner G, Forsgren M, Enocksson E, Grandien M, Granstrom G. Varicella- zoster infections in late pregnancy. Scand J Infect Dis Suppl 1990;71:19–26.
8.Prober CG, Gershon AA, Grose C, McCracken GH Jr, Nelson JD. Consensus: varicella-zoster infections in pregnancy and the perinatal period. Pediatr Infect Dis J 1990;9:865–9.
9.Brunell PA. Varicella in pregnancy, the fetus, and the newborn: problems in management. J Infect Dis 1992;166(Suppl 1):S42–7.
10.Wallace MR, Hooper DG. Varicella in pregnancy, the fetus, and the newborn: problems in management. J Infect Dis 1993;167:254.
11.McIntosh D, Isaacs D. Varicella zoster virus infection in pregnancy. Arch Dis Child Fetal Neonatal 1993;68:1–2.
12.Faix RG. Maternal immunization to prevent fetal and neonatal infection. Clin Obstet Gynecol 1991;34:277–87.
13.Committee on Infectious Diseases, American Academy of Pediatrics. Varicella-zoster infections. In: Report of the Committee on Infectious Diseases. 22nd ed. Elk Grove Village, IL: American Academy of Pediatrics, 1991:521–2.
14.Brown ZA, Watts DH. Antiviral therapy in pregnancy. Clin Obstet Gynecol 1990;33:276–89.
15.Laforet EG, Lynch CL Jr. Multiple congenital defects following maternal varicella: report of a case. N Engl J Med 1947;236:534–7.
16.Brice JEH. Congenital varicella resulting from infection during second trimester of pregnancy. Arch Dis Child 1976;51:474–6.
17.Bai APV, John TJ. Congenital skin ulcers following varicella in late pregnancy. J Pediatr 1979;94:65–7.
18.Preblud SR, Cochi SL, Orenstein WA. Varicella-zoster infection in pregnancy. N Engl J Med 1986;315:1416–7.
19.Alkalay AL, Pomerance JJ, Rimoin DL. Fetal varicella syndrome. J Pediatr 1987;111:320–3.
20.Salzman MB, Sood SK. Congenital anomalies resulting from maternal varicella at 25½ weeks of gestation. Pediatr Infect Dis J 1992;11:504–5.