Varicella infection in the pregnant woman may have an impact on both the mother and the foetus. The incidence of VZV in pregnancy is estimated to be 1-2 per 2000.

Seroprevalence studies demonstrate that over 90% of white British women are immune to varicella. By contrast, figures for Bangladeshi women in London are 86%. Seropositivity is as low as 50% in a rural population of Sri Lanka and such women will be at increased risk of infection if they move to a higher prevalence location. One might anticipate that universal childhood immunisation may reduce the incidence of varicella in pregnancy by reducing the risk of contact but there is no data on this.

Varicella can result in a fatal maternal outcome in pregnancy but it is not clear that the risk is greater than for other adults. Infection of the foetus may result in foetal varicella syndrome - this is uncommon, affecting 1-2% of cases of varicella in pregnancy, but can threaten foetal viability and have severe life lasting consequences. Maternal infection just before or after delivery can result in neonatal infection which can be life threatening but may be modified by the use of VZIG.

Prevention of infection in pregnancy would be ideal – infection may have severe clinical consequences but additionally has significant health care costs (including VZIG) as well as non medical costs. The health economic impact of varicella in pregnancy is significant and prevention strategies to avoid varicella in females of child bearing age will be addressed.

Reactivation of varicella, shingles, is not common and usually well tolerated in the mother with no likelihood of consequence to the foetus.

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