Background The acquisition of genital herpes during pregnancyhas been associated with spontaneous abortion, prematurity,and congenital and neonatal herpes. The frequency of seroconversion,maternal symptoms of the disease, and the timing of its greatesteffect on the outcome of pregnancy have not been systematicallystudied.
Methods We studied 7046 pregnant women whom serologic testsshowed to be at risk for herpes simplex virus (HSV) infection.Serum samples obtained at the first prenatal visit, at approximately16 and 24 weeks, and during labor were tested for antibodiesto HSV types 1 and 2 (HSV-1 and HSV-2) by the Western blot assay,and the results were correlated with the occurrence of antenatalgenital infections.
Results Ninety-four of the women became seropositive for HSV;34 of the 94 women (36 percent) had symptoms consistent withherpes infection. Women who were initially seronegative forboth HSV-1 and HSV-2 had an estimated chance of seroconversionfor either virus of 3.7 percent; those who were initially seropositiveonly for HSV-1 had an estimated chance of HSV-2 seroconversionof 1.7 percent; and those who were initially HSV-2–seropositivehad an estimated chance of zero for acquiring HSV-1 infection.Among the 60 of the 94 pregnancies for which the time of acquisitionof HSV infection was known, 30 percent of the infections occurredin the first trimester, 30 percent in the second, and 40 percentin the third. HSV seroconversion completed by the time of laborwas not associated with an increase in neonatal morbidity orwith any cases of congenital herpes infection. However, amongthe infants born to nine women who acquired genital HSV infectionshortly before labor, neonatal HSV infection occurred in fourinfants, of whom one died.
Conclusions Two percent or more of susceptible women acquireHSV infection during pregnancy. Acquisition of infection withseroconversion completed before labor does not appear to affectthe outcome of pregnancy, but infection acquired near the timeof labor is associated with neonatal herpes and perinatal morbidity.
Source Information
From the Departments of Obstetrics and Gynecology (Z.A.B., D.H.W., S.B.), Laboratory Medicine (S.S., R.L.A., L.C.), Statistics (J.Z.), and Medicine (L.C.), University of Washington, Seattle; and the Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Wash. (J.K., A.M., M.H.). The opinions expressed in this article are solely those of the authors and do not necessarily reflect those of the Department of the Army or the Department of Defense.
Address reprint requests to Dr. Brown at Box 356460, University of Washington, Seattle, WA 98195-6460.
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