Immune Globulin, Varicella-Zoster (Human) in pregnancy and breastfeeding

Immune Globulin, Varicella-Zoster (Human)]]>

Risk Factor: C
Class: Serums, toxoids, and vaccines/ Serums

Contents of this page:
Fetal Risk Summary
Breast Feeding Summary

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.



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