Just two years ago, Zika infections, microcephaly, and potential brain damage in the newborn were hardly topics that came up often in the standard childbirth education class. Childbirth educators and other birth professionals did not prepare to speak on these topics in their classes, nor did parents ask questions about them. Today, the reality is that Zika is mentioned several times during my class series and pregnant people are typically being screened each time they visit their health care provider. Today's childbirth educator needs to be informed, prepared to answer questions and have some resources in their pocket for more information on the Zika virus if needed.

The Centers for Disease Control and Prevention just released a comprehensive, up to date report that captures and speaks to the impact of the Zika virus on pregnant people and children since this mosquito-borne virus became a concern here in the United States. Vital Signs: Update on Zika Virus-Associated Birth Defects and Evaluation of All U.S. Infants with Congenital Zika Virus Exposure - U.S. Zika Pregnancy Registry, 2016 includes an analysis of completed pregnancies (which include live births and pregnancy losses, regardless of gestational age) in the 50 U.S. states and the District of Columbia (DC) with laboratory evidence of possible recent Zika virus infection reported to the U.S. Zika Pregnancy Registry (USZPR) from January 15 to December 27, 2016. The USZPR is an enhanced national surveillance system to monitor pregnancy and fetal/infant outcomes among pregnancies with laboratory evidence of possible recent Zika virus infection. There were 1,297 people who were reported to the USZPR during the period encompassed by the report. They lived in 44 states.

Some facts on rate of Zika-associated birth defects

• 5% of fetuses/infants of a pregnant parent who had a laboratory evidence of possible recent Zika virus infection were determined to have Zika-associated birth defects.
• 10% of fetuses/infants of a pregnant parent who had a laboratory-confirmed Zika virus infection were determined to have Zika-associated birth defects.
• 15% of fetuses/infants of a pregnant parent who had a laboratory-confirmed Zika virus infection in the first trimester were determined to have Zika-associated birth defects.
• 51% of the fetuses/infants affected by birth defects had brain abnormalities and/or microcephaly.

The proportion of fetuses and infants with birth defects among pregnancies with confirmed Zika virus infection at any time during pregnancy was more than 30 times higher than the baseline prevalence in the pre-Zika years, and as mentioned above, a higher proportion of those with first trimester infections had birth defects. It is clear that fetuses and infants are most vulnerable to birth defects when the parent is infected by the Zika virus during the first trimester.

Recommendations

It is clear from this analysis that the Zika virus infection is a serious risk for birth defects. Pregnant people are urged to avoid any Zika virus exposure. The Centers for Disease Control and Prevention recommends that all pregnant people be screened for possible Zika virus exposure at every prenatal visit. Infants born to a parent with laboratory evidence of Zika virus infection should be tested for exposure. Children with findings that potentially suggest congenital Zika syndrome should be tested regardless of maternal testing results to determine possible transmission. The initial evaluation of infants should include a comprehensive physical examination, including a neurologic examination, postnatal neuroimaging, and standard newborn hearing screen. Additional evaluation might be considered based on clinical and laboratory findings, however routine developmental assessment is recommended as part of pediatric care. It is suspected that infants born to parents who were determined to have laboratory evidence of possible Zika exposure are not receiving the recommended evaluation. It is important to identify all infants who are affected so that appropriate intervention services are available as early as possible. The CDC is working with public health officials, health care providers and others to be sure that everyone is aware of recommendations and best practice.

If you would like additional information and want to understand what the screening should look like for pregnant people at every prenatal appointment, check out the CDC's Zika Screening Tool for Pregnant Women. The CDC also has created an interactive world map of areas at risk of Zika.

People teaching childbirth education need to be prepared to respond to questions and concerns from families and refer them to their health care provider for more information. Currently, there is no vaccine to prevent the Zika infection. The Zika virus can be passed through sexual contact with an infected partner, and both male and female condoms reduce the chance of passing on the infection. Planning to avoid travel to high-risk areas is recommended, but be aware that the Zika virus has been determined to be present in the continental USA. Pregnant people with any suspected symptoms need to contact their provider as soon as possible. The most common symptoms of Zika are:

• Fever
• Rash
• Headache
• Joint pain
• Conjunctivitis (red eyes)
• Muscle pain

Are you covering information on the Zika virus in your classes and with your clients? Are the families you work with asking questions and expressing concern? Unfortunately, Zika prevention and awareness is a fact of life for all people, and especially those who are pregnant or planning to become pregnant. Let us know your thoughts in the comments below.

References

Reynolds MR, Jones AM, Petersen EE, et al. Vital Signs: Update on Zika Virus-Associated Birth Defects and Evaluation of All U.S. Infants with Congenital Zika Virus Exposure - U.S. Zika Pregnancy Registry, 2016. MMWR Morb Mortal Wkly Rep 2017;66:366-373. DOI: http://dx.doi.org/10.15585/mmwr.mm6613e1

Photo source - Zika mosquito - Muhammad Mahdi Karim

Published: April 13, 2017

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