To assess the association between maternal herpes zoster (HZ) during pregnancy, either before or after 20 weeks of gestation, and adverse neonatal outcomes, as well as neurodevelopmental disorders in offspring.

This nationwide, retrospective cohort study analyzed data from the National Health Insurance Research Database in Taiwan between 2017 and 2020. Among 630 456 eligible singleton pregnancies, 2922 (0.46%) children were born to women diagnosed with HZ during pregnancy. The primary outcomes were adverse neonatal outcomes, including preterm delivery, low birth weight, low Apgar scores, and congenital defects. The secondary outcome was the diagnosis of a neurodevelopmental disorder within the first 2 years of life. Multivariable logistic regression models were used to evaluate the association between maternal HZ and adverse outcomes, with stabilized inverse probability of treatment weighting employed as a sensitivity analysis to confirm robustness.

After adjusting for maternal age, socioeconomic deprivation, and gestational status using multivariable regression models, no significant associations were found between maternal HZ during pregnancy and adverse neonatal outcomes or neurodevelopmental disorders. Sensitivity analyses with stabilized inverse probability of treatment weighting yielded similar results. Furthermore, maternal HZ diagnosed before or after 20 weeks of gestation was not significantly associated with an adverse neonatal outcome or neurodevelopmental disorder.

Maternal HZ during pregnancy, even before 20 weeks of gestation, was not associated with increased odds of adverse neonatal outcomes or neurodevelopmental disorders within the first 2 years of life. These findings reassure clinicians and pregnant women that an episode of HZ during pregnancy is highly unlikely to affect neonatal health or early neurodevelopment.