Herpes and Pregnancy: What You Should Know

Herpes simplex virus is a common disease that many women face. Find out how to manage it during pregnancy and learn how to protect your baby.

If you’re pregnant and have herpes simplex virus (HSV), you’re probably wondering how this infection will affect your unborn baby. You’re not alone. Nearly 45 million Americans have genital herpes, according to the Centers for Disease Control (CDC). And 800,000 pregnant women battle with this infection each year (out of the approximately 500,000 new cases of genital herpes annually in the US alone, about 1,000 cases are newborn babies). To help you ensure the health of your baby, here are answers to some common questions.

What risks do my baby and I face?

According to the March of Dimes, one in five pregnant women has been infected with genital herpes, although most do not know it. Because of this, obstetricians have always feared herpes, knowing that about half of babies born vaginally to women with legions risk getting the disease while the other half risk death. Fortunately, only a small minority of women will pass the infection on to their babies or suffer other pregnancy complications resulting from herpes.

“Approximately 1,500 to 2,000 new cases of neonatal HSV infection are diagnosed each year. Neonatal HSV infection may lead to long-term neurologic impairment and death,” reports Dr. Richard Fischer, MD, do-division head of Maternal-Fetal Medicine at Cooper University Hospital in Camden, New Jersey.

The International Herpes Alliance (IHA) adds that neonatal herpes can cause “skin, eye, or mouth infections, damage to the central nervous system and other internal organs, mental retardation, or death.” The organization also says, however, that medication may help prevent or reduce lasting damage if it administered to your baby early.

How can my baby contract HSV?

There are three main ways that herpes can spread to your infant, according to the IHA:

  • During birth if the virus is present in the birth canal during delivery
  • If the baby is kissed by someone who suffers from cold sores
  • In rare instances, HSV may be spread by touch (if someone touches an active cold sore and immediately touches the baby)

Despite HSV being so common, the risk of your baby being affected by neonatal herpes is low if you’ve contracted the STD before your third trimester. The IHA statistics show that the majority of women suffering from genital herpes give birth to healthy babies.

What are my treatment options?

According to OB-GYN Dr. Gerard DiLeo, MD, many doctors recommend an antiviral medication during the last month of pregnancy, “to diminish the theoretical silent shedding, and if there are no active lesions, allowing for a vaginal delivery.” But he adds that this is still quite investigational.

The National Women’s Health Information Center (NWHIC) confirms the difficulty in answering this question. “It is not yet known if all genital herpes drugs are safe for pregnant women to take,” says the organization. “Some doctors may recommend a herpes antiviral be taken either as a pill or through an IV (a needle into a vein) during pregnancy.” The NWHIC recommends that you discuss the possibility of medication with your doctor to determine what’s best for you and your baby.

Can I deliver vaginally?

If you are not experiencing an active herpes outbreak, your doctor will most likely suggest a vaginal delivery (but he or she will plan on avoiding routine use of instruments). However, some doctors will proceed with a C-section. Unfortunately, as of 2007, there is insufficient information to clearly support one option or the other, says the IHA. As a result, this decision will need to be made by you and your doctor.

You and your doctor will also need to consider when you contracted herpes. If you were infected before your pregnancy, vaginal delivery is usually a safe option. The American Social Health Association (ASHA) says women who’ve acquired HSV prior to pregnancy have a lower risk of transmitting the virus to their babies. “This is because their immune systems make antibodies that are temporarily passed to the baby through the placenta. Even if herpes is active in the birth canal during delivery, the antibodies help protect the baby,” ASHA reports.

Pregnant women who are infected with genital herpes for the first time near the time of their delivery have a 30 to 50 percent chance of passing the infection on to their babies during a vaginal delivery whether they exhibit symptoms or not, adds the March of Dimes.

But, if you were first infected during the last trimester, “some doctors will recommend a Cesarean delivery under these circumstances, even if no outbreak is present,” says the IHA. A newly infected mother just doesn’t have the antibodies in place yet to fight this virus, so there isn’t enough natural protection for the baby to have a vaginal birth. (Also, new herpes infections are more active than older ones, increasing the possibility of a breakout in the birth canal during labor and delivery.)

How will I know if my baby is infected?

The ASHA says that the pediatrician will watch your newborn closely for about three weeks. You and your doctor should be wary of the following symptoms:

  • skin rash
  • fever
  • crankiness
  • lack of appetite

While these can be symptoms of several mild illnesses, says the ASHA, don’t wait to see if your baby will get better. “Take [your baby] to the pediatrician at once, [and] be sure to tell the pediatrician you have genital herpes,” the organization urges.

What happens if my baby is infected?

Infected newborns are treated with one of two popular antiviral drugs (acyclovir or vidarabine), which can help babies born with herpes if they are treated right away. The March of Dimes reports that these two drugs are quite successful in treating localized infections of the eyes, skin, or mouth; but they are less effective when applied later, once the infection has spread to the brain and other internal organs.

Can I breastfeed if I have HSV?

The NWHIC says that you can breastfeed, but only if your sores are covered. “Herpes is spread through contact with sores and can be dangerous to a newborn. If you have sores on your nipple or areola (the darker skin around the nipple), you should stop breastfeeding on that breast.”

Instead, the NWHIC suggests pumping or hand expressing your milk from that breast until the sore clears. But they add this cautionary note: “If the parts of your breast pump that contact the milk also touch the sore(s) while pumping, you should throw the milk away.”

If my partner has HSV but I don’t, how can I protect my baby?

You can help keep yourself and your baby safe from infection by following the guidelines set out by the ASHA:

  • Use condoms from start to finish every time you have sexual contact, even if you have no symptoms. Herpes can be spread when no symptoms are present (through a process called asymptomatic shedding).
  • If you have genital outbreaks, abstain from sex until the outbreak has completely healed.
  • Talk with your healthcare provider about taking antiviral medication to suppress outbreaks and reduce the risk of transmission between outbreaks.
  • Consider abstaining from sex (oral, vaginal, and anal) during the last trimester. Explore alternatives such as touching, kissing, fantasizing, and massage.
  • If you have oral herpes (cold sores or fever blisters), avoid performing oral sex on your partner to prevent transmitting the virus.

HSV is a common disease. According to the ASHA, 20 percent of Americans have genital herpes, and most don’t have symptoms. If you already know you are carrying the virus, be sure to let your OB-GYN know as soon as you find out you are pregnant. If you’re unsure if you have the disease or have never been tested, discuss the possibility of testing with your partner and your OB-GYN. Finding out if you’re infected and knowing what to expect can help protect you, your partner, and your baby.

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