Multiple Congenital Defects Following Maternal Varicella

Laforet, Eugene G.; Lynch, Charles L.

doi:10.1056/nejm194704102361504

Cited by 212 publications

(57 citation statements)

References 10 publications

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“…In addition, few retrospective case reports have described CVS after maternal varicella zoster virus (VZV) infection contracted between the 21st and 28th week of gestation [1,2] . Since CVS was first described in 1947 [3][4][5][6] , about 110 cases have been reported [7][8][9] , but the causal association with maternal infection has only been confirmed in far fewer cases by detecting VZV DNA in fetal tissues or detecting specific IgG antibodies in later infancy. CVS typically manifests with segmental symptoms including scars and limb deformities as well as ocular and brain abnormalities and mental retardation.…”

Section: Introductionmentioning

confidence: 99%

Congenital Varicella Syndrome: Still a Problem?

Auriti¹,

Piersigilli²,

Gasperis

et al. 2009

Fetal Diagn Ther

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A woman contracted chickenpox in the 12th week of gestation. Her general practitioner and later the consultant obstetrician warned her about the small risk of giving birth to a disabled child. She decided to continue the pregnancy without undergoing invasive tests to diagnose fetal intrauterine infection. Symptoms of congenital varicella syndrome (CVS) were detected by ultrasound in the 29th and 34th weeks of gestation. On admission to hospital, the baby was not considered infectious and was not isolated because polymerase chain reaction analysis to detect varicella zoster virus (VZV) DNA in the blood, cerebrospinal fluid, saliva, skin scrapings and feces gave negative results. He was also not separated from his mother. The mother was without clinical complications. Varicella during pregnancy may result in VZV transmission to the fetus or newborn. Intrauterine VZV infection in the first 28 weeks of gestation may result in CVS with limb deformities, brain abnormalities and mental retardation. Usually the newborn is not infectious, and therapy and isolation are unnecessary. When the mother catches the infection in the second trimester, the newborn may manifest shingles in the first 2 years of life. A maternal rash erupting 5 days before to 2 days after delivery is frequently associated with clinically severe varicella in the newborn, leading to high mortality if untreated. Then the newborn is infectious and must be isolated. This case report underlines the need for expert medical counseling for women who contract chickenpox at any time during pregnancy. It also underlines the importance of immunizing susceptible women of childbearing age before they become pregnant.

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Section: Introductionmentioning

confidence: 99%

Congenital Varicella Syndrome: Still a Problem?

Auriti¹,

Piersigilli²,

Gasperis

et al. 2009

Fetal Diagn Ther

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show abstract

“…On the basis prospective studies, the incidence of fetal and congenital varicella syndrome is estimated as 2.2% [2,8]. Following the initial description by Laforet and Lynch [9], further cases of congenital varicella syndrome have infrequently been reported. So far there are only 48 published case reports (summarized in table 4).…”

Section: Discussionmentioning

confidence: 99%

Varicella-Zoster Virus Infections in Pregnancy

Sauerbrei¹

1998

Intervirology

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Chickenpox is an uncommon disease in women during pregnancy. If, however, maternal varicella infects the fetus, intrauterine death or severe diseases (congenital or fetal varicella syndrome) may ensue depending on the time of maternal infection. On the basis of our own clinical observations and virological testing we report on 31 women with varicella during pregnancy and their infants. Five neonates born to mothers with varicella between the 8th and 21st week showed clinical signs of the congenital varicella syndrome. Varicella-zoster virus DNA could be detected in different tissues, including lung, liver, skin and adrenal glands. As a consequence of maternal chickenpox within 12 days before delivery, 6 newborn babies developed neonatal varicella. Measures for diagnosis, treatment and prophylaxis are discussed.

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“…In fetal varicella (Table 5) limb reduction defects are part of the spectrum of congenital anomalies described in the literature and are frequently associated with cicatricial lesions of the overlying skin (22). In the cases with unspecified viral infections, terminal transverse defects at the metacarpophalangeal level in the majority of cases suggests a vascular disruption (17) and thus are a fairly unspecific effects of a viral agent.…”

Section: Discussionmentioning

confidence: 99%

Maternal factors, medications, and drug exposure in congenital limb reduction defects.

Froster

Baird

1993

Environ Health Perspect

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As part of an ongoing study on all limb reduction defects occurring among 1,213,913 consecutive live births in the province of British Columbia, Canada, during 1952-1984, cases with documented maternal drug exposure and chronic maternal diseases were analyzed separately. This population-based study was made possible through the existence of an ongoing Health Surveillance Registry, which documents all infants born with congenital, genetic, or chronically handicapping conditions in the province of British Columbia. Strict rules of confidentiality are obeyed. For this part of the analysis of limb reduction defects, cases with documented maternal illness, drug abuse, and exposure to environmental hazards early in pregnancy were analyzed as a separate group to identify specific, recurring patterns of anomalies. A total of 51 cases with possibly related maternal factors were identified. Among them were five cases with maternal epilepsy, four cases with documented maternal diabetes, and three cases with uterine anomalies. Three infants, all born in 1962, had documented thalidomide exposure. It is rarely possible to identify particular teratogenic factors or specific maternal factors as etiologically related to the pattern of limb reduction defects or a spectrum of congenital malformations. Exposure to environmental factors during pregnancy is not reliably registered and can thus only occasionally be ascertained in retrospective studies. This means that very large numbers of cases and cross-referencing to other family members are required to assess whether a potential teratogen is related to limb defects or not.

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Multiple Congenital Defects Following Maternal Varicella

Cited by 212 publications

References 10 publications

Congenital Varicella Syndrome: Still a Problem?

Congenital Varicella Syndrome: Still a Problem?

Varicella-Zoster Virus Infections in Pregnancy

Maternal factors, medications, and drug exposure in congenital limb reduction defects.

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