The Risk with Herpes during Pregnancy

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What are the risks my unborn baby faces if I am infected with genital herpes during pregnancy?

The biggest fear with pregnancy and having genital herpes is that you could spread the virus to the neonate during labor or delivery. Neonatal herpes is quite uncommon (approximately 1,500 newborns are affected every year), yet the condition can be devastating. Thus, it is vital to know how to cut your baby’s exposure to becoming infected with herpes during pregnancy.

You can spread herpes to the baby during delivery if you are contagious, or shedding HSV, at that time. The transmission risk is high if you contract herpes for the very first time (an initial infection) late in the pregnancy.

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Much less usually, you can spread HSV if you have a recurring infection. If you have ever had an outbreak, the virus stays in the body and can become triggered.

In rare instances, a pregnant woman could transmit HSV to the baby via the placenta if she contracts the infection for the first time in the first trimester. If a fetus is infected in this manner, the virus can give rise to a miscarriage or severe birth defects.

Will I require a C-section if I have herpes?

It depends, most of the time.

If you were infected initially with herpes before the third trimester or before becoming pregnant, and you do not present symptoms of a herpes outbreak (or a future outbreak) once the water breaks or labor starts, you’ll be able to labor and select a vaginal delivery.
In this case, the risk of the baby getting the infection is less than 1%, as stated by the CDC.

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That’s as the antibodies start to develop soon after you are first infected, and they are transmitted to the baby via the placenta. In 6 to 12 weeks, the baby will develop an immunity due to these antibodies, which provide the neonate protection if you are unknowingly shedding virus.

But, if you are having a herpes outbreak or symptoms of a future outbreak once the water breaks or when laboring, you will require an immediate C-section delivery. This happens if you present any visible sores on the vagina, cervix, or external genitals, and any symptoms, such as pain, burning or tingling, that sometimes indicate a future outbreak. (Presently, there are no fast and reliable means to test whether or not you are actually shedding virus.)

The only exception could be if you have symptoms or herpes lesions and the water breaks while the baby is still premature. In that circumstance, your doctor could try to delay the delivery to provide your baby with more time to develop. (In the meantime you could be treated with antiviral medication.)