What are the facts on pregnancy and Zika?

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THERE have been two reported cases of Zika infection in Malaysia so far, with more expected in the future as the virus spreads across the nation. The greatest fear is its impact on pregnant mothers. Are those fears real or is it all media hype?

Prof Dr Imelda Balchin, consultant obstetrician and gynaecologist, at the Kompleks Kesihatan Wanita & Kanak-Kanak, Universiti Malaya, answers some questions that may be plaguing pregnant couples. She is also the lead for Labour Ward and Lead for Obstetrics, at UM’s Department of Obstetrics & Gynaecology.

What is the impact of contracting the Zika infection when pregnant?

Zika infection is a mild viral infection. Four out of five adults who are infected with the virus will not have any symptoms or signs of infection and will not feel unwell at all. One out of five adults will have mild symptoms such as fever, with or without measles-like rash, joint pains and conjunctivitis. These are self-limiting conditions, which means they will resolve without any further problems, and without requiring any treatment. There is no treatment available, and there is no report of severe infection in a pregnant woman. There are a few reports of the Guillain-Barre syndrome. This is a rare immune disorder which attacks the nervous system (find out more at www.cdc.gov/zika/heathefffects/gbs-qa.html).

Zika viruses can be sexually transmitted as well as via Aedes-mosquito bites. Therefore, all pregnant women who are proven to have the Zika infection should be careful not to transmit the infection to their husbands by using barrier contraception (condoms) for at least eight weeks.

Zika can also be transmitted through a blood transfusion.

Some Zika viruses can be transmitted from the pregnant mother to the unborn baby via the placenta. We do not know how often this happens, and no research study is able to confirm this, because the majority of patients with Zika infection did not have any problems and did not have any test for Zika. There are reports that in some parts of Brazil, the Zika infection has been linked with severe brain abnormalities in the unborn babies and with poor head growth (called microcephaly, which means small heads). However, reports in other parts of South and Central America have not found the same impact in pregnant mothers with Zika infection. Although the Zika infection has been “linked”, Zika infection alone is not a proven cause of brain abnormalities in babies. More research is ongoing, and we hope to have more information.

Are the risks the same regardless of which trimester she is in?

The risk of transmission of the Zika virus from an infected pregnant mother to the unborn baby is the same for all trimesters. However, there is a possibility of 1% increased risk of microcephaly if transmitted during the first trimester.

Is there any way to detect if the unborn baby will have microcephaly?

Yes. If a pregnant woman has the Zika infection during pregnancy, confirmed by laboratory tests, she will be referred to Foetal Medicine units for serial scans of the baby to assess head growth and to detect other brain abnormalities. However, if the scan is normal, we are not able to predict which babies will develop problems later. This is why the scans are repeated at regular intervals.

If it can be detected, what can a mother do about it? Is abortion an option in Malaysia?

If brain abnormalities in the unborn baby is detected, there is no treatment for this. We are not able to predict, from the ultrasound scans done during pregnancy, what problems the baby will have in the long term. Some babies will have no long term neurological problems, some babies will have mild problems and some will have severe problems.

Abortion depends on the severity of these brain abnormalities, the presence of any other foetal abnormalities, the gestational age of the unborn baby and if the mother has other medical problems in her pregnancy. Each patient will be assessed individually and there must be a consensus between experts with regard to an abortion.

Generally, an abortion is only permissible if continuing the pregnancy causes serious harm to the mother’s health, or if the foetus has a life-limiting condition. Therefore, microcephaly alone is not an indication for an abortion in Malaysia.

What can pregnant women do to minimise their risk of contracting Zika?

Prevent mosquito bites.

Clean up the home and neighbouring areas to reduce Aedes mosquito breeding grounds.

Avoid travelling to Zika areas, including Central and South America. Since Singapore has reported over 100 confirmed Zika cases, avoid travelling to Singapore.

Avoid having unprotected sexual intercourse with men who have travelled from Zika areas.

Some of the symptoms for a Zika infection are common during pregnancy. When should she go to the hospital?

All pregnant women should go to the hospital if they have a fever. The doctors will decide if they meet the criteria for Zika testing, or if they need treatment for other types of infections. All hospitals in Malaysia that handle pregnancies and childbirth are able to handle Zika. The blood tests can be couriered to hospitals or labs which have the facilities for testing, or the doctors will refer the patient to another hospital.

Is it possible to test for Zika every month when she goes for her antenatal checkup? Is it necessary?

There is a strict criteria and guidelines for Zika testing. The tests are done from blood and urine samples, only from patients who meet the clinical criteria for testing. As dengue infection is more prevalent in Malaysia, and dengue infection is a more dangerous infection transmitted by the same Aedes mosquito, tests will be done to exclude dengue infection first, before tests for Zika infection are performed.