Zika Virus: Everything Pregnant Women Should Know

If you're pregnantor trying to conceivethe Zika virus is probably a top-ofmind concern right now, and with good reason: This mosquito-borne virus is
dominating headlines with its scary multi-country advance and potentially
devastating consequences for pregnant women and their babies.
Zika surfaced just over a year ago in South America, and Brazil has been
disproportionately affected, with thousands of babies suffering severe birth
defects, including brain damage, in utero when their mothers contracted the
virus. But it has now spread to more than three dozen countries and
territories in the Americas, and has recently landed in the United States
(although it's important to note that these U.S. cases were brought by
returning travelers from affected regions). According to the Centers for
Disease Control and Prevention (CDC), 168 pregnant women in the US and
the District of Columbia have been diagnosed with Zika and another 142
have been identified in the US territories, which includes the US Virgin
Islands and Puerto Rico.
Per the CDC, mosquitoes in the continental United States or Hawaii
have not spread Zika. However, lab tests have confirmed Zika virus in
travelers returning to the United States. These travelers have gotten the
virus from mosquito bites and some non-travelers got Zika through sex with
a traveler. Cases of local transmission have been confirmed in three US
territories: Puerto Rico, the US Virgin Islands, and American Samoa.
The virus is likely to spread further, according to the World Health
Organization (WHO), because the mosquito that transmits Zika is in all but
two countries of the Americas, and the people in these regions lack
immunity to the virus.
If you're expecting (and frankly, even if you're not), it's crucial to arm
yourself with information and up-to-date advice. This is what you need to
know:
What is Zika virus?
The Zika virus is an insect-borne illness that can be primarily transmitted by
infected Aedes mosquitoes, the same kind that carry dengue and yellow
fever. The name comes from the Zika Forest in Uganda where monkeys with
the virus were first found in 1947.
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Why is it dangerous?
For the relatively few people who show signs of a Zika infection, the illness
is often very mild. But in pregnant woman, the effects can be devastating,
and can include pregnancy loss or a baby born with an abnormally small
head and braina condition known as microcephaly, says Edward R.B.
McCabe, M.D., Ph.D., Senior Vice President and Chief Medical Officer of the
March of Dimes. Microcephaly may be associated with developmental
delays, mental retardation, and seizures, and in some cases can be fatal.
Until recently, Zika virus had only been associated with significant risk to
the fetusit wasnt established that the effects were actually caused by
it. But now the news has changed and health officials can report a direct link
between Zika and microcephaly. Still, there are many unknownsincluding
how likely it is that an infection in a pregnant woman will be passed on to
her fetus; whether some fetuses are infected but don't develop
microcephaly; how often pregnancy loss may occur in expecting women
with Zika virus; and whether pregnancy makes women more susceptible to
the virus, says MarjorieTreadwell, M.D., director of the Fetal Diagnostic
Center at the University of Michigan and a maternal and fetal medicine
expert.
To date, there have been no infants born with microcephaly and other poor
outcomes linked to locally acquired Zika virus infection during pregnancy in
the continental United States. One infant with microcephaly linked to travelassociated Zika virus infection during pregnancy has been reported in
Hawaii as well as one with microcephaly born in a hospital in New Jersey to
a woman who had previously tested positive for Zika virus infection and had
traveled to Central America during pregnancy.
While the Zika virus remains in the blood of an infected person for a few
days to a week, according to the CDC, there's no current evidence to
suggest that it poses a risk of birth defects in future pregnancies. And Zika
won't cause infections in a baby that's conceived after the virus has left the
bloodstream.
How is Zika transmitted?
Zika is primarily spread through the bite of infected mosquitos. When a
mosquito bites and draws blood from someone who's infected, the insect
itself becomes infected and then goes on to bite other people.

The CDC continues to investigate and track cases of Zika virus infection,
including a few pregnant women, that have been transmitted
sexually (there are 11 so far, as of late May). This type of transfer is
surprisingand of great concernbecause it could indicate that sexual
transmission may be easier and more likely than experts once believed. In
each of the confirmed cases so far, a man who had traveled to a region
affected by Zika then passed the virus to his female partner (it's not yet
known if women can pass Zika to men).
The Zika virus can also be transmitted from mother to baby during
pregnancy or around the time of birth, but according to the American
College of Obstetricians and Gynecologists (ACOG), there are no clinical
studies to measure the risk to an unborn child if the mother is infected. In
rare instances, the Zika virus may be passed along via a blood transfusion,
according to the CDC.
Zika virus has been detected in fetal tissue, amniotic fluid, full-term infants,
and in the placenta, according to ACOG, and trace amounts of the virus
have also been found in breast milk, but because the amount is tiny, it's
unlikely to pose a threat. Oral infections of Zika haven't been documented
and, if one were to occur, it would likely be the same mild version as seen in
adults. The many benefits of breastfeeding outweigh this possible risk.
What are the symptoms of Zika?
A Zika infection is similar to a mild case of the flu and may include such
symptoms as a low-grade fever, headache, rash, muscle and joint pain, and
conjunctivitis (pink eye). Symptoms may last several days to a week. Only
20 percent of people infected with the Zika virus will actually become ill,
reports Cynthia Moore, M.D., Ph.D., of the National Center on Birth Defects
and Developmental Disabilities at the Centers for Disease Control and
Prevention (CDC), adding, "We don't know at this time if pregnant women
are more likely to develop symptoms if infected."
Testing for Zika virus
According to the CDC, the FDA still hasnt approved a commercially
available diagnostic test for Zika virus. But two institutions in Texas did
develop the first rapid hospital-based ones. Scientists at Texas Children's
Hospital and Houston Methodist Hospital can directly detect Zika's genetic
material or ribonucleic acid (RNA) in a pregnant woman's amniotic fluid, or
anytime in blood, urine, amniotic or spinal fluid and provide results in a
matter of hours. This test is currently available to hospital patients who've
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traveled to an affected region and are experiencing acute symptoms of

Zika.
Several state and territory health departments are also able to test for Zika,
but the test isn't perfect. "Because it cross reacts with other related viruses,
it's possible to have a positive test but not actually have the Zika virus,"
says Treadwell. Because of this, the CDC had previously advised the test
only for people who'd been exposed (i.e., traveled to a high-risk country)
and showed symptoms.
Now, the guidelines urge asymptomatic pregnant women who've been to
places with known ongoing Zika transmission be tested between 2 and 12
weeks after they've returnedor right away if symptoms are present. The
CDC also recommends that pregnant women without symptoms but who
live in a Zika-affected area be tested for the virus at the start of prenatal
care as well as later on, at the mid point of the second trimester. Even if you
don't show signs, your unborn baby should be examined, usually via
ultrasound. If there are concerns following an ultrasound, amniocentesis
may be the next step.
Federal health officials are urging that newborns be tested if the mother has
visited an affected area and also exhibits symptoms of the Zika virus. Your
doctor should contact a health department for information about testing for
Zika. Even if you don't show signs, your unborn baby should be examined,
usually via ultrasound. If there are concerns following an ultrasound,
amniocentesis may be the next step.
Underscoring the gravity of Zika and its potential spread to the United
States, President Obama requested approximately $1.9 billion in emergency
funding from Congress in Februarymoney that will be earmarked for
research to create vaccines and diagnostic tests for Zika and to aid U.S.
territories, including Puerto Rico and the Virgin Islands, where cases of the
virus have been confirmed. This money will also go toward mosquito-control
programs in at-risk southern U.S. states.
Reducing the risk
New guidance from the CDC now directs pregnant women to be very
cautious when it comes to having sex with a partner who's traveled to a
region affected by Zika. Couples should use condoms during all forms of sex
to reduce the risk of potential transmission or abstain entirely for the
duration of the pregnancy. It's unknown how long men should use condoms
during sex because the viability of Zika in sperm still isn't clear.
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Because there's no vaccine for Zika, you can further reduce your risk by
staying current with the latest recommendations. If you're pregnant, delay
travel to the regions listed in the CDC's advisory (see below). If travel can't
be avoided, take every precaution to avoid mosquito bites, including:
Wearing shirts with long sleeves and pants, rather than shorts

Using bug spray with DEET, which is safe for pregnant and nursing
women (check the label and follow the directions carefully

Treating clothes with permethrin, a type of insecticide

If you aren't pregnant but have concerns because your male partner has
been to a Zika-affected region, you can use condoms or abstain, notes the
CDC. However, simply visiting the region isn't the only factor for contracting
the disease. Risk also depends on a person's length of stay, how many
mosquito bites he received and whether prevention measures were taken to
prevent the bites.
For those couples who want to have a baby with a male partner who's
recently traveled or lived in an exposed area, ask your doctor for advice.
A Zika test may be possible but priority will first be given to women who are
already pregnant.
The latest recommendations
The CDC has issued a level-2 travel notice urging women who are pregnant
to avoid visiting the following countries: American Samoa, Barbados, Bolivia,
Brazil, Cape Verde, Colombia, Commonwealth of Puerto RicoUS
Territory, Costa Rica, Curacao, Dominican Republic, Ecuador, El Salvador,
French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras,
Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Saint Martin,
Samoa, Suriname, Tonga, U.S. Virgin Islands, and Venezuela.
This list is changing almost daily, so it's important to check the CDC's travel
information site for updates.
Pregnant women in any trimesteras well as women who are trying to
become pregnant or thinking about becoming pregnantshould talk to their
doctor or other healthcare provider before traveling to these areas and
strictly follow steps to avoid mosquito bites during the trip.
"Although most viruses have a more serious impact during the first
trimester, we can't say whether this is completely true for Zika," says
Treadwell.
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Symptoms
Many people infected with Zika virus wont have symptoms or will only have
mild symptoms. The most common symptoms of Zika are

Fever
Rash

Joint pain

Conjunctivitis (red eyes)

Other symptoms include:

Muscle pain
Headache

How long symptoms last

Zika is usually mild with symptoms lasting for several days to a week.
People usually dont get sick enough to go to the hospital, and they very
rarely die of Zika. For this reason, many people might not realize they have
been infected. Symptoms of Zika are similar to other viruses spread through
mosquito bites, like dengue and chikungunya.
How soon you should be tested
Zika virus usually remains in the blood of an infected person for about a
week. See your doctor or other healthcare provider if you develop
symptoms and you live in or have recently traveled to an area with Zika.
Your doctor or other healthcare provider may order blood tests to look for
Zika or other similar viruses like dengue or chikungunya. Once a person has
been infected, he or she is likely to be protected from future infections.
When to see a doctor or healthcare provider
See your doctor or other healthcare provider if you have the symptoms
described above and have visited an area with Zika, this is especially
important if you are pregnant. Be sure to tell your doctor or other
healthcare provider where you traveled.