Immune Globulin, Varicella-Zoster (Human) in Pregnancy and Breastfeeding
Fetal Risk Summary
Varicella-Zoster (human) immune globulin (VZIG) is obtained from the plasma of normal volunteer blood donors. In most of 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 (1,2,3,4,5,6,7,8,9,10,11,12 and 13). One Reference cited the increased risk of complications in adults as 9-25-fold greater than in children (4). 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 (1,9,11,12). Moreover, VZIG may modify the mother's infection such that she has a subclinical, asymptomatic infection, but not prevent fetal infection or disease (1,9,10,12).
Congenital malformations following intrauterine varicella in pregnancy are relatively uncommon, but case reports have periodically appeared since 1947 (5,6 and 7,9, 10,14,15,16,17 and 18). 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 (5,7,9,18), although one case occurred when the mother had varicella at 25.5 weeks' gestation (19). One review (9) 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 (5) 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 (1,13). Administration of VZIG to newborns of mothers who develop varicella within a 5-day interval before or 48 hours after delivery is recommended (1,5,9,11,12 and 13).
The American College of Obstetricians and Gynecologists Technical Bulletin No. 160 recommends one IM dose of the immune globulin be given to healthy pregnant women within 96 hours of exposure to varicella to protect against maternal, but not congenital, infection (13).
Breast Feeding Summary
No data are available.
- Centers for Disease Control. Immunization Practices Advisory Committee. Varicella-zoster immune globulin for the prevention of chickenpox. MMWR 1984;33:84100.
- 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):2330.
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- Faix RG. Maternal immunization to prevent fetal and neonatal infection. Clin Obstet Gynecol 1991;34:27787.
- 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, 1991:5212.
- Brown ZA, Watts DH. Antiviral therapy in pregnancy. Clin Obstet Gynecol 1990;33:27689.
- American College of Obstetricians and Gynecologists. Immunization during pregnancy. Technical Bulletin. No. 160, October 1991.
- Laforet EG, Lynch CL Jr. Multiple congenital defects following maternal varicella: report of a case. N Engl J Med 1947;236:5347.
- Brice JEH. Congenital varicella resulting from infection during second trimester of pregnancy. Arch Dis Child 1976;51:4746.
- Bai APV, John TJ. Congenital skin ulcers following varicella in late pregnancy. J Pediatr 1979;94:657.
- Preblud SR, Cochi SL, Orenstein WA. Varicella-zoster infection in pregnancy. N Engl J Med 1986;315:14167.
- Alkalay AL, Pomerance JJ, Rimoin DL. Fetal varicella syndrome. J Pediatr 1987;111:3203.
Salzman MB, Sood SK. Congenital anomalies resulting from maternal varicella at 251/2 weeks of gestation. Pediatr Infect Dis J 1992;11:5045.