The Centers for Disease Control and Prevention has released interim guidelines for the care of pregnant women during a Zika virus outbreak.
The guidelines, developed in consultation with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, come on the heels of a Jan. 15 advisory warning pregnant women to avoid traveling to tropical countries and territories with outbreaks of the mosquito-borne virus. The virus is typically associated with only mild symptoms, but has been linked with cases of microcephaly and other poor outcomes in pregnancy.
“Health care providers should ask all pregnant women about recent travel. Pregnant women with a history of travel to an area with Zika virus transmission who report two or more symptoms consistent with Zika virus disease (acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis) during or within 2 weeks of travel, or who have ultrasound findings of fetal microcephaly or intracranial calcifications, should be tested for Zika virus infection in consultation with their state or local health department,” according to the guidelines, which were published Jan. 19 in an early release of the Morbidity and Mortality Weekly Report (MMWR. 2016 Jan 19;65[Early Release]:1-4).
Testing is not indicated for women who have not traveled to areas with Zika virus transmission, according to CDC.
For women who test positive for the virus, serial ultrasounds to monitor fetal growth and anatomy should be considered, as well as referral to a maternal-fetal medicine specialist or infectious disease specialist with expertise in pregnancy management, according to the guidelines.
While a positive reverse-transcription polymerase chain reaction (RT-PCR) result on amniotic fluid would suggest intrauterine infection and could potentially be useful to pregnant women and their health care providers, it is currently not known how sensitive or specific the test is for congenital infection or whether a positive result is predictive of a subsequent fetal abnormality.
“Health care providers should discuss the risks and benefits of amniocentesis with their patients,” CDC officials wrote in the interim guidance.
The following tests are advised for live births with evidence of infection: histopathological examination of the placenta and umbilical cord, testing of frozen placental tissue and cord tissue for Zika virus RNA, and testing of cord serum for Zika and dengue virus IgM and neutralizing antibodies. Guidelines for infected infants are currently being developed.
No specific treatment exists for Zika virus infection; supportive care, including rest, fluids, use of analgesics and antipyretics, and acetaminophen for fever is advised.
The CDC continues to recommend that pregnant women avoid travel to areas where Zika virus transmission is ongoing. Strict steps to avoid mosquito bites are advised for those who do travel to such areas. This includes use of protective clothing and U.S. Environmental Protection Agency–registered insect repellents, as well as staying and sleeping in screened-in or air-conditioned rooms. Insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant women when used as directed on the label, according to the CDC.
Updates on areas with ongoing Zika virus transmission are available on the CDC website.