Herpes and pregnancy can occur at the same time. In fact 20% to 25% of pregnant women worldwide have genital herpes – some are active and some are asymptomatic.
Although the mothers-to-be are not at risk, the unborn baby may be in danger.
The degree of risk the baby faces is dependent on three major factors:
The herpes infection timeline. Whether antibodies are present in the mother-to-be. Whether there has been enough time for antibodies to develop in the baby before the onset of labor. Let me explain:
As a result of a herpes primary infection, the system produces antibodies to the particular type of virus involved.
If a woman contracts herpes, approximately six weeks after the primary outbreak the resultant antibodies in her system will prevent infection of an additional form of her particular HSV infection.
What’s more important regarding herpes and pregnancy, after six to nine weeks, the baby will acquire antibodies via the placenta.
Once that has happened, it is extremely difficult for cross infection to occur while the infant is still in the womb. It also makes it unlikely that the baby will become infected if the mother happens to be in the viral shedding stage during birth.
The Herpes Infection Timeline
There are three possible scenarios if herpes and pregnancy coincide:
If the woman had herpes before becoming pregnant, antibodies will be present in her system and she will transfer them to the fetus. If the mother is in the viral shedding stage during labor, there is less than a 1% chance of the baby becoming infected during vaginal birth. If primary infection occurred shortly before, or during the first trimester of pregnancy, the unborn baby is at risk. Since it takes approximately 6 weeks for antibodies to appear, there is a 3% chance of the infant becoming infected by viral shedding during vaginal birth. In rare cases, transmission could occur via the placenta. In this instance there is a 5% possibility of the baby being born with serious birth defects. If primary infection occurred during the second or third trimester of the pregnancy, this situation presents the highest risk of transferring the virus to the baby during vaginal birth. In this scenario, if the virus is shedding during labor, there is an up to 50% chance of the infant acquiring neonatal disease. Therefore a Caesarian section, rather than vaginal birth is essential. In the case of a first outbreak during pregnancy, the doctor should call for a “Western blot” blood test in order to:
a) Identify the type of virus.
b) To tell whether the outbreak was a non-primary first occurrence, or a primary outbreak.
Since the immune system is suppressed during pregnancy, 80% of herpes positive pregnant women will experience an average of 3 outbreaks during the gestation period.
Herpes Treatment During Pregnancy
The American College of Obstetricians and Gynecologists (ACOG) recommend daily suppressive antiviral therapy to be given to herpes positive women from the 36th week of pregnancy.
This limits HSV recurrence and shedding during childbirth, thereby reducing the need for caesarean section.
Since the drug ‘acyclovir’ was subjected to a clinical study of 1000 pregnant women in which there were no increases in birth defects, it remains the drug of choice during pregnancy.
For women infected during the second or third trimester, daily suppressive treatment with antiviral herpes medicine as described above, should be considered. For others, this antiviral therapy is recommended during the final 10 days prior to delivery.
This will all but eliminate the chances of viral shedding while giving birth.
Herpes and Pregnancy – Vaginal Delivery or Cesarean Section?
Vaginal birth presents the greatest risk of cross transmission between mother and child. If lesions are detected on either the cervix, inside walls of the vagina, urethra or on the vulva prior to delivery, a Cesarean section would be necessary. As a safety precaution, women infected during the second or third trimester of pregnancy should seriously consider opting for a Cesarean section. This would virtually eliminate the chances of the baby becoming infected by viral shedding. If a woman has oral herpes lesions, they should be covered with an occlusive dressing before vaginal delivery. In other cases there is less than a 1% chance of the baby suffering from neonatal disease, so a vaginal delivery would be the logical option for most women.
Herpes and Pregnancy – Precautions During Pregnancy
If both you and your partner appear to be herpes negative, the following is worth discussing:
Since 90% of herpes positive victims have never had a primary outbreak, both of you should consider having a herpes blood test.
This would be a sensible precaution against unwittingly transmitting the virus either way during the shedding process. Alternatively, you might both consider taking daily antiviral medication throughout your pregnancy.
A latex condom should be used during vaginal, anal or oral sex in order to reduce the chances of transmission. Skip all sexual contact if either you or your partner has a herpes outbreak or experiences prodromal symptoms (tingling, itching or pain in the area of an impending outbreak). If either of you has oral herpes, avoid skin-to-skin contact with the infected area. Abstain from sex altogether during the third trimester of your pregnancy.
Tags: Antibodies, Baby Faces, Genital Herpes, Herpes, Hsv Infection, Onset Of Labor, Vaginal Birth, Womb
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