Are varicella (chickenpox) titers required before pregnancy?

Varicella Titers Before Pregnancy: Assessment and Management

Varicella titers are not routinely required before pregnancy, but assessing immunity status is recommended for women planning pregnancy who lack evidence of immunity to varicella. 1

Determining Immunity Status

Evidence of immunity to varicella zoster virus (VZV) includes any of the following:

1. Documentation of 2 appropriately timed doses of varicella vaccine
2. Laboratory evidence of immunity or laboratory confirmation of disease
3. Varicella diagnosed by a healthcare professional or verification of history of varicella disease
4. History of herpes zoster diagnosed by a healthcare professional 1

Recommendations for Women Planning Pregnancy

For Women with Unknown Immunity Status:

• Prenatal screening for VZV immunity is recommended for pregnant adolescents and women 1
• If planning pregnancy, women without evidence of immunity should receive varicella vaccination before conception 2, 3
• After vaccination, women should avoid pregnancy for 1 month following each dose of the vaccine 1, 2

For Non-Immune Women:

• Complete the 2-dose vaccination series before pregnancy 1
• The second dose should be administered at least 28 days after the first dose 1

Important Considerations

Contraindications During Pregnancy:

• Varicella vaccine should NOT be administered during pregnancy due to theoretical risks to the fetus 1, 3
• Live attenuated vaccines are contraindicated during pregnancy 2

Post-Pregnancy Management:

• Non-immune women who were not vaccinated before pregnancy should receive the first dose of varicella vaccine before discharge from the hospital after delivery 1
• The second dose should be administered at least 28 days later 1
• Vaccination during breastfeeding is permitted 2

Exposure Management During Pregnancy:

• Pregnant women without immunity who are exposed to varicella should be considered for varicella zoster immune globulin (VARIZIG) 1, 4, 3
• VARIZIG should be administered as soon as possible, ideally within 96 hours of exposure, but can be given up to 10 days post-exposure 5
• VARIZIG administration during pregnancy is primarily to prevent complications in the mother rather than to protect the fetus 1

Clinical Pearls and Pitfalls

• Common Pitfall: Relying solely on patient-reported history of chickenpox without verification can lead to misclassification of immunity status. For atypical or mild cases, assessment by a physician is recommended 1

• Important Consideration: While varicella vaccination is contraindicated during pregnancy, inadvertent vaccination during pregnancy has not been associated with congenital varicella syndrome or patterns of birth defects 1, 2

• Risk Management: Pregnant women who develop varicella infection have increased risk of complications including pneumonitis and can transmit the virus to the fetus, potentially causing congenital varicella syndrome 6, 3

• Documentation: The antenatal varicella immunity status should be documented for all pregnant women to guide management in case of exposure 3