Question: What’s the deal with Zika virus in pregnancy?
Answer: The Zika virus is causing quite a stir these days in the already exciting world of obstetrics and gynecology.
News has spread quickly about this virus — which causes microcephaly and stillbirth — since the 2015 outbreak struck much of South America. Fortunately, a robust amount of new research and guidance is available daily to health care providers from the Centers for Disease Control and Prevention, the Pan-American Health Organization, academic centers, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists.
Zika virus is a flavivirus spread through mosquito bites from a specific type of mosquito called the Aedes aegypti. It is the same species that is known to carry yellow fever. This mosquito is not found in the northern U.S. Most people have no symptoms from Zika virus, but one in five have some mild symptoms.
These symptoms are non-specific. Some of the symptoms are fever, rash, joint inflammation and conjunctivitis. Current testing for Zika virus is done through the state health department and the CDC. Currently, there is no vaccination against and no known treatment for Zika virus.
Zika virus is associated with several birth defects, but is most commonly known for an association with significant microcephaly. Microcephaly is a disorder of neurodevelopment with a degree of variability between cases. The most widely used definition is a head circumference measurement that is more than two standard deviations below the mean.
Vertical transmission rates, as well as the rates that major complications are seen among infected fetuses, are unknown. Also unknown is the incidence of Zika virus among pregnant patients living in, or traveling to, endemic areas.
Feb. 12, the American College of Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine published “Practice Advisory: Updated Interim Guidance for Care of Obstetric Patients And Women Of Reproductive Age During a Zika Virus Outbreak.” This can guide physicians caring for women to be able to manage these issues in a consistent manner nationwide and to maintain a registry of cases to continually improve understanding of this virus.
This publication advises the following prevention guidance:
Avoiding exposure is best. Pregnant women should delay travel to areas where Zika outbreaks are ongoing, when possible. Women considering pregnancy should discuss with their obstetric providers the advisability of travel. See the CDC and PAHO websites for updated lists of affected countries.
When traveling to areas where Zika has been reported, women should take all precautions to avoid mosquito bites, including the use of EPA-approved bug spray with DEET, covering exposed skin, staying in air-conditioned or screened-in areas, and treating clothing with permethrin.
Guidelines have also been established for the evaluation and management of pregnant women with a history of travel to, or residing in, an area with ongoing Zika virus transmission. This includes the recommendation that women of reproductive age desiring pregnancy follow precautions for Zika virus prevention. For women not planning a pregnancy, it is most recommended to use abstinence, as there is a possible sexual mode of transmission in a small number of cases.
Barrier contraceptives may prevent transmission, but this is not known. It is recommended that women of reproductive age with plans to travel to, or coming from, endemic areas of Zika virus consult their OB/GYN or other women’s health provider to discuss preconception or post-exposure strategies.
Dr. William Leach is an obstetrician/gynecologist with HFM Women’s Health.
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