If you had chickenpox as a child, you will never contract it as an adult. But that doesn't mean you won't have to deal with shingles, which is caused by the highly contagious varicella-zoster virus, the same one responsible for chickenpox. Shingles, which affects an estimated one in five people, is a painful, blistering condition. It can show up at any time, but is especially alarming if it strikes during pregnancy. Fortunately, shingles in pregnancy is rare. And, for most women who develop shingles during pregnancy, the outlook is good.
Symptoms and Diagnosis of Shingles
After an outbreak of chickenpox, usually in childhood, the virus that causes it stays in your body, lying dormant in certain nerve cells. Although your immune system usually keeps the virus in check, anything that affects the immune system's ability to hold back the virus -- illnesses, immunosuppressive drugs, severe stress, or aging-related changes, for example -- can allow the virus to return with a vengeance.
Early symptoms of shingles include burning or shooting pain and tingling or itching, generally on one side of the body or face. For some people, the pain is severe. It may be accompanied by fever, chills, nausea, diarrhea, and difficulty urinating. The pain and tingling are followed by a rash, which begins with reddish bumps, most often on the trunk. In a few days the bumps become fluid-filled blisters, which usually crust over and fall off after seven to 10 days.
Even when the rash goes away, the skin color at the rash site may be different. Also, nerve pain may persist at the site of the rash (a condition called postherpetic neuralgia). About one-fifth of people who get shingles develop postherpetic neuralgia. In most people, the pain goes away within four months from the first sign of the rash.
Shingles is typically easy to diagnose. Your health care provider will suspect shingles if you have a rash on one side of the body, along with sharp, burning pain and a history of chickenpox.
Shingles Treatment During Pregnancy
If you believe you have shingles, it's important to see your doctor right away, because you must begin one of these medications within a few days of a shingles outbreak for best results. If your doctor prescribes an antiviral medication, it's important to take it exactly as directed. Most are taken once daily for several days. When taken as directed, these drugs should be safe during pregnancy.
In addition to the medications your doctor prescribes, there are over-the-counter (OTC) medications and self-help measures for relieving shingles pain and itching and preventing infection. These include:
- Cold compresses and cool baths to relieve blisters
- Loose clothing and clean gauze coverings over affected areas to hasten healing of blisters and prevent infection
- Antihistamines (particularly Benadryl), oatmeal baths, and calamine lotion to reduce itching
- The OTC painkiller acetaminophen. Before taking any OTC medication, it's important to speak with your doctor. Pregnant women should not take NSAIDs late in pregnancy.
Shingles Prevention: Reduce Your Risk
The varicella-zoster virus is highly contagious. If you have not had chickenpox, it's important that you avoid exposure to anyone known to have the infection -- or even crowds where you may come in contact with the infection, particularly if you are pregnant. If you already had chickenpox, you cannot catch shingles from someone with chickenpox or shingles.
Having chickenpox during pregnancy could potentially lead to chickenpox infection or birth defects in your unborn child, depending on when you are infected. Shingles, too, could potentially cause problems for your baby, but most experts agree the risk is less than with chickenpox. In one large study, there was no evidence of fetal harm in pregnant women who developed shingles.
If you're not sure if you have had chickenpox, your doctor can perform a blood test to check for antibodies to VZV. If you have the antibodies (indicating you have already had chickenpox infection), you run the risk of shingles in the future, but you cannot catch shingles from someone else.
There is also a vaccine called Zostavax that can help prevent shingles. In clinical studies, the vaccine reduced the overall occurrence of shingles by half. For people who were vaccinated and got shingles anyway, the severity was dramatically reduced. But the time to get the vaccine is before you get pregnant. The vaccine's manufacturer recommends waiting at least three months after getting the vaccine before attempting to become pregnant.
Shingles can be quite painful. Many people who see their doctor for shingles say it was the pain that ultimately led them to seek treatment. Some report that the sensation of anything brushing across the inflamed nerve endings on the skin is almost unbearable. Even when the rash is gone, postherpetic neuralgia can persist, sometimes for years.
Shingles can cause other lasting complications as well. If it occurs on the face, it can damage your eyes. Shingles of the eye can lead to scarring, which can damage your vision. It can also lead to glaucoma, an eye disease that can cause blindness later in life.
Shingles can also cause hearing or balance problems, as well as weakness of the muscles on the affected side of the face. In rare cases, shingles can spread into the brain or spinal cord and cause serious complications such as stroke or meningitis (an infection of the membranes outside the brain and spinal cord).
According to the CDC, more than one-third of people who get shingles will develop serious complications. People whose immune systems are suppressed because of medication or diseases such as HIV run the greatest risk of complications. Complications are also more common among people over age 60, which precludes women of childbearing age. Nevertheless, if a shingles outbreak affects your eye or you notice any symptoms outside of the area of the outbreak, you should speak to your doctor right away.
The Bottom Line for You and Your Baby
The incidence of shingles in pregnant women is very low. If you are planning to get pregnant and are concerned about shingles, speak to your doctor about the possibility of the shingles vaccine. If you are already pregnant, practice healthy habits and let your doctor know if you have any symptoms. Early recognition and treatment will minimize the risk of complications for you and your baby.