What is the treatment for hand, foot, and mouth disease (HFMD) in pregnancy?

Treatment of Hand, Foot, and Mouth Disease in Pregnancy

The treatment of hand, foot, and mouth disease (HFMD) during pregnancy is primarily supportive care, focusing on symptom management as the condition is typically self-limiting and resolves within 7-10 days without specific antiviral therapy.

Diagnosis

Hand, foot, and mouth disease during pregnancy is primarily a clinical diagnosis based on:

• Characteristic vesicular rashes on hands and feet
• Oral aphthae or vesicles
• Mild fever and malaise

Laboratory confirmation when needed:

• Direct viral detection from vesicle fluid (68.7% sensitivity) is more effective than serological testing (1.9% sensitivity) 1
• PCR testing of vesicle fluid is the most reliable diagnostic method

Treatment Approach

First-Line Management: Supportive Care

1. Pain Management

   • Acetaminophen (paracetamol) for pain and fever control
   • Avoid NSAIDs during pregnancy, especially in the third trimester
   • Consider consultation with pain specialists for severe cases 2

2. Hydration and Nutrition

   • Encourage adequate fluid intake
   • Cold, soft foods and liquids if oral pain is significant
   • Avoid acidic, spicy, or salty foods that may irritate oral lesions

3. Oral Care

   • Salt water rinses (1/2 teaspoon salt in 1 cup warm water)
   • Avoid commercial mouthwashes containing alcohol
   • Ice chips or popsicles to soothe oral discomfort

4. Skin Care

   • Keep lesions clean and dry
   • Daily washing with mild antibacterial products to prevent secondary infection 2
   • Topical calamine lotion for itching if present

Management of Complications

1. Secondary Bacterial Infection

   • Monitor for signs of secondary infection (increased redness, swelling, purulent discharge)
   • If infection is suspected:
     • Obtain bacterial and viral swabs of affected areas 2
     • Consider short-term topical antimicrobials
     • For systemic signs of infection, oral clindamycin is the preferred antibiotic during pregnancy 2
     • Avoid doxycycline due to risk of congenital anomalies and tooth discoloration 2

2. Severe Disease

   • Hospitalization may be necessary for severe cases with complications 2
   • Multidisciplinary approach involving obstetrics, maternal-fetal medicine, and infectious disease specialists 2

Monitoring and Follow-up

1. Maternal Monitoring

   • Regular assessment of symptoms and disease progression
   • Monitor for neurological symptoms (rare but serious complications include meningoencephalitis) 3
   • Watch for signs of dehydration if oral intake is compromised

2. Fetal Monitoring

   • While data on fetal outcomes are limited and not conclusive, prudent monitoring throughout gestation is recommended 1
   • Regular obstetric care with standard fetal assessments
   • No specific additional monitoring is required unless maternal condition deteriorates

Prognosis and Expectations

• Most cases resolve spontaneously within 7-10 days without complications 3
• Onychomadesis (nail shedding) may occur as a delayed complication but is benign and not associated with adverse pregnancy outcomes 4
• Limited evidence suggests that most pregnancies affected by HFMD result in normal outcomes 5, 1

Prevention Measures

• Frequent handwashing with soap and water
• Avoid close contact with infected individuals
• Disinfection of contaminated surfaces
• Avoid touching eyes, nose, and mouth with unwashed hands

Special Considerations

• No specific antiviral therapy is currently approved for HFMD 3
• EV-A71 vaccines exist but are only available in China and not specifically indicated during pregnancy 3
• The disease appears to be increasingly affecting adults, including pregnant women, so awareness is important 6

Remember that while HFMD is typically mild and self-limiting, close monitoring is essential during pregnancy to ensure both maternal and fetal wellbeing.