Even though varicella is rare in pregnancy, the disease can lead occasionally to disastrous illnesses for both the mother and her neonate. By contrast, normal zoster is not associated with special problems during pregnancy and peri- natal period. Pregnant women, who contract varicella, are at risk of varicella pneumonia which must be regarded as medical emergency. At any stage during pregnancy, chickenpox may cause intrauterine infection. The consequences for the fetus depend on the time of maternal disease. During the first two trimesters, maternal varicella may result in congenital varicella syndrome which may occur in nearly 2%. Typical symptoms are skin lesions in dermatomal distribution, neurological defects, eye diseases, and skeletal anomalies. Maternal infection near term is associated with a substantial risk of intrauterine acquired neonatal chickenpox in the neonate. If the mother develops varicella rash between day 4 (5) ante partum and day 2 post partum, generalized neonatal varicella leading to death in about 20% of the cases has to be expected. The present paper reviews the clinical consequences and the currently available concepts of prevention, diagnosis, and therapy of varicella-zoster virus infections during pregnancy.
Wutzler, P., F?rber, I., Wagenpfeil, S., Bisanz, H., and Tischer, A. (2001) Seroprevalence of varicella-zoster vi-rus in the German population. Vaccine, 20, 121-124.
Sever, J. and White, L.R. (1968) Intrauterine viral infec-tions. Annual Review of Medicine, 19, 471-486.
Stagno, S. and Whitley, R.J. (1985) Herpesvirus infec- tions of pregnancy (Part II): Herpes simplex virus and varicella-zoster virus infections. New England Journal of Medicine, 313, 1327-1330.
Enders, G. and Miller, E. (2000) Varicella and herpes zoster in pregnancy and the newborn. In Arvin, A.M., Gershon, A.A. (eds.), Varicella-Zoster Virus, Virology and Clinical Management, University Press, Cambridge, 317-347.
Robert Koch-Institut (2003) Zur Seropr?valenz gegen Varicella-Zoster-Virus und zur Verl?sslichkeit anamnesti- scher Angaben. Epidemiologisches Bulletin, 43, 347.
Smego, R.A. Jr. and Asperille, M.O. (1991) Use of acy-clovir for varicella pneumonia during pregnancy. Obstetrics & Gynecology, 78, 1112-1116.
Sauerbrei, A. and Wutzler, P. (2001) Neonatal varicella. Journal of Perinatology, 21, 545-549.
Baren, J.M., Nenneman, P.L., and Lewis, R.J. (1996) Primary varicella in adults: pneumonia, pregnancy, and hospital admission. Annals of Emergency Medicine, 28, 165-169.
Harris, R.E. and Rhoades, E.R. (1965) Varicella pneumo-nia complicating pregnancy: Report of a case and review of literature. Obstetrics & Gynecology, 25, 734-740.
Harger, J.H., Ernest, J.M., Thurnau, G.R., Moawad, A., Thom, E., Landon, M.B., Paul, R., Miodovnik, M., Dombrowski, M., Sibai, B., Van Dorsten, P., McNellis, D., and National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units (2002) Frequency of congenital varicella syndrome in a prospective cohort of 347 pregnant women. Obstetrics & Gynecology, 100, 260-265.
Haake, D.A., Zakowski, P.C., Haake, D.L., and Bryson, X.J. (1990) Early treatment with acyclovir for varicella pneumonia in otherwise healthy adults: Retrospective controlled study and review. Reviews of Infectious Dis-eases, 12, 788-798.
Sauerbrei, A. and Wutzler, P. (2005) Varicella-zoster virus infections during pregnancy: Epidemiology, clinical symptoms, diagnosis, prevention and therapy. Current Pediatric Reviews, 1, 205-216.
Prober, C.G., Gershon, A.A., Grose, C., McCracken, G.H., and Nelson, J.D. (1990) Consensus: Varicella-zoster in-fections in pregnancy and the perinatal period. Pediatric Infectious Disease Journal, 9, 865-869.
Enders, G., Miller, E., Cradock-Watson, J., Bolley, I., and Ridehalgh, M. (1994) Consequences of varicella and herpes zoster in pregnancy: Prospective study of 1739 cases. Lancet, 343, 1548-1551.
Pastuszak, A.L., Levy, M., Schick, B., Zuber, C., Feld-kamp, M., Gladstone, J., Bar-Levy, F., Jackson, E., Don-nenfeld, A., Meschino, W., and Koren, G. (1994) Out-come after maternal varicella infection in the first 20 weeks of pregnancy. New England Journal of Medicine, 330, 901-905.
Laforet, E.G. and Lynch, C.J. Jr. (1947) Multiple con-genital defects following maternal varicella. New Eng-land Journal of Medicine, 236, 534-537.
Sauerbrei, A. and Wutzler, P. (2003) Das fetale Varizellen- syndrom. Monatsschrift Kinderheilkunde, 151, 209-213.
Schulze, A. and Dietzsch, H.J. (2000) The natural history of varicella embryopathy: A 25-year follow-up. Journal of Pediatrics, 137, 871-874.
Higa, K., Dan, K., and Manabe, H. (1987) Varicella- zoster virus infections during pregnancy: Hypothesis concerning the mechanisms of congenital malformation. Obstetrics & Gynecology, 69, 214-221.
Grose, C. (1989) Congenital varicella-zoster virus infec-tion and the failure to establish virus-specific cell-mediated immunity. Molecular Biology and Medicine, 6, 453-462.
Sauerbrei, A., Müller, D., Eichhorn, U., and Wutzler, P. (1996) Detection of varicella-zoster virus in congenital varicella syndrome: A case report. Obstetrics & Gyne-cology, 88, 687-689.
Sauerbrei, A. and Wutzler, P. (2000) The congenital vari- cella syndrome. Journal of Perinatology, 20, 548-554.
Miller, E., Cradock-Watson, J.E., and Ridehalgh, M.K. (1989) Outcome in newborn babies given anti-varicella- zoster immunoglobulin after perinatal maternal infection with varicella-zoster virus. Lancet, 2, 371-373.
Hubbard, T.W. (1878) Varicella occurring in an infant twenty four hours after birth. British Medical Journal, 1, 822.
Baba, K., Yabuuchi, H., Takahashi, M., and Ogra, P.L. (1982) Immunologic and epidemiologic aspects of varicella infection acquired during infancy and early childhood. Journal of Pediatrics, 100, 881-885.
Nikorowitsch, R., Wiedersberg, H., Ruikold, E., Zwahr, C., Althen, B., Holzhausen, H.J., and Sauerbrei, A. (1989) T?dlicher Verlauf einer konnatalen Varizelleninfektion. Zeitschrift für Klinische Medizin, 44, 1961-1963.
Heidl, M. (1985) Varicella-Zoster-Virus-Infektion in der Schwangerschaft, beim Neugeborenen und jungen S?ugling. Zeitschrift für Klinische Medizin, 40, 245-250.
Advisory Committee on Immunization Practices (ACIP) (1996) Prevention of varicella. Morbidity and Mortality Weekly Report, 45, 1-36.
Deutsche Gesellschaft für P?diatrische Infektiologie (2003) Handbuch 2003: Infektionen im Kindesalter, Futuramed, München, pp. 732-739.
Al-Katawee, Y.A., Al-Hassoun, Y.A., Taha, M.N., and Al-Moslem, K. (2005) Congenital varicella-zoster virus infection: A rare case of severe brain and ocular malfor-mations without limb or cutaneous involvement in a newborn after maternal subclinical infection. Saudi Medical Journal, 26, 869-871.
Akisu, M., Yalaz, M., Aksu, G., Arslanoglu, S., Genel, F., Kutukculer, N., and Kultursay, N. (2003) Maternally ac-quired varicella-zoster virus antibodies disappear at 6 months of age in prematurely born children. Panminerva Medicine, 45, 155-156.
Gershon, A.A., Raker, R., Steinberg, S., Topf-Olstein, B., and Drusin, L.M. (1976) Antibody to varicella-zoster vi-rus in parturient women and their offspring during the first year of life. Pediatrics, 58, 692-696.
Koskimies, O., Lapinleimu, K., and Saxén, L. (1978) Infections and other maternal factors as risk indicators for congenital malformations: A case-control study with paired serum samples. Pediatrics, 61, 832-837.
Johansson, A.B., Rassart, A., Blum, D., Van Beers, D., and Liesnard, C. (2004) Lower-limb hypoplasia due to intrauterine infection with herpes simplex virus type 2: Possible confusion with intrauterine varicella-zoster syn-drome. Clinical Infectious Diseases, 38, e57-62.
Spranger, S., Stute, H., Blankenagel, A., Jauch, A., Hager, D., and Tariverdian, G. (1998) MIDAS-syndrom: Eine X-chromosomale Erkrankung: Differenzialdiagnose zum kongenitalen Varizellensyndrom. Monatsschrift Kinder-heilkunde, 146, 761-765.
Gershon, A.A. (1998) Varicella-zoster virus. In Feigin, R.D. and Cherry, J.D. (eds.), Textbook of Pediatric Infec-tious Diseases (4th Edition), W. B. Saunders Company, Philadelphia, 1769-1777.
Sauerbrei, A., Glück, B., Jung, K., Bittrich, H., and Wutzler, P. (2000) Congenital skin lesions caused by in-trauterine coxsackievirus B3 infection: A case report. In-fection, 28, 326-328.
Gershon, A.A., Steinberg, S.P., and The National Institute of Allergy and Infectious Disease Varicella Vaccine Collabo-rative Study Group (1990) Live attenuated varicella vaccine: Protection in healthy adults compared with leukemic chil-dren. Journal of Infectious Diseases, 158, 661-666.
Shields, K.E., Galil, K., Seward, J., Sharrar, R.G., Cordero, J.F., and Slater, E. (2001) Varicella vaccine exposure dur-ing pregnancy: Data from the first 5 years of the pregnancy registry. Obstetrics & Gynecology, 98, 14-19.
Wilson, E., Goss, M.A., Marin, M., Shields, K.E., Sew-ard, J.F., Rasmussen, S.A., and Sharrar, R.G. (2008) Varicella vaccine exposure during pregnancy: Data from 10 years of pregnancy registry. Journal of Infectious Diseases, 197 (2), S178-S184.
Watson, B. (2002) Varicella: A vaccine preventable disease? Journal of Infection, 44, 220-225.
Vázquez, M. and Shapiro, E.D. (2005) Varicella vaccine and infection with varicella-zoster virus. New England Journal of Medicine, 352, 439-440.
Kuter, B.J., Ngai, A., Patterson, C.M., Staehle, B.O., Cho, I., Matthews, H., Provost, P.J., and White, C.J. (1995) Safety, tolerability, and immunogenicity of two regimens of Oka/Merck varicella vaccine (Varivax?) in healthy adolescents and adults. Vaccine, 13, 967-972.
Sauerbrei, A. and Wutzler, P. (2004) Labordiagnostik der Varizellen. Kinder?rztliche Praxis, Sonderheft Impfen, 18-21.
Sauerbrei, A. and Wutzler, P. (2006) Serological detec-tion of varicella-zoster virus-specific immunoglobulin G by an enzyme-linked immunosorbent assay using glyco-protein antigen. Journal of Clinical Microbiology, 44, 3094-3097.
Robert Koch-Institut (2004) Empfehlungen der St?ndigen Impfkommission (STIKO) am Robert Koch Institut/Stand: Juli 2004. Epidemiologisches Bulletin, 30, 235-250.
Royal College of Obstetricians and Gynecologists (2001) Chickenpox in pregnancy, Guideline No. 13.
Guris, D., Jumaan, A.O., Mascola, L., Watson, B.M., Zhang, J.X., Chaves, S.S., Gargiullo, P., Perella, D., Civen, R., and Seward, J.F. (2008) Chancing varicella epidemiol-ogy in active surveillance sites: United States 1995-2005. Journal of Infectious Diseases, 197(2), S71-S75.
Marin, M., Watson, T.L., Chaves, S.S., Civen, R., Watson, B.M., Zhang, J.X., Perella, D., Mascola, L., and Seward, J.F. (2008) Varicella among adults: Data from active sur-veillance project, 1995-2005. Journal of Infectious Dis-eases, 197(2), S94-S100.
Harish, R., Jamwal, A., and Dang, K. (2009) Congenital varicella syndrome/VZV fetopathy. Indian Journal of Pediatrics, DOI 10.1007/s12098-009-0259y, in press.
Auriti, C., Piersigilli, F., De Gasperis, M.R., and Seganti, G. (2009) Congenital varicella syndrome: Still a problem? Fetal Diagnosis and Therapy, 25, 224-229.
Gabutti, G., Penna, C., Rossi, M., Salmaso, S., Rota, M.C., Bella, A., Crovari, P., and Serological Study Group (2001) The seroepidemiology of varicella in Italy. Epi-demiology and Infection, 126, 433-440.
Pandolfi, E., Chiaradia, G., Moncada, M., Rava, L., and Tozzi, A.E. (2009) Prevention of congenital rubella and congenital varicella in Europe. Eurosurveillance, 14, 1-5.
Pretorius, D.H., Hayward, I., Jones, K.L., and Stamm, E. (1992) Sonographic evaluation of pregnancies with ma-ternal varicella infection. Journal of Ultrasound in Medi-cine, 11, 459-463.
Verstraelen, H., Vanzieleghem, B., Deroort, P., Vanhae-sebrouck, P., and Temmerman, M. (2003) Prenatal ultra-sound and magnetic resonance imaging in fetal varicella syndrome: Correlation with pathology findings. Prenatal Diagnosis, 23, 705-709.
Mouly, F., Mirlesse, V., Meritet, J.F., Rozenberg, F., Pois-sonier, M.H., Lebon, P., and Daffos, F. (1997) Prenatal di-agnosis of fetal varicella-zoster virus infection with poly-merase chain reaction of amniotic fluid in 107 cases. American Journal of Obstetrics & Gynecology, 177, 894-898.
Gross, G., Schofer, H., Wassilev, S., Friese, K., Timm, A., Guthoff, R., Pau, H.W., Malin, J.P., Wutzler, P., and Do-err, H.W. (2003) Herpes zoster guideline of the German Dermatology Society (DDG). Journal of Clinical Virol-ogy, 26, 277-289.
Tan, M.P. and Koren, G. (2006) Chickenpox in pregnancy: Revisited. Reproductive Toxicology, 21, 410-420.
Paulman, P.M. and McLellan, R. (1990) Varicella during pregnancy: The timing of effective treatment. Journal of the American Board of Family Practice, 3, 121-123.
Zieger, W., Friese, K., Weigel, M., Becker, K.P., and Melchert, F. (1994) Varizellen-Infektion am Geburtstermin. Zeitschrift für Geburtshilfe und Perinatologie, 198, 134-137.
Miller, E. (1994) Varicella-zoster virus infection in preg- nancy. Archives of Disease in Childhood, 70, F157-158.
Holland, P., Isaacs, D., and Moxon, E.R. (1986) Fatal neonatal varicella infection. Lancet, 2, 1156.
King, S.M., Gorensek, M., Ford-Jones, E.L., and Read, S.E. (1986) Fatal varicella-zoster infection in a newborn treated with varicella-zoster immunoglobulin. Pediatric Infectious Diseases, 5, 588-589.
Wutzler, P., Sauerbrei, A., Scholz, H., Müller, D., und Wiedersberg, H. (1990-1991) Varicella-Zoster-Virusin- fektionen in der Schwangerschaft. P?diatrische Praxis, 41, 213-224.
Sauerbrei, A., Pawlak, J., Luger, C., and Wutzler, P. (2003) Intracerebral VZV reactivation in congenital varicella syndrome? A case report. Developmental Medicine & Child Neurology, 45, 837-840.
Schulze-Oechtering, F., Roth, B., Enders, G., and Grosser, R. (2004) Kongenitales Varizellensyndrom: Besteht eine Infektionsgefahr für die Umgebung? Deutsche Medizini- sche Wochenschrift, 208, 25-28.