FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 330:901-905 March 31, 1994 Number 13 Next

	Full Text Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Infection with the varicella-zoster virus during pregnancy can produce an embryopathy characterized by limb hypoplasia, eye and brain damage, and skin lesions. The risk is greatest when infection occurs during the first 20 weeks of pregnancy, but the magnitude of the risk is uncertain.

Methods We studied 106 women with clinically diagnosed varicella infection in the first 20 weeks of pregnancy and compared the outcomes with those in 106 age-matched, nonexposed controls.

Results Among the women with varicella, there was a trend toward more elective terminations of pregnancy (14 percent, vs. 7.5 percent among the controls; P = 0.1), corresponding to a significantly higher perception of teratogenic risk (P = 0.03). The proportions of miscarriages and live births and the mean birth weights were similar in the two study groups; there were more premature births ( 37 weeks) among the women with varicella infection (14.3 percent vs. 5.6 percent, P = 0.05). Congenital defects occurred in four infants born to the women with varicella (varicella embryopathy, hydrocephalus, meningocele and clubfeet, and hammer toe) and two infants born to the controls (ventricular septal defect and hip dislocation). The risk of varicella embryopathy after infection in the first 20 weeks was 1.2 percent (95 percent confidence interval, 0 to 2.4 percent). When we pooled our results with those from other prospective studies, the mean risk of embryopathy after infection with varicella-zoster virus in the first trimester was 2.2 percent (95 percent confidence interval, 0 to 4.6 percent).

Conclusions The absolute risk of embryopathy after maternal varicella infection in the first 20 weeks of pregnancy is about 2 percent.

Source Information

From the Motherisk Program, Hospital for Sick Children, Toronto (A.L.P., M.L., J.G., F.B.-L., E.J., G.K.); Pregnancy Healthline, Pennsylvania Hospital, Philadelphia (B.S., A.D.); Pregnancy Risk Information Service, Camden, N.J. (C.Z.); Pregnancy Riskline, University of Utah, Salt Lake City (M.F.); and the Department of Genetics, North York Hospital, Toronto (W.M.).

Address reprint requests to Dr. Koren at the Division of Clinical Pharmacology, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada.

Full Text of this Article

Related Letters:

Varicella Infection in Pregnancy
Bassett D.C.J., Pastuszak A. L., Koren G.
Extract | Full Text  
N Engl J Med 1994; 331:482, Aug 18, 1994. Correspondence

This article has been cited by other articles:

• Marodi, L. (2006). Neonatal Innate Immunity to Infectious Agents. Infect. Immun. 74: 1999-2006 [Full Text]  
• (2005). Chickenpox, pregnancy and the newborn. DTB 43: 69-72 [Abstract] [Full Text]  
• Mazzella, M., Arioni, C., Bellini, C., Allegri, A. E. M., Savioli, C., Serra, G. (2003). Severe hydrocephalus associated with congenital varicella syndrome. CMAJ 168: 561-563 [Abstract] [Full Text]  
• Harger, J. H., Ernest, J. M., Thurnau, G. R., Moawad, A., Thom, E., Landon, M. B., Paul, R., Miodovnik, M., Dombrowski, M., Sibai, B., Van Dorsten, P., McNellis, D. (2002). Frequency of Congenital Varicella Syndrome in a Prospective Cohort of 347 Pregnant Women. Obstet Gynecol 100: 260-265 [Abstract] [Full Text]  
• Breuer, J (2001). Vaccination to prevent varicella and shingles. J. Clin. Pathol. 54: 743-747 [Abstract] [Full Text]  
• Dimova, P. S., Karparov, A. A. (2001). Congenital Varicella Syndrome: Case With Isolated Brain Damage. J Child Neurol 16: 595-597 [Abstract]  
• Aitken, C., Jeffries, D. J. (2001). Nosocomial Spread of Viral Disease. Clin. Microbiol. Rev. 14: 528-546 [Abstract] [Full Text]  
• Bhatia, P, Bhatia, K (2000). Pregnancy and the lungs. Postgrad. Med. J. 76: 683-689 [Full Text]  
• Cohen, J. I., Brunell, P. A., Straus, S. E., Krause, P. R. (1999). Recent Advances in Varicella-Zoster Virus Infection. ANN INTERN MED 130: 922-932 [Abstract] [Full Text]  
• Seidman, D. S, Stevenson, D. K, Arvin, A. M (1996). Varicella vaccine in pregnancy. BMJ 313: 701-702 [Full Text]  
• AL-QATTAN, M. M., THOMSON, H. G. (1995). Congenital Varicella of the Upper Limb: A preventable disaster. J Hand Surg Eur Vol 20: 115-117 [Abstract]  
• Bassett, D.C.J., Pastuszak, A. L., Koren, G. (1994). Varicella Infection in Pregnancy. NEJM 331: 482-482 [Full Text]