The Zika virus and pregnancy: evidence, management, and prevention

Abstract

Objective: To comprehensively review the available evidence and existing consensus reports and guidelines regarding the pregnancy and reproductive implications of the mosquitotransmitted Zika virus (ZIKV) infection. A primary focus was to provide pertinent information to aid clinicians in the management of pregnancies at risk for, exposed to, or with confirmed ZIKV infection. Method: An extensive literature review was performed using Pubmed. Practice guidelines and consensus reports were accessed from international, national, and professional organizations' websites. The clinical articles for ZIKV infection testing varied from case reports to small epidemiologic studies. Results: A ZIKV epidemic has been declared in several countries in the Americas. Fifty-two travelassociated ZIKV infection cases have been reported throughout the USA (as of February 10, 2016). The consequences of congenital fetal/newborn ZIKV infection could potentially have devastating consequences including miscarriage, fetal death, and major anomalies such as microcephaly, brain and brain-stem defects, and long-term neurologic sequelae. While not definitive, current evidence suggests the existence of nonvector-borne transmission through sexual activity with an infected male partner. For women at risk for sexual transmission, condom use is advised, especially during pregnancy. Conclusion:While ZIKV infection appears to be a mild disease in the general population the potential consequences to the fetus and newborn could be profound. Management guidelines are currently evolving and will be significantly impacted as new evidence develops. It is therefore imperative that obstetric health-care providers keep abreast of this rapidly evolving information landscape that has so far characterized this outbreak.

Zika Virus Infection in Pregnant Women and Microcephaly

“…It is important to remember that the vertical transmission rate of CHIKV varies from 27.5 to 48.3%, with a neonatal mortality rate of 5.1%. 74 In turn, maternal infection by DENV causes a miscarriage rate 3.3 times higher than that observed among pregnant women in control groups. 75 To date, there is no justification to change the set of routine laboratory exams for prenatal care used in the prenatal care community.…”

Unintended consequences and the paradox of control: Management of emerging pathogens with age-specific virulence

“…Such discounting is standard practice in many areas of social policy [ 23 ], as well as in disease management [ 24 – 28 ]. With the ongoing development of additional management options [ 19 – 22 , 33 , 34 ] and screening and pre-natal/neo-natal treatment [ 35 ], there is reason to believe that future costs projected based on current ZVD risks may not be fully realized.…”

Zika Virus Infection during Pregnancy; Maternofetal Risk Assessment, Transmission, Complications, and Management: A Review of the Literature

“…There is an alarming situation due to the fact that worldwide, in a number of reported cases, maternofetal ZIKV transmission is causing congenital abnormalities related to (a) neurology such as microcephaly (23, 24); neurological calcification and growth retardation, (b) ophthalmology like retinal damage, optic nerve damage, and (c) fetal mortality (25) along with miscarriages and still births (26). The vertical transmission of ZIKV can occur either through the placenta or during labor and delivery (27).…”