Understanding Shingles During Pregnancy: Symptoms, Risks, Treatment

Understanding Shingles During Pregnancy

Shingles, also known as herpes zoster, can be a painful and uncomfortable skin rash caused by the varicella zoster virus. This is the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant or inactive in the body. Years later, it may reactivate as shingles. Getting shingles while pregnant can be concerning, but with proper treatment it typically resolves without complications.

Symptoms of Shingles

The main symptom of shingles is a painful rash that develops into itchy, fluid-filled blisters. The rash usually occurs in a single stripe or band on one side of the body. Less commonly, it may occur on both sides. The rash and blisters can occur anywhere on the body, but commonly develop on the chest, back, abdomen, face and neck. Other symptoms may precede the rash by a few days, including:

• Tingling, burning or itching of the skin
• Increased sensitivity to touch
• Feeling unwell
• Headache
• Fever
• Chills

Some people may only experience pain in the affected area without ever developing a rash. This is known as zoster sine herpete.

Causes of Shingles

After a person recovers from chickenpox, the varicella zoster virus remains in the body, lying dormant in the nerve roots. Years later, it may reactivate as shingles. Researchers aren't sure why the virus reactivates in some people but there are certain risk factors that make it more likely:

• Older age. Most cases occur in people over 50.
• Weakened immune system from illness or medication.
• High stress levels.
• Cancer.
• HIV/AIDS.
• Certain medications like steroids or chemotherapy.

Pregnancy itself is not thought to increase the risk of developing shingles. However, pregnancy stresses the body and weakens the immune system. This may allow activation of the virus in some cases.

Is Shingles Dangerous During Pregnancy?

For most pregnant women, shingles will resolve without major complications. However, there are some concerns to be aware of:

• Birth defects - Having chickenpox during the first 20 weeks of pregnancy may very rarely increase the risk of certain birth defects. Shingles is caused by the same virus so there is a theoretical risk. However, shingles occurs far less often than chickenpox in pregnant women.
• Pneumonia - If shingles develops on the face, the blisters can become infected. Bacterial pneumonia is a rare complication.
• Pain - The severe nerve pain of shingles can be difficult to control in pregnancy. Pain and stress may have indirect effects on the pregnancy.
• Scarring - Shingles may potentially leave behind scars on the skin.

Overall, shingles has a low risk of complications. Only very rarely does it directly impact the developing baby. The main concerns are managing pain and preventing secondary infections in the mother.

Is Shingles Contagious to My Baby?

Shingles itself is not contagious. The varicella zoster virus is already present in the body from a past chickenpox infection. However, someone with shingles can spread chickenpox to others who have never had it or the chickenpox vaccine. This includes spread to the developing baby.

The risk of transmission to the baby is low. But it may occur if the mother comes into contact with open blisters and has no immunity. To prevent spread, avoid skin-to-skin contact and keep blisters covered. Tell any other children or people susceptible to chickenpox to avoid contact until the rash has healed. In most cases, the baby will be unaffected.

When Does Shingles Occur During Pregnancy?

Shingles is unusual during pregnancy, with an estimated incidence of only 0.7 cases per 1000 pregnancies. The reasons for reactivation of the virus are not well understood. It appears most likely to occur in the third trimester and early postpartum period. Researchers hypothesize that factors may include:

• Immune changes in pregnancy, allowing reactivation.
• The stress of labor and delivery.
• Fatigue and sleep disruption after giving birth.

The timing correlates with when women are most immunocompromised and under the most physical stress. While shingles can happen anytime during pregnancy, the third trimester seems to carry the greatest risk.

Treating Shingles in Pregnant Women

Treatment aims to ease symptoms and shorten the duration of shingles. Options may include:

• Antivirals - These medications fight the varicella zoster virus and reduce the severity and length of shingles. The preferred antivirals for pregnancy are acyclovir and valacyclovir.
• Wet compresses - Cool compresses can soothe itching and pain.
• Over-the-counter pain relievers - Acetaminophen is considered safe for pregnancy. Nonsteroidal anti-inflammatories like ibuprofen should be avoided in the third trimester.
• Zostavax vaccine - This shingles vaccine is not recommended during pregnancy.
• Corticosteroids - Steroid creams, oral steroids and steroid injections should be used cautiously in pregnancy and mainly for severe cases.
• Lidocaine patches - These can relieve pain and numb the shingles rash.
• Calamine lotion - This can help dry out blisters and soothe itching.
• Keep blisters clean and covered - Prevent infection of blisters.

Your physician will guide treatment, taking into account how far along you are in the pregnancy. The benefits of medication will be weighed against any potential risks to the baby. Mild cases may resolve with conservative treatment alone.

Preventing Shingles in Pregnancy

All pregnant women should be up to date on the chickenpox vaccine, as this prevents shingles down the road. If you haven't had chickenpox or the vaccine, avoid contact with anyone who has the illness. Other prevention tips include:

• Get adequate prenatal care.
• Reduce stress levels when possible.
• Eat a balanced diet to support immunity.
• Get enough vitamin D from sunlight, fortified foods or supplements.
• Have good hygiene and avoid people who are sick.
• Ask family/friends to help avoid fatigue and exhaustion after the birth.

There is also a shingles vaccine recommended for certain adults called Shingrix. However, it is not given during pregnancy or to those trying to conceive. After giving birth, discuss options for reducing shingles risk with your physician.

Shingles Recovery and Outlook After Pregnancy

With prompt treatment, most pregnant women make a full recovery from shingles. The antiviral medications are effective in improving symptoms and shortening duration. Any blisters and rash should fully heal within 2-4 weeks. Some things that can help with recovery:

• Take care of yourself and get adequate rest.
• Follow up as instructed for prenatal care.
• Use calamine lotion or colloidal oatmeal for any post-shingles itching.
• Consider probiotics to support immune recovery.
• Continue pain relievers as needed under medical guidance.

In most cases, shingles will resolve well before your due date. It is very unlikely to have any direct effect on your delivery or your baby. However, some women continue to experience pain even after the rash heals. This postherpetic neuralgia is a complication that should resolve by 6 months postpartum. Talk to your doctor if the pain persists.

The Bottom Line

Shingles during pregnancy can be alarming but is typically not dangerous. Prompt treatment can ease symptoms and lower risks of complications. Take precautions to prevent spread to your baby. Talk to your healthcare provider about optimal management based on your specific circumstances. Most pregnant women with shingles go on to have a normal delivery and healthy baby.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.