Zika Update for Pregnant People - Critical Information for Prevention & Exposure

By Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA), CLE

Though it's no longer the top news story (thank you, politics), the Zika virus still exists and continues to present a threat to healthy fetal development in pregnant people. In fact, The Centers for Disease Control and Prevention (CDC) just released a comprehensive, up-to-date report that describes the impact of the Zika virus on pregnant people and children since the mosquito-borne virus became a concern 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 pregnancies (which culminated either in live births or pregnancy losses) 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. A total 1,297 people living in 44 states were reported to the USZPR during the time period mentioned. The following information was gathered from the people reported:

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

Among the count of cases of Zika in the United States, most are travel related -- that is, the person contracted Zika from outside the U.S. or sexually from someone who acquired Zika outside the U.S. However, there is a small number of cases of Zika that is presumed to be from mosquitos in the United States -- 216 incidences coming out of South Florida in Miami-Dade County and 6 in Brownsville, Texas.

Prevention of Zika for Pregnant People

The following can be done to prevent Zika in pregnancy:

• Avoid travel to areas with Zika -- view the latest map
• Take steps to avoid getting Zika from sex, including using protection during vaginal, anal, and oral sex with those people who live in or travel to areas with Zika
• Prevent mosquito bites by covering more areas of your skin with long clothes, staying indoors, and wearing bug repellent

Screening, Testing, and Exposure to Zika in Pregnancy

Due to the continued threat of Zika and the high rate of birth defects seen so far, the CDC recommends that all pregnant people get screened by their health care provider at every prenatal appointment. Screening for Zika is simple and involves a question and answer exchange with your health care provider to determine if you may have been exposed.

If you or your health care provider believe you may have been exposed to Zika, it's important to seek further testing. Testing for Zika is done by taking blood and checking urine. Learn more about the types of tests done for Zika from the CDC.

If a parent has laboratory evidence of Zika during pregnancy, it is recommended that the infant be evaluated after birth for Zika-related effects. Early diagnosis helps to provide early care and intervention, which can be critical to the health and well being of the child. Infant testing includes a comprehensive physical exam and measurement of the head circumference. Further testing could include a neurologic exam and brain imaging. Continued monitoring of the baby's milestones and development is important. Testing of the placenta for evidence of Zika also should be considered.

If it is confirmed that your child has health issues related to exposure to Zika, it's important to work with your health care providers to create a coordinated, ongoing health care plan. The key to improved infant and child health is early diagnosis and intervention.

To learn more about all topics and questions related to Zika and pregnancy, I encourage you to visit the CDC Zika Virus website, where you will find a wealth of information to read on your own or to use in conjunction with a conversation with your health care provider at your next visit.