Herpes and Pregnancy: What Expecting Parents Should Know
A thorough guide to managing herpes during pregnancy, including transmission risks to the baby, delivery considerations, antiviral therapy, and what to discuss with your OB-GYN.
By Kind Dating · Community perspective and general information.
Herpes and Pregnancy: The Essential Overview
If you have herpes and are pregnant or planning to become pregnant, the most important thing to know is that most people with genital herpes have healthy pregnancies and healthy babies. Neonatal herpes is serious but rare, and proper medical management lowers the risk further.
ASHA estimates that about 20 to 25 percent of pregnant women have genital herpes, while fewer than 0.1 percent of babies born in the United States each year get neonatal herpes. In other words, most people with genital herpes give birth to healthy babies. CDC also notes that some research suggests genital herpes may be linked to miscarriage or early delivery, which is one more reason prenatal care visits matter.
This article covers the major considerations, but it is not a substitute for personalized medical advice. Every pregnancy is different, and your OB-GYN or midwife is your best resource for guidance specific to your situation.
Risk of Transmission to the Baby
The primary concern with herpes during pregnancy is neonatal herpes, which occurs when the virus passes to the baby, usually during delivery. It is rare: the WHO estimates it occurs in about 10 of every 100,000 births worldwide. But it is serious, which is why prevention matters.
The risk is highest when the mother acquires genital herpes near the time of delivery. A newly infected mother has not yet developed antibodies that would give the baby some protection, and a new infection is more likely to be active during birth. CDC puts the risk of transmission to the baby in this situation at 30 to 50 percent.
For mothers who had herpes before pregnancy, or who acquired it in the first half of pregnancy, CDC puts the risk at less than 1 percent. ASHA explains that the mother's antibodies pass to the baby through the placenta and help protect the baby even if the virus is active during delivery.
Antiviral Therapy During Pregnancy
CDC treatment guidelines recommend daily suppressive antiviral therapy starting at 36 weeks of pregnancy for people with recurrent genital herpes. CDC notes this reduces cesarean deliveries by reducing outbreaks at term, although it might not prevent every transmission to newborns. The American College of Obstetricians and Gynecologists (ACOG) also publishes guidance on herpes in pregnancy; your OB-GYN or midwife can tell you which medicine and dose is right for you.
CDC says acyclovir is believed to be safe during all trimesters of pregnancy and during breastfeeding. Data for valacyclovir and famciclovir in pregnancy are more limited, although animal data suggest low risk. One case-control study reported a higher risk of a rare birth defect (gastroschisis) with antiviral use around conception and in early pregnancy, so discuss the timing and choice of medicine with your provider.
If you acquire a new herpes infection during pregnancy, especially in the second half, CDC advises care in consultation with maternal-fetal medicine and infectious disease specialists. This is a situation that requires close medical supervision.
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If you have an active genital herpes outbreak or warning signs of one (such as tingling, itching, or pain where sores usually appear) when labor starts, your healthcare provider will likely recommend a cesarean section to reduce the risk of transmission to the baby during vaginal delivery. CDC advises that everyone be asked about symptoms and examined for lesions at the onset of labor.
If there are no lesions or warning symptoms at the time of delivery, CDC says vaginal delivery is appropriate. The suppressive antiviral therapy started at 36 weeks reduces the chance of an outbreak being present at the time of labor.
The decision between vaginal delivery and cesarean section should be made in consultation with your healthcare team, taking into account your specific history, the type and timing of your herpes infection, and whether you are currently experiencing any symptoms.
What Your Partner Should Know
If you do not have herpes but your partner does, preventing acquisition during pregnancy is important. The third trimester is the highest-risk period for new infection because a primary outbreak near delivery poses the greatest risk to the baby.
CDC advises pregnant people without known genital herpes to avoid vaginal sex during the third trimester with a partner who has or may have genital herpes, and to avoid receiving oral sex in the third trimester from a partner who has or may have oral herpes, to prevent genital HSV-1. Earlier in pregnancy, consistent condom use and the partner taking daily suppressive therapy can lower the risk.
If you are unsure of your herpes status, talk with your provider. Routine herpes screening in pregnancy is not recommended, but CDC notes that a type-specific blood test can be useful, for example for someone with no history of genital herpes whose partner has it.
After Delivery: Protecting Your Newborn
After birth, the main concern is preventing direct contact between herpes sores and the newborn. If you have a cold sore, do not kiss the baby until it has healed, and wash your hands before touching the baby, as ASHA advises.
ACOG says you can breastfeed in most cases, because herpes is not passed through breast milk. Cover any sores the baby could touch, wash your hands before and after feeding, and do not breastfeed from a breast that has a sore until it heals.
Educate family members and visitors as well. Anyone with an active cold sore should not kiss the newborn. Neonatal herpes can be acquired from any carrier, not just the mother. Awareness and basic precautions in the early weeks of life are important for all newborns.
Planning for Pregnancy with HSV
If you have herpes and are planning to become pregnant, the best time to discuss it with your healthcare provider is before conception. Early planning allows your provider to establish a management strategy, discuss antiviral therapy, and address any questions or concerns you have.
Having herpes should not discourage you from becoming a parent. With proper medical management, the risks to the baby are very small, and most people with genital herpes have healthy babies.
You are not alone in this, and the medical tools to protect your baby are well established. Bring your questions to your OB-GYN or midwife early.
Sources
- Genital Herpes: Sexually Transmitted Infections Treatment Guidelines, 2021 — Centers for Disease Control and Prevention
- About Genital Herpes — Centers for Disease Control and Prevention
- Genital Herpes and Pregnancy — American Sexual Health Association
- Genital Herpes (patient FAQ) — American College of Obstetricians and Gynecologists
- Herpes simplex virus (fact sheet) — World Health Organization
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis, treatment, and answers to your personal health questions. Statistics cited are from publicly available sources including the WHO and CDC and may be updated as new research becomes available.
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