Medical & Science·12 min read·March 17, 2026

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.

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 the vast majority of people with HSV have healthy pregnancies and healthy babies. Neonatal herpes, while serious, is rare and preventable with proper medical management.

Approximately 25 to 30 percent of pregnant people in the United States have genital herpes, and the overwhelming majority of them deliver healthy babies without complications. The key is working with a healthcare provider who understands HSV management during pregnancy and following established guidelines.

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 is transmitted to the baby, typically during delivery. Neonatal herpes is rare, affecting an estimated 1 in 3,000 to 1 in 20,000 live births in the United States, depending on the source.

The risk is highest when the mother acquires a new herpes infection during the third trimester. In this scenario, the mother has not yet developed antibodies that would provide some protection to the baby, and there may be active viral shedding during delivery. The transmission rate in this situation can be as high as 30 to 50 percent.

For mothers who had herpes before pregnancy (a recurrent infection), the risk of neonatal transmission is much lower, estimated at less than 1 percent with appropriate management. This is because maternal antibodies cross the placenta and provide some protection to the baby, and because recurrent infections involve lower levels of viral shedding than primary infections.

Antiviral Therapy During Pregnancy

Current guidelines from the American College of Obstetricians and Gynecologists (ACOG) recommend daily suppressive antiviral therapy starting at 36 weeks of pregnancy for women with a history of genital herpes. This reduces the risk of an outbreak at the time of delivery and decreases the likelihood of a cesarean section being needed.

Acyclovir and valacyclovir are both considered safe for use during pregnancy. They have been studied extensively in pregnant populations, and the available data shows no increased risk of birth defects or other adverse outcomes. Your healthcare provider can help you decide which medication and dosing schedule is appropriate.

If you acquire a new herpes infection during pregnancy, antiviral treatment may be started earlier and at higher doses. This is a situation that requires close medical supervision, particularly if the new infection occurs in the third trimester.

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Delivery Considerations

If you have an active genital herpes outbreak or prodromal symptoms (tingling, itching, or pain that precedes an outbreak) at the time of labor, your healthcare provider will likely recommend a cesarean section to reduce the risk of transmission to the baby during vaginal delivery.

If there are no active lesions or prodromal symptoms at the time of delivery, vaginal delivery is generally considered safe, particularly for women with recurrent (not newly acquired) herpes. The suppressive antiviral therapy started at 36 weeks significantly 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.

Precautions in serodiscordant couples during pregnancy include consistent condom use, the infected partner taking daily suppressive antiviral therapy, and avoiding sexual contact during outbreaks. Some couples choose to abstain from intercourse during the third trimester to eliminate the risk of new infection entirely.

If you are unsure of your herpes status, discuss type-specific testing with your healthcare provider early in pregnancy. Knowing your status allows for appropriate planning and risk management.

After Delivery: Protecting Your Newborn

After birth, the main concern is preventing direct contact between herpes lesions and the newborn. If you have an active oral herpes outbreak (cold sore), avoid kissing the baby until the sore has completely healed. Wash your hands thoroughly before handling the baby, especially if you have touched any lesions.

Breastfeeding is safe as long as there are no herpes lesions on the breasts. If a lesion is present on the breast, avoid nursing from that side until it heals, but you can continue from the other breast.

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 does not affect fertility, and it should not discourage you from becoming a parent. With proper medical management, the risks to the baby are very small. Millions of people with HSV have healthy pregnancies and healthy children.

The Oath community includes many parents and parents-to-be who have navigated pregnancy with herpes successfully. You are not alone in this journey, and the medical tools to protect your baby are well-established and effective.

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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