Shingles In Pregnancy: Causes, Symptoms And Treatment

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Shingles is a viral infection that manifests as painful rashes or blisters, often on one side of the body or face (1) (2). Shingles or herpes zoster and chickenpox share a common causative agent, varicella zoster virus. If you are affected with shingles in pregnancy, it is not known to cause fetal complications. Although rare, the availability of different pregnancy-safe treatments can help alleviate the symptoms of shingles and discomfort. In general, around one in every three people in the US develop shingles and are mostly above 50 years (3).

The below post discusses shingles in pregnancy, including its causes, symptoms, and treatments.

What Are The Causes Of Shingles?

Stress and fatigue may cause shingles during pregnancy

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Shingles is a secondary infection of chickenpox contracted from another person containing the virus. It remains dormant in the posterior root ganglion after the primary infection (chickenpox) and travels to the skin upon reactivation,  resulting in shingles (4).

Besides the advancing age and the body’s natural changes, a person who has had chickenpox may develop shingles later in life from other factors as follows (4) (5):

  • Underlying health conditions, such as HIV or cancer that compromise the immune system
  • Exposure to radiation or chemotherapy
  • Lack of nutrition
  • Stress and fatigue
  • Intake of immunosuppressants, including cyclosporin or corticosteroids
  • Exertion of pressure on the nerve root
Things to know
Herpes zoster virus is infectious to people who have not had chickenpox previously (4).

What Are The Symptoms Of Shingles In Pregnancy?

The manifestation of shingles usually proceeds in stages. These are (2) (6):

Early symptoms:

  • Pain or tingling sensation in the affected area
  • Malaise or headache
  • High temperature
Shingles may lead to a high temperature during pregnancy

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  • Sensitivity in the area of the skin before the rash occurs

Later symptoms:

  • Development of painful rash in the tingling area of the skin about one to five days after the early symptoms
  • Formation of fluid-filled itchy blisters over the rash after seven to ten days

Symptoms can appear anywhere in the body— around the stomach, the chest, and the eyes. However, they typically occur only on one side of the body and are expected to subside within two to four weeks without posing any threat to the baby or the pregnancy.

Quick fact
The virus travels in specific nerves and causes the rash to appear in bands on one side that correspond to the area where the nerve transmits signals (12).

When To See A Doctor?

Contact your healthcare provider if you come in contact with an infected person

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If you have contacted an infected patient, you should consult a healthcare provider immediately for timely treatment. This might help shorten the disease’s duration and reduce the severity. A prolonged manifestation may cause complications if not addressed on time.

How Is Shingles In Pregnancy Diagnosed?

Upon manifestation, the healthcare provider may want to know if you’ve had chickenpox in the past and any direct contact with an infected person. Diagnosis involves a lab test, where a small portion of the rash is scraped and examined. Upon confirmation, the healthcare provider will proceed with effective and pregnancy-safe treatment (2).

How Is Shingles In Pregnancy Treated?

Below are some medications and home measures you can follow only after consultation with a healthcare provider (7) (8):

  1. Antiviral drugs: The category B antiviral drugs for shingles recommended in the early stages of pregnancy include acyclovir, valacyclovir, and famciclovir. The medicines are likely to be effective when taken within 72 hours of blister eruption.
  1. Painkillers: Analgesics include category B drugs, such as acetaminophen and short-term opioid medicines. Most opioid medicines except for codeine are safe for pregnancy with proper monitoring. Acetaminophen is usually prescribed for relief from severe neuritis pain.
  1. Self-care measures: Some recommended home measures include:
  • Cold compresses on the rashes or blisters for pain relief
  • Lukewarm baths
  • Application of calamine lotion and other creams (pramoxine or menthol) for relief from itchiness
Calamine lotion can help get relief from itchiness

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Note: Some medications are not suitable for pregnant people, and the over-the-counter medicines should not be taken without a doctor’s prescription.

Can You Prevent Shingles?

Prevention of shingles can be achieved only by taking the shingles vaccine,  Shingrix. CDC recommends it for people of 50 years and above. The vaccine is given in two doses, with the second dose administered after two to six months of the first one. Shingrix is more than 90% effective, and you will be immune at least for about seven years from the time of vaccination (9).

If pregnant women contract the disease, they should not get the vaccination until post-delivery. Women who have had Shingrix vaccination are recommended to wait for at least one month to get pregnant (10). Since the virus can be transferred from a person with shingles to another person, it is better to stay away from infected people for the safety of yourself and your baby.

What Are The Complications Of Shingles During Pregnancy?

Complications may arise if the symptoms of shingles persist for longer than four weeks. They can include (2) (7):

  • Postherpetic neuralgia (PHN): Patients with severe pain or compromised senses during the infection can be at a higher risk of PHN. It is characterized by acute pain that can last for 30 to 90 days even after the blisters subside. Early treatment can help prevent further problems with category B opioids as it is the common and safe treatment choice.
  • Secondary bacterial infection: The rash may be further infected by a bacterial agent, which is not commonly seen in pregnant women. The healthcare provider may prescribe oral antibiotics for the bacterial infection, mostly for staphylococcal or streptococcal infections, for the baby’s safety.
  • Vision impairment: If the rash develops around the eyes, it can compromise the vision of the infected person through an infection in the cornea. This can further lead to temporary or permanent loss of sight.
Quick tip
If you get shingles right before or a few days after delivery, cover the rash and wash your hands often to protect your newborn (3).

Frequently Asked Questions

1. I’m pregnant, and I have shingles. Will this harm my baby?

Shingles do not cause fetal complications or increase the chance of birth defects. However, if an unvaccinated pregnant woman contracts the virus for the first time during pregnancy, it can lead to chickenpox. Chickenpox during pregnancy, unlike shingles, can pose a threat to the baby in the form of congenital varicella syndrome or neonatal varicella depending on the time of exposure (11) (3).

2. What if my husband has shingles when I am pregnant?

If a pregnant woman has been vaccinated against chickenpox or exposed before, she is not at risk of contracting the disease from her infected husband. However, if an unvaccinated pregnant woman’s intimate partner has shingles, she may be infected (11).

Shingles will not raise concerns for the mother or the baby. The best way to prevent shingles is by getting vaccinated before pregnancy and maintaining distance from the infected people. It is important to be aware about the symptoms to seek appropriate and timely treatment to prevent further complications.

References:

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