The CDC has issued interim guidelines for U.S. healthcare providers in caring for pregnant women in the wake of the recent Zika virus outbreak in Central and South America, as published in an early release of Morbidity and Mortality Weekly Report.
Maternal-fetal transmission of the mosquito-borne Zika virus has been documented, and the virus has been confirmed in infants with microcephaly. The CDC recommends that all pregnant women consider postponing travel to areas where Zika virus transmission is ongoing – including Central and South America, Mexico, Puerto Rico, and the Caribbean. Pregnant women who do travel to these areas should focus on preventing mosquito bites.
It is estimated that 80% of people who are infected with Zika virus are asymptomatic; severe disease is uncommon and fatalities are rare. Those who do exhibit symptoms typically present with the acute onset of fever, maculopapular rash, arthralgia, or nonpurulent conjunctivitis, which can last from several days to 1 week.
“Mosquitoes that spread Zika virus bite both indoors and outdoors,” wrote Emily E. Petersen, MD, of the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion at the CDC. “It is important to ensure protection from mosquitoes throughout the entire day.”
The CDC urges healthcare providers to check in with all pregnant patients regarding recent travel. Women who have traveled to an area with current Zika virus transmission should be evaluated for the infection and tested. If evidence of Zika virus exists in either serum or amniotic fluid, serial ultrasounds should be used to monitor fetal anatomy and growth every 3 to 4 weeks. No vaccines, prophylactic medications, or antiviral treatment is currently available to prevent Zika virus infection.
Prevention recommendations are as follows:
- Wearing long-sleeved shirts and long pants
- Using Environmental Protection Agency (EPA)-registered insect repellents
- Using permethrin-treated clothing and gear, and
- Staying and sleeping in screened-in or air-conditioned rooms.
In the event of a live birth with evidence of maternal or fetal Zika virus infection, the CDC recommends the following tests:
- Histopathologic examination of the placenta and umbilical cord
- Testing of frozen placental tissue and cord tissue for Zika virus RNA
- Testing of cord serum for Zika and dengue virus IgM and neutralizing antibodies.
Treating pregnant women with diagnoses of Zika virus:
- Rest, fluids, or use of analgesics and antipyretics
- Treat fever with acetaminophen
- Aspirin and other nonsteriodal anti-inflammatory drugs should be avoided until dengue is ruled out to avoid hemorrhage risk
- If laboratory evidence of Zika virus exists, refer patients to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management.
- Peterson EE, Staples JE, Meaney-Delman D, et al. Interim guidelines for pregnant women during a Zika virus outbreak – United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1-4. doi: 10.15585/mmwr.mm6502e1er