Drug and Therapeutics Bulletin (DTB) is reminding doctors of the risks chickenpox can pose to pregnant women and their babies.

In most women, chickenpox in pregnancy causes no lasting harm to them or their baby. However, up to 14 per cent of pregnant women with the infection develop pulmonary involvement, with potentially fatal pneumonia in severe cases.

Also, up to 1.4 per cent of babies exposed to chickenpox infection in the first 28 weeks of pregnancy develop the potentially fatal condition fetal varicella syndrome, which is characterised by problems such as skin loss and scarring, underdevelopment and/or weakness of limbs and a reduced birth weight. And some babies exposed to their mother's chickenpox infection around the time of delivery go on to develop varicella infection of the newborn.

Pregnant women who have definitely had chickenpox are immune to getting the infection again. Also, their babies will be protected during pregnancy by antibodies that have been transferred from the mother.

Pregnant women who have never had chickenpox should avoid exposure to people with chickenpox or shingles and should seek urgent medical attention if such exposure does occur. Prompt treatment with varicella-zoster immunoglobulin (VZIG) can help prevent or reduce the severity of infection in such women. VZIG also needs to be given to those newborn infants at risk of having received inadequate transfer of protective antibodies from their mothers.

Other important aspects of care include giving the antiviral drug aciclovir to pregnant women who develop complications of chickenpox or newborn babies with chickenpox or whose mothers develop the chickenpox rash between 4 days before and 2 days after delivery.

Dr Ike Iheanacho, editor, DTB:
“It is crucial that healthcare professionals remain alert to the dangers of chickenpox infection during and following pregnancy. By doing so, they can help to ensure women and their babies receive prompt, appropriate care to tackle and minimise these risks.”

In the bag for Gps - a summary of the DTB article on suggested medicines GPs should carry in case of emergency while on home visits and the storage of such medicines.

Many GPs have given up responsibility for out-of-hours services, due to alternative provision by primary care trusts. However, there remains a need for many GPs to carry an appropriately stocked bag for dealing with acute situations when on home visits. So continuing its long-running series on Drugs for the doctor's bag, DTB offers practical suggestions on what should be carried for treating adult patients in a range of key clinical scenarios, including the following:

_ acute pain
_ opioid overdose
_ nausea and vomiting
_ asthma
_ infection
_ diabetic emergencies
_ myocardial infarction and angina
_ acute left ventricular failure
_ psychiatric emergencies
_ seizures
_ bleeding
_ anaphylaxis
_ hypoadrenalism.