What is the management of hand, foot, and mouth disease in a pregnant patient?

From the Guidelines

Hand, foot, and mouth disease in pregnant patients should be managed with supportive care, focusing on symptom relief and hydration, as the condition is typically self-limiting. The primary goal is to alleviate symptoms and prevent complications, with an emphasis on maintaining adequate hydration and managing pain and fever.

• Treatment options include:
  • Acetaminophen (500-1000 mg every 6 hours, not exceeding 4000 mg daily) for fever and pain relief, which is considered safe during pregnancy 1.
  • Topical oral anesthetics like viscous lidocaine (2%, applied to oral lesions as needed) to manage painful mouth sores.
  • Cold liquids, popsicles, and soft foods to minimize oral discomfort.
• It is essential to avoid NSAIDs, particularly in the third trimester, due to potential fetal complications, as recommended by the American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases 1.
• Pregnant women should be monitored for dehydration and secondary infections, although the risk of vertical transmission to the fetus is low.
• Good hand hygiene and avoiding close contact with infected individuals are crucial preventive measures.
• Most patients recover completely within 7-10 days without specific antiviral therapy, and the focus should remain on supportive care and symptom management.

From the Research

Management of Hand, Foot, and Mouth Disease in Pregnant Patients

• The management of hand, foot, and mouth disease (HFMD) in pregnant patients is primarily supportive, focusing on hydration and pain relief 2.
• Treatment may include the use of acetaminophen or ibuprofen for pain and fever management, but oral lidocaine is not recommended 2.
• Antiviral treatment is not available for HFMD 2, 3.

Prevention of HFMD

• The best methods to prevent the spread of HFMD are handwashing and disinfecting potentially contaminated surfaces and fomites 2.
• Vaccines, such as the inactivated Enterovirus A71 (EV-A71) vaccine, have been approved and shown to provide a high level of protection against EV-A71-related HFMD, but their effectiveness may be limited by the simultaneous circulation of multiple pathogens 3, 4.

Complications in Pregnant Patients

• HFMD can lead to severe complications, including neurological and cardiopulmonary sequelae, although these are rare 5, 3, 4.
• A case report described a pregnant woman who developed pseudomembranous conjunctivitis associated with HFMD, which was treated with topical steroids and removal of the pseudomembrane 5.

Clinical Considerations

• HFMD is typically a self-limited illness, but pregnant patients should be closely monitored for any signs of complications 2, 6.
• The diagnosis of HFMD should be considered in pregnant patients presenting with fever, oral ulcers, and skin manifestations affecting the palms, soles, and buttocks 2, 6.