Prenatal Diagnosis and Management of Congenital Varicella

Diagnostic Approach

The Centers for Disease Control and Prevention recommends diagnosis of maternal varicella infection is primarily clinical, based on characteristic vesicular rash 1
Confirm maternal infection through serologic testing for varicella-specific IgM and IgG antibodies, as recommended by the American Academy of Pediatrics 2
Document timing of maternal infection, as risk of congenital varicella syndrome varies significantly by gestational age, according to the Centers for Disease Control and Prevention 1, 3

The Centers for Disease Control and Prevention states that the risk of congenital varicella syndrome is approximately 0.4% (95% CI: 0.05-1.5%) during the first trimester 1
The highest risk period is during the second trimester, with approximately 2.0% risk (95% CI: 0.8-4.1%) of congenital varicella syndrome, as reported by the Centers for Disease Control and Prevention 1
The risk decreases significantly after 20 weeks gestation, according to the Centers for Disease Control and Prevention 1

The Centers for Disease Control and Prevention recommends administering varicella-zoster immune globulin (VZIG) as post-exposure prophylaxis for susceptible pregnant women exposed to varicella 1
For peripartum maternal infection (5 days before to 2 days after delivery), administer VZIG to the newborn immediately after birth, as recommended by the Centers for Disease Control and Prevention 1
The American Academy of Pediatrics recommends testing infant serum for varicella-specific antibodies and performing comprehensive clinical evaluation of infants born to mothers with confirmed varicella during pregnancy 2

The Centers for Disease Control and Prevention reports that herpes zoster may develop during infancy or early childhood in approximately 0.8-1.7% of infants exposed to VZV in utero during 13-36 weeks gestation 1