How should a pregnant woman with varicella be advised and treated?
The woman should be advised that the risk of congenital varicella syndrome is relatively low (0.4% for infection 1-12 weeks of pregnancy and 2.0% for infection 13-20 weeks of pregnancy). The safety of systemic acyclovir therapy among pregnant women has not been established. Although studies involving animals have not indicated teratogenic effects of acyclovir, adequate, well-controlled studies among pregnant women have not been conducted. Acyclovir is classified as Category C in the FDA use-in-pregnancy rating (i.e., risk cannot be ruled out, but potential benefits may justify the possible risk) (Burroughs Wellcome Company, Zovirax package insert). AAP does not recommend oral acyclovir for pregnant women; however, in instances of serious, viral-mediated complications (e.g., pneumonia), AAP states that intravenous acyclovir should be considered. Burroughs Wellcome Company, in collaboration with CDC and academic epidemiologists, maintains the Acyclovir in Pregnancy Registry to monitor th
