Being pregnant is one of the happiest times in a woman’s life. At the same time, when you become pregnant, you start worrying about all sorts of things, especially when there is a pandemic raging around the world. While we are all concerned about being around people and catching something from them in the year 2020, this worry can be a constant source of anxiety for a pregnant woman. Expecting mothers to worry about being around people who are sick and about developing a health condition that may affect their health and their baby’s health. One of the common diseases that pregnant women must take seriously is shingles.
It is estimated that one in three people will end up developing shingles at some point in their life.1 Shingles, or herpes zoster, is more common in older adults, but it is still a risk that disease that you need to be aware of if you are pregnant.
What is Shingles?
Shingles is a viral infection caused by the varicella-zoster virus, the same virus that causes chickenpox. Most people get chickenpox at least once in their lifetime. However, even after the chickenpox is over, the varicella-zoster virus may continue to live in your nervous system for years before it reactivates in the form of shingles.2,3 Due to this, shingles are sometimes also called herpes zoster.
This viral infection is typically characterized by a red rash on your skin that may cause burning and pain. Shingles commonly presents as a stripe of blisters present on one side of the body, usually affecting the neck, face, or the torso.4 Most cases of shingles tend to clear up within two to three weeks and rarely occur more than once in the same person.
The first symptoms of shingles are usually burning and pain, usually restricted to only one side of the body. This also tends to occur in small patches. A red rash on the skin typically follows after the pain and burning. The characteristics of this skin rash are as follows:
- It appears like red patches.
- Wraps around one side of the body, typically from the spine to the torso
- Fluid-filled blisters that break easily
- They are usually itching.
- They may appear on the face and ears.
In some people, the symptoms of shingles may extend well beyond the pain and rash. These symptoms may include:
There can be some rare and severe complications of shingles, including:
- Loss of hearing or excruciating pain in one ear, loss of taste, or dizziness.
- Rash or pain that involves the eye – this needs to be treated immediately to avoid any type of permanent damage to the eyes.
- Bacterial infections
- The exact reason behind why the varicella-zoster virus (VZV) remains dormant for years and suddenly becomes active again to cause shingles is not clearly understood.
Can You Catch Shingles When You Are Pregnant?
One of the biggest myths associated with shingles during pregnancy is that you may catch it from another person. However, shingles are not contagious and cannot be passed on from one person to another. Chickenpox, on the other hand, is an infectious disease and can even spread to someone when a person having chickenpox coughs.5
A person who has shingles can only spread the virus to another person if that uninfected person has had direct contact with a shingles rash that has not healed yet. While you cannot catch shingles from being exposed to such people, you can become exposed to Varicella Zoster Virus and end up getting chickenpox. It is then possible for shingles to appear someday, but this can only happen once the chickenpox has run its course.6
Once you get chickenpox, you become immune to it for the rest of your life. However, if you are pregnant and you have never had chickenpox, it is essential that you avoid being around people who have shingles or chickenpox, even if they are about to get over their condition.7
What Concerns Should You Have About Shingles When Pregnant?
If you have already had chickenpox and you are pregnant, you and your unborn baby are safe from being exposed to any person who has chickenpox or shingles. However, you can still develop shingles during your pregnancy if you have had chickenpox in childhood. Even though this is quite unusual since shingles usually occur well after the childbearing years, but in rare cases, it can still happen. It is essential to understand that if you just develop shingles, it will not have any harmful effect on your baby.
It is necessary to keep an eye out for any out of the ordinary symptoms. For example, if you notice a rash of any type during your pregnancy, let your doctor know at once. While it might not be shingles or chickenpox, it could still be some other potentially serious condition that needs to be diagnosed and treated.8
In cases of women who have never had chickenpox, and they get exposed to a person with chickenpox or shingles, one needs to inform the doctor right away. Your doctor may recommend that you get a blood test done to determine if there are antibodies for the chickenpox virus in the bloodstream. If antibodies are found, this means you had chickenpox in the past, and you probably don’t remember it, or you were vaccinated against it. In such a case, you and your baby are unlikely to be at risk of getting chickenpox.9
However, if no antibodies for the chickenpox virus are found, you may receive an immunoglobulin injection. This injection contains the chickenpox antibodies, and receiving this injection means that you may avoid getting chickenpox and probably shingles as well in the near future. It may also mean that you may have a less severe case of chickenpox even if you catch the virus. It is important to get an immunoglobulin injection within 96 hours of being exposed to VZV in order for it to be as effective as possible.10
Keep in mind that before receiving an immunoglobulin injection, or any other type of injection, it is necessary to let your doctor know that you are pregnant. Regardless of whether it is early on in your pregnancy or are close to your delivery date, you need to be careful with all the supplements, medicines, and food that enters your body because it is ultimately going to impact your baby as well.
Recognizing The Symptoms Of Shingles And Chickenpox
Chickenpox typically causes small blisters to appear anywhere on the body. The first symptom of chickenpox is usually a rash of blisters that appears on the trunk and face. After this, it tends to spread to the legs and arms.
If you have shingles, you will notice that these rashes tend to be larger in size. The rashes are also commonly on only one side of the body or face, through some other locations may be affected as well. This type of rash will appear as a stripe or band on the affected part of the body.11
You are also likely to feel some itchiness or pain in the affected area of the rash. In fact, itchiness or pain can occur several days before the actual rash develops. The rashes themselves are also itchy and cause quite a lot of discomfort. Some people also report experiencing a lot of pain once the rashes appear. Shingles are also known to cause a headache and fever in some cases.
Over time, the rashes will scab over and disappear altogether. However, shingles can still be contagious as long as the rashes remain exposed and scabbed over. It usually takes two weeks for shingles to get better.
How is Shingles Diagnosed During Pregnancy?
Diagnosing shingles during pregnancy or in people who are not pregnant is an easy process. Your doctor can give you a diagnosis based on the symptoms, mostly based on a rash that appears only on one side of the body, along with pain in the affected area.
Some doctors confirm their diagnosis of shingles with a skin culture. For doing this, your doctor will remove a tiny piece of skin from one of the rash blisters you have. This skin sample will then be sent to a laboratory, and the culture reports will help in determining if you have shingles.12
Treatment Options for Shingles
If you are diagnosed with shingles, your doctor is likely to prescribe an antiviral medication. These may include:
- Famciclovir (brand name Famvir)13
- Valacyclovir (brand name Valtrex)14
- Acyclovir (brand name Zovirax)15
Since you are pregnant, you will need to ensure that you let your doctor know so that they can prescribe medications that are safe to have at this time. There are many antiviral drugs that are safe for the mother and baby.
You will also be put on an antiviral medication if you are diagnosed with chickenpox during your pregnancy.
You must realize that the best outcome will occur if your treatment is started as soon as the first rash appears. It is recommended that you consult your doctor within 24 hours of spotting the first symptom.
Can You Prevent Shingles During Pregnancy?
The many advances in medical research and treatment options have lowered the number of people who get chickenpox and shingles worldwide. The primary reason behind this is vaccinations.
The chickenpox vaccination has become commonplace, and in many countries, it is mandatory for children to be vaccinated against chickenpox. It was in 1995 that the vaccine for chickenpox became available for widespread use, following which, the number of chickenpox cases globally dropped significantly.16
The chickenpox vaccine is usually administered when a child is 1 to 2 years old, followed by a booster shot of the vaccine when the child turns 4 to 6 years old. Today, these vaccinations are almost 100 percent effective in preventing chickenpox if you get both the initial dose of the vaccine as well as the booster dose.17 However, there might still be a small chance of some people getting chickenpox even after getting the vaccine.
In 2006, the US Food and Drug Administration approved the shingles vaccine. This vaccination is typically an adult booster vaccine against VZV.18 The US-based Centers for Disease Control and Prevention recommends that everyone who is 60 years and older should get the shingles vaccination.19
If you want to reduce the risk of getting shingles during your pregnancy, you should ideally get the chickenpox vaccine if you have not had chickenpox or have not gotten vaccinated for chickenpox before you get pregnant. Once you are pregnant, though, the best means of preventing shingles will be to stay away from people who have active ongoing forms of shingles or chickenpox. Remember that even in the scabbing stage, shingles can still be contagious.
The chances of developing shingles while being pregnant are usually very low. And even if you do end up getting shingles, it is unlikely to affect your baby. However, it may make your pregnancy more challenging to go through due to the discomfort and pain associated with the condition.
If you are planning to get pregnant and you have not had chickenpox, you should talk to your doctor about getting the chickenpox vaccine at least three months before you conceive. If you are concerned about getting shingles since you have had chickenpox earlier, you can also ask your doctor about the possibility of getting the shingles vaccination done a couple of months before you conceive.
- Cdc.gov. 2020. [online] Available at: <https://www.cdc.gov/shingles/about/overview.html> [Accessed 26 December 2020].
- Gould, D., 2014. Varicella zoster virus: chickenpox and shingles. Nursing Standard, 28(33).
- Hannon, B. and Ruth, M., 2009. Chicken Pox and Shingles. Dynamic Modeling of Diseases and Pests, pp.137-151.
- Engler, D., Sibanda, M. and Motubatse, H.J., 2017. Shingles. SA Pharmaceutical Journal, 84(6), pp.60-64.
- Glynn, C., Crockford, G., Gavaghan, D., Cardno, P., Price, D. and Miller, J., 1990. Epidemiology of shingles. Journal of the Royal Society of Medicine, 83(10), pp.617-619. Litchfield, S.M., 2010. Shingles. AAOHN Journal, 58(6), pp.228-231.
- Lamont, R.F., Sobel, J.D., Carrington, D., Mazaki‐Tovi, S., Kusanovic, J.P., Vaisbuch, E. and Romero, R., 2011. Varicella‐zoster virus (chickenpox) infection in pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology, 118(10), pp.1155-1162.
- Tan, M.P. and Koren, G., 2006. Chickenpox in pregnancy: revisited. Reproductive Toxicology, 21(4), pp.410-420.
- Shrim, A., Koren, G., Yudin, M.H., Farine, D., Gagnon, R., Hudon, L., Basso, M., Bos, H., Crane, J., Davies, G. and Delisle, M.F., 2012. Management of varicella infection (chickenpox) in pregnancy. Journal of Obstetrics and Gynaecology Canada, 34(3), pp.287-292.
- Miller, E., Cradock-Watson, T.E. and Ridehalgh, M.S., 1989. Outcome in newborn babies given anti-varicella-zoster immunoglobulin after perinatal maternal infection with varicella-zoster virus. The Lancet, 334(8659), pp.371-373.
- Simpson, R.H., 1954. Studies on shingles. Is the virus ordinary chickenpox virus?. Lancet, pp.1299-302.
- Nazarko, L., 2019. Diagnosis, treatment and prevention of shingles: the role of the healthcare assistant. British Journal of Healthcare Assistants, 13(1), pp.20-25.
- Perry, C.M. and Wagstaff, A.J., 1995. Famciclovir. Drugs, 50(2), pp.396-415.
- Shinkai, I. and Ohta, Y., 1996. Valacyclovir. Bioorganic & medicinal chemistry, 4(1), pp.1-2.
- Grose, C. and Wiedeman, J., 1997. Generic acyclovir vs. famciclovir and valacyclovir. The Pediatric infectious disease journal, 16(9), pp.838-841.Krause, P.R. and Klinman, D.M., 1995. Efficacy, immunogenicity, safety, and use of live attenuated chickenpox vaccine. The Journal of pediatrics, 127(4), pp.518-525.
- Cdc.gov. 2020. Vaccines: VPD-VAC/Varicella/Vaccine Effectiveness And Duration Of Protection. [online] Available at: <http://www.cdc.gov/vaccines/vpd-vac/varicella/hcp-effective-duration.htm> [Accessed 26 December 2020].
- Mitka, M., 2006. FDA approves shingles vaccine. Jama, 296(2), pp.157-158.
- Cajigal, S., 2006. CDC RECOMMENDS SHINGLES VACCINE. Neurology Today, 6(23), pp.29-30.