Transcription:
Zika and Pregnancy: What You Need To Know

Melanie (Host):  The Zika virus infection can cause a serious birth defect called “microcephaly” as well as other severe fatal brain defects. So, it’s critical for pregnant women and those trying to conceive to learn about the virus, the impacted areas and how to protect themselves.  My guest today is Dr. Maling Parker. She’s a Maternal Fetal Medicine Specialist/Perinatologist with Allina Health’s Minnesota Perinatal Physicians. Welcome to the show, Dr. Parker.  We’ve heard a lot in the media about Zika.  Tell us what it is.

Dr. Maling Parker (Guest):  Good morning.  Thanks for having me.  Zika virus is one of a group of viruses called “flavia viruses” that is transmitted by a specific species of mosquito that has the potential, like you said, to cause birth defects in babies when pregnant moms are infected.

Melanie:  How is it spread?

Dr. Parker:  It’s spread through a couple of ways.  It’s spread through the bites of an infected mosquito and it can also be sexually transmitted from males to females through infected semen.

Melanie:  So, a woman might get bitten by a mosquito and, if she’s pregnant, this can cause real serious issues if she does contract it while she’s pregnant.  Is this something that could happen right away?  Does she race off to the doctor?  Explain what happens for a pregnant woman if she thinks she might be susceptible to this.

Dr. Parker:  Sure.  The problem is most adults who are infected by the Zika virus may not even know that they have an infection.  For the majority of adults, they’ll feel no symptoms whatsoever.  A small percentage of adults will feel sort of classic symptoms like fever, joint pain and red eyes or have a rash across their face that dissipates in two to three days.  Like I said, the vast majority of people will never know that they were infected.  What can happen is a woman can be exposed to Zika virus during pregnancy, not know and not discover until many weeks later that their baby has a problem which is discovered on ultrasound.

Melanie:  That was going to be my next question.  How do you discover it?  If a woman thinks she might have been infected, then how soon would an ultrasound show that this is the problem?

Dr. Parker:  It may takes weeks to months for the ultrasound to pick up any signs of microcephaly.  What we’re telling women now is that if they travel to an area that has active Zika virus infection, that they should let their doctors know so that their blood can be tested, even if they did not have any symptoms.

Melanie:  Do you recommend people get tested if their partners have been to one of these areas or if they have or just general population?  I think people are going to want to start getting tested now.

Dr. Parker:  If a woman has the potential for Zika exposure, she should definitely talk to her doctor about being tested.  That exposure includes exposure to men who were in Zika virus areas or if they themselves traveled to those areas.

Melanie:  Where is Zika present mostly and has it gotten to the United States yet?

Dr. Parker:  Luckily, Zika has not been locally transmitted in the United States yet.  I should say the continental United States.  There has been Zika infection in American territories, like Puerto Rico and the U.S. Virgin Islands.  Right now it’s mainly restricted to Central American and South America.

Melanie:  What are the precautions that a pregnant woman in areas where Zika is present take?  Should they just avoid these areas all together or go with a lot of mosquito repellent?  What do you tell them?

Dr. Parker:  First and foremost is to educate yourself about which countries are affected and to stay away from those countries.  The CDC is constantly updating their travel restrictions website to let people know where Zika virus has been locally transmitted.  The main recommendation is to stay away from those countries when you’re pregnant or contemplating pregnancy.  If you absolutely must travel to a Zika area, then it’s important to follow mosquito bite prevention in the way of using mosquito repellents that have DEET in them, covering up arms and legs if you need to go outside, leaving windows closed and using air conditioning and using mosquito netting at night.

Melanie:  What recommendations do you have if a woman is with a partner who’s been to one of those areas but they may want to try and get pregnant?  Do you tell them to hold off?  Do you tell them to use protection?  What do you tell them?

Dr. Parker:  Absolutely.  If you are contemplating pregnancy and you’re a woman and you’ve traveled to a Zika area, you need to wait 8 weeks even if you did not have any symptoms.  You need to wait 8 weeks before trying to get pregnant.  So, that means using barrier protection during intercourse—barrier protection condoms.  If your partner traveled to a Zika area, then your partner needs to wait 6 months before having unprotected intercourse.  It’s recommended that all pregnant women have protected intercourse if their male partner has been to a Zika area.

Melanie:  Is there a vaccine for Zika yet?

Dr. Parker:  Unfortunately, there’s not.  That’s why most of the Zika counseling relies on prevention because so far that is no vaccine for Zika virus and there’s not treatment for microcephaly.

Melanie:  What happens when a pregnant woman is diagnosed with Zika, Dr. Parker?  Is this something that then you watch the pregnancy closely?  What do you do with a pregnant woman that has been diagnosed?

Dr. Parker:  Absolutely.  If she has blood testing that confirms that she was infected with Zika virus, then her baby needs to be followed with ultrasound.  There will be multiple ultrasounds throughout the pregnancy because microcephaly may not show up until later on in pregnancy – weeks after the initial infection occurred.  She’ll get ultra sounded probably every month or so to follow the growth of the baby and the baby’s head.  Then, of course, the baby will need to have testing after birth.

Melanie:  So, they get tested after birth and you said there is no cure or treatment.  What is life like for a baby with microcephaly?

Dr. Parker:  Unfortunately, microcephaly has the potential to be very devastating.  A small percentage of children with microcephaly will have normal intelligence but the majority will have some degree of mental retardation, developmental delay. They may also suffer from seizures.  Again, this is not a reversible or treatable condition.

Melanie:  Dr. Parker, what about people who are not intending to get pregnant who are just everyday, average people?  When they come down with Zika are there any symptoms. What about children? If you take your children to the Caribbean, for example, is there any risk to them to getting Zika?

Dr. Parker:  Absolutely.  The main risk is for reproductive aged people.  That’s not to say that adults and children can’t suffer symptoms from Zika virus as well.  The main symptoms that they would not are probably fever, rash, joint pain, red eyes.  Typically, the symptoms go away within a couple of days up to a week.  The recommendation is just for supportive care, meaning Tylenol for fever and things like that, rest hydration.  It’s been shown recently that in a very, very small percentage of adults, infection with Zika virus may lead to a neurological condition called Guillain-Barre Syndrome.  There’s not enough information yet about that and we’re not sure why some adults are affected with this neurological condition.

Melanie:  What about transmission from nursing?  Has there been any proof of that yet?

Dr. Parker:  We don’t have that information yet.  We don’t have enough follow up from babies in the U.S. who are born with the Zika virus and microcephaly but it does not appear that Zika virus persists in breast milk at this time.  The only bodily fluid that it’s been isolated in so far is blood and semen.

Melanie:  Tell us a little bit about the blood testing.  Are all doctors’ offices able to do this now if a pregnant woman is somewhere and she goes to her gynecologist. Can she get tested by every doctor?

Dr. Parker:  Yes, but the doctor needs to work with the Minnesota Department of Health.  All testing goes through the Minnesota Department of Health and the CDC, the Center for Disease Control.  Because this is nationally notifiable condition, all doctors are required to report results to local and state health departments.  Before any Zika testing is performed, doctors need to call the Minnesota Department of Health just to notify them that the testing is being done.

Melanie:  What great information.  You are so well spoken, Dr. Parker.  Thank you so much for being with us and in just the last few minutes your best advice for women and for men traveling to these areas and the Zika virus.  What you really want them to know.

Dr. Parker:  Absolutely.  The main thing is pregnant women and their partners should avoid the 38 countries where Zika virus is locally transmitted.  If travel is absolutely necessary, take precautions to avoid mosquito bites.  Use DEET mosquito repellent.  It is safe in pregnancy.  For pregnant women whose partners travel to these areas, they should avoid having unprotected intercourse for the duration of pregnancy.  It’s also important that if you’ve been infected with Zika virus and you come home to the United States that you avoid being bitten by a mosquito for the next 7 days in order to prevent local infection from happening in the United States.

Melanie:  Such great information. Thank you so much, Dr. Parker for being with us.  For more information on the Zika virus you can go to cdc.gov.  If you want more information about this show and the information we’re giving you can go to allinahealth.org.  That’s allinahealth.org.  You’re listening to The WELLcast with Allina Health.  This is Melanie Cole.  Thanks so much for listening.