Consequences of chickenpox in early pregnancy - Tips from Other Journals

Date: June, 1992

Varicella (chickenpox) is relatively uncommon in childbearing women, because most are exposed to the disease before adolescence. The incidence of chickenpox in pregnancy is estimated at 0.7 cases per 1,000 pregnancies. When women contract chickenpox in early pregnancy, their offspring may have the congenital varicella syndrome. This syndrome, which was first described in 1947, includes microcephaly, cataracts, autonomic disorders (especially Horner's syndrome), rudimentary fingers, microphthalmia, muscular atrophy and hypoplastic limbs. The incidence of this syndrome following first-trimester infection is unknown but may be as high as 9 percent. Balducci and colleagues prospectively followed 40 women with chickenpox during the first trimester to determine the pregnancy outcome, particularly the incidence of fetal abnormalities.

The patients met clinical criteria for chickenpox and gave appropriate exposure histories. Clinical examination and ultrasound were used to assess fetal status, particularly the presence of any limb defects or microcephaly. After delivery, all infants were examined for evidence of chickenpox and families were contacted after one year to assess the developmental status of the infants.

Three of the patients had spontaneous abortions before nine weeks of gestation, and one patient chose to terminate the pregnancy. A second patient elected to terminate the pregnancy during the second trimester after the discovery of a major congenital abnormality. Autopsy on this fetus and on one of those aborted earlier did not reveal evidence of varicella or the congenital varicella syndrome. Material from the other abortions was not available for review. Of the remaining 35 pregnancies, two were delivered pre-term (at 34 and 35 weeks) and the others were uneventful. None of the 35 infants born showed congenital varicella syndrome, and no abnormalities were apparent in the 27 children available for follow-up at one year of age.

This is the largest prospective study of chickenpox in the first trimester to date and indicates that the risk of congenital varicella syndrome is low. (Obstetrics and Gynecology, January 1992, vol. 79, p. 5.)

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