Pregnancy and Herpes

Charlotte Grayson, M.D. Health Pro February 20, 2008
  • If you are pregnant or thinking of becoming pregnant and you have herpes, you may have a lot more on your mind than morning sickness, maternity clothes and cribs. You might be concerned about whether you can have a healthy baby.

     

    While this worry is understandable - the effects of neonatal herpes are devastating - this complication is exceeding rare. It is estimated that 20-25% of pregnant women have genital herpes. Contraction of the infection by the babies occurs in less than 0.1% of cases.

     

    Transmission is lowest in women who acquire herpes before pregnancy. The risk of transmission is highest when a woman acquires herpes late in pregnancy.

     

    If you are pregnant and have genital herpes, talk to your obstetrician about how to minimize the risk of infecting your baby.

     

    If your partner has either oral or genital herpes and you are pregnant and uninfected, avoid unprotected sex, and avoid sex altogether when the partner has an outbreak.

     

    In 90% of cases, neonatal herpes is transmitted when the infant comes into contact with the virus in the birth canal during delivery. The highest risk occurs if the mother has an active outbreak, though there is a risk of transmission from asymptomatic shedding.

     

    As I said before, despite the large numbers of women with genital herpes, neonatal transmission is very rare. Why? Well, babies of mothers with long standing herpes infections have a natural protection against the virus. Herpes antibodies in the mother's blood cross the placenta to the fetus. These antibodies help protect the baby from acquiring the infection during birth.

     

    Even women who acquire herpes during the first two trimesters of pregnancy usually produce enough antibodies to provide some protection to their unborn babies.

     

    But, the risk of transmission is higher in babies born prematurely and in babies born to women who acquired the disease late in pregnancy.

     

    Finally, about 5%-8% of babies who contract neonatal herpes are infected after birth, often when they are kissed - by an adult who has an active infection of oral herpes (cold sores).

     

    Unfortunately, when infants do contract neonatal herpes, the results can be devastating. Half of infected infants who are treated with aintiviral medication do not have permanent damage. But the other half may suffer mental retardation, other neurological damage or death.

     

    If you are pregnant and know you have genital herpes, that fact alone gives you a significant advantage in protecting your baby. Studies show that most cases of neonatal herpes occur in babies whose mothers don't have any idea they are infected.

     

    This statistic is due, in part, simply to the large number of people who have genital herpes and don't know it. But it's also due to the lack of precautions taken by women and doctors who don't realize that neonatal herpes is a possibility.

     

    If a woman has a herpes outbreak or the prodrome of an outbreak at the time of delivery, most health experts recommend a cesarean section to prevent the baby from coming into contact with the active virus.

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    If a woman with herpes does not have active lesions at the time of delivery, experts agree that vaginal delivery is safe.

     

    So, it's important to learn what you need to know, and then relax and enjoy the excitement of the pregnancy. And remember, the odds are strongly in your favor of having a happy and healthy baby.