Varicella Infection in Pregnancy

Varicella (chickenpox) is a common childhood illness. Most adults are immune to the virus because of previous exposure. Pregnant women who contract varicella risk complications such as pneumonia. Varicella may be transmitted from mother to fetus and could cause congenital varicella syndrome or perinatal infection. Susceptibility to varicella should be determined before pregnancy. Varicella zoster immune globulin may be considered for the mother or newborn if exposure occurs. Acyclovir may decrease the risk of maternal complications from infection.     

Results of Microbial Testing Exploring the Etiology of Deep Breast Pain During Lactation: A Systematic Review and Meta‐analysis of Nonrandomized Trials

Introduction: Controversy over the etiology of deep or burning breast pain during lactation continues to persist, despite a long history of published studies and case reports. This article reviews the literature exploring the etiology of deep breast pain, summarizes the results, and identifies possible explanations for the controversies surrounding this disorder. Methods: A clinical query and a librarian‐assisted search of MEDLINE were used to find articles published between 1896 and 2010. Inclusion criteria consisted of comparing microbial testing results from symptomatic and asymptomatic lactating women. Cases were restricted to those experiencing deep or burning breast pain when possible. Results: Prospective studies consisting of 1 unmatched case‐control and 6 cohorts were found. Trials typically detected higher microbial levels in the milk or nipple(s) or both of symptomatic women, irrespective of the detection method or type and range of microbes (bacterial, yeast, or fungal) studied. Case milk samples were positively associated with finding Staphylococcus aureus (relative risk ratio [RR] 7.29; 95% confidence interval [CI], 3.25‐16.36) or Candida (RR 8.45; 95% CI, 3.96‐18.06). Moreover, recent reports about small‐colony variants and biofilm‐producing organisms may explain the atypical symptoms unique to this disorder. Discussion: In lactating women reporting deep breast pain, evidence consistent with infection is persistently found, and explanations exist for the disorder’s atypical characteristics. Although lactating women with deep breast pain are more likely to test positive for Candida, the risk of testing positive for S aureus is also present. Thus, these women should have cultures done. Management options include treating immediately while awaiting results or waiting until results are available to guide treatment. With either approach, providers must consider the risk of falsely negative tests.     

Pregnancy and Lactation following Anorexia and Bulimia

Ten years after her battle with anorexia nervosa and bulimia began, a 26-year-old woman restored her normal body weight to 102 pounds from a low of 47 pounds (21.3 kilograms), became pregnant, delivered a healthy infant at term, and was successfully breastfeeding at five months. Her dietary intake, which was computer analyzed and compared with the recommended dietary allowances for pregnancy and lactation, revealed few nutrient deficiencies. Ample pregnancy weight gain provided an energy reserve for lactation.