Advising Pregnant Women About Zika: The Latest Guidance From CDC

Titilope Oduyebo, MD, MPH

Disclosures

February 17, 2016

Editorial Collaboration

Medscape &

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Hello. I am Dr Titilope Oduyebo, an obstetrician-gynecologist with the Pregnancy and Birth Defects Team for CDC's 2016 Zika Virus Response. Over the next few minutes, I will discuss what we know about Zika virus infection during pregnancy and review the current CDC recommendations for the screening, testing, and management of women with possible Zika virus exposure.

Currently, data on pregnant women infected with Zika virus are limited. Data suggest that pregnant women can be infected with Zika virus in any trimester; however, the incidence of Zika virus infection in pregnant women is not known.[1-3] There is no evidence to suggest that pregnant women are more susceptible to Zika virus or experience more severe disease than nonpregnant individuals.

With respect to Zika virus transmission, there is evidence of transmission of Zika virus from mother to fetus during pregnancy and also around the time of delivery.[1-3] Because neither a vaccine nor a prophylactic medication is available to prevent Zika virus infection, CDC recommends that pregnant women in any trimester should consider postponing travel to areas with ongoing Zika virus transmission. If a pregnant woman lives in or travels to an area with Zika virus transmission, she should strictly follow steps to avoid mosquito bites.

Strategies to avoid mosquito bites are multifaceted. CDC recommends the use of EPA-registered insect repellents, such as DEET, picaridin, and IRIR3535. These insect repellants are considered safe for use in pregnancy when used in accordance with the package label. Other strategies include wearing long-sleeved shirts and pants to cover exposed skin, wearing permethrin-treated clothing, and staying and sleeping in screened-in or air-conditioned rooms. Because the mosquitos that transmit Zika virus bite mostly during the daytime, it is recommended that pregnant women practice these strategies throughout the entire day.[4,5]

I would like to briefly review CDC's updated interim guidelines for healthcare providers caring for pregnant women and women of reproductive age with possible Zika virus exposure, which were published on February 5, 2016, in CDC's Morbidity and Mortality Weekly Report.[6] CDC updated its interim guidelines for US healthcare providers caring for pregnant women during a Zika virus outbreak. As in the original guidance, pregnant women with a history of travel to an area with Zika virus infection and who have symptoms consistent with Zika virus disease (which include fever, rash, joint pain, and red eyes) should be prioritized for testing for Zika virus infection. The updated guidelines include a new recommendation to offer serologic testing to pregnant women with a history of travel to an area with ongoing Zika virus transmission and who are asymptomatic (meaning they do not report clinical illness consistent with Zika virus disease). Testing should be performed 2-12 weeks after travel. Although we have limited information about antibody testing of asymptomatic persons, data from related viruses suggest that this testing may be useful when the timeframe of exposure is known.

The updated guidelines also provide guidance to healthcare providers caring for women living in areas with ongoing Zika virus transmission and include recommendations for screening, testing, and management of pregnant women and recommendations for counseling women of reproductive age (15-44 years). Pregnant women who reside in areas with ongoing Zika virus transmission have an ongoing risk for infection throughout pregnancy. Thus, in pregnant women with clinical illness consistent with Zika virus disease, testing is recommended during the first week of illness. In addition, testing is recommended at the initiation of prenatal care with follow-up testing at mid–second trimester for asymptomatic pregnant women living in areas with ongoing Zika virus transmission. Local health officials should determine when to implement testing of these pregnant women based on information about levels of Zika virus transmission and laboratory capacity. Healthcare providers should discuss reproductive life plans, including pregnancy intention and timing, with women of reproductive age in the context of the potential risks associated with Zika virus infection.

For more detailed information about CDC's recommendations, please read CDC's "Updated Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure." CDC's guidance will be updated as we learn more. For more information about Zika virus, visit www.cdc.gov/zika.

Titilope Oduyebo, MD, MPH , is an obstetrician-gynecologist completing an Epidemic Intelligence Service (EIS) fellowship at the Centers for Disease Control and Prevention. Dr Oduyebo completed internship and residency training at the Brigham and Women's Hospital and Massachusetts General Hospital. She earned her MD from Yale University School of Medicine, MPH from Johns Hopkins School of Public Health, and BS from University of Maryland, College Park.

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