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Am J Perinatol 2016; 33(07): 625-639
DOI: 10.1055/s-0036-1580089
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Zika Virus and Pregnancy: A Review of the Literature and Clinical Considerations

Caroline Marrs
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
,
Gayle Olson
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
,
George Saade
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
,
Gary Hankins
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
,
Tony Wen
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
,
Janak Patel
2   Division of Pediatric Infectious Diseases, Department of Pediatrics, The University of Texas Medical Branch, Galveston, Texas
,
Scott Weaver
3   Departments of Pathology and Microbiology and Immunology, The University of Texas Medical Branch, Galveston, Texas
› Author Affiliations
Further Information

Publication History

19 February 2016

25 February 2016

Publication Date:
03 March 2016 (online)

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Zika Virus and Pregnancy: A Review of the Literature and Clinical Considerations (Podcast)Am J Perinatol 2016; 33(07): e1-e1
DOI: 10.1055/s-0036-1580699

Abstract

The latest Zika virus (ZIKV) outbreak has reached epidemic proportions as it spreads throughout South and Central America. In November 2015, the Brazilian Ministry of Health reported a 20-fold increase in the number of cases of neonatal microcephaly, which corresponds geographically and temporally to the ZIKV outbreak. Case reports have provided some evidence of a causal link between maternal ZIKV infection, fetal microcephaly, and intracranial calcifications. The sparse data regarding ZIKV in pregnancy come solely from case reports and personal communications, and recommendations for management of ZIKV exposure during pregnancy are rapidly evolving. Our objective is to review and synthesize the current literature regarding ZIKV as it pertains to pregnancy and provide some assistance to clinicians who may have to manage a pregnant patient with potential exposure to ZIKV. We will also explore certain aspects of related viruses in pregnancy in hopes to shed light on this little-known topic.

Keywords

Zika virus - pregnancy - fetus - transmission - microcephaly
 

  • References

  • 1 Agencia Saude. Microcefalia: Ministerio da Saude divulga boletim epidemiologico. 2015 . Available at: http://portalsaude.saude.gov.br/index.php/cidadao/principal/agencia-saude/20805-ministerio-da-saude-divulga-boletim-epidemiologico . Accessed January 23, 2016
    PubMedGoogle Scholar
  • 2 Pan American Health Organization. Epidemiological Alert: Neurological Syndrome, Congenital Malformations, and Zika Virus Infection. Implications for Public Health in the Americas. Washington, DC: World Health Organization, Pan American Health Organization; December 1, 2015. Available at: http://www.paho.org/hq/index.php?option=com_docman&task=doc_download&Itemid=&gid=32405&lang=en . Accessed January 29, 2016
    PubMedGoogle Scholar
  • 3 European Centre for Disease Prevention and Control. Rapid Risk Assessment: Microcephaly in Brazil Potentially Linked to the Zika Virus Epidemic – 24 November 2015. Stockholm: ECDC; 2015
    Google Scholar
  • 4 European Centre for Disease Prevention and Control. Rapid Risk Assessment: Zika Virus Epidemic in the Americas: Potential Association with Microcephaly and Guillain-Barré Syndrome – 10 December 2015. Stockholm: ECDC; 2015
    Google Scholar
  • 5 European Centre for Disease Prevention and Control. Rapid Risk Assessment. Zika Virus Disease Epidemic: Potential Association with Microcephaly and Guillain–Barré Syndrome. Second update, 8 February 2016. Stockholm: ECDC; 2016
    Google Scholar
  • 6 Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Arboviral Diseases and Dengue Branches. Updated diagnostic testing for Zika, chikungunya, and dengue viruses in US Public Health Laboratories (Memorandum). January 13, 2016. Available at: http://www.aphl.org/Materials/CDCMemo_Zika_Chik_Deng_Testing_011916.pdf . Assessed January 20, 2016
    PubMedGoogle Scholar
  • 7 Petersen EE, Staples JE, Meaney-Delman D , et al. Interim guidelines for pregnant women during a Zika virus outbreak – United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 (2) 30-33
    CrossrefPubMedGoogle Scholar
  • 8 Society of Maternal Fetal Medicine. Practice advisory: updated interim guidance for care of obstetric patients during a Zika virus outbreak. February 12, 2016. Available at: https://www.smfm.org/publications/220-acog-smfm-joint-practice-advisory-interim-guidance-for-care-of-obstetric-patients-during-a-zika-virus-outbreak . Accessed February 12, 2016.
    PubMedGoogle Scholar
  • 9 Oster AM, Brooks JT, Stryker JE , et al. Interim guidelines for prevention of sexual transmission of Zika virus – United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 (5) 120-121
    CrossrefPubMedGoogle Scholar
  • 10 Pan American Health Organization. Preliminary Guidelines for the Surveillance of Microcephalia in Newborns in Settings with Risk of Circulation of the Zika Virus. Washington, DC: World Health Organization, Pan American Health Organization; January 21, 2016. Available at: http://www.paho.org/hq/index.php?option=com_content&view=article&id=11620%3Avirus-zika-and-possible-link-to-microcefalia&catid=8424%3Acontent&Itemid=41711&lang=en . Accessed February 10, 2016
    PubMedGoogle Scholar
  • 11 WHO. WHO statement of the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. February 1, 2016. http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/ . Accessed February 2, 2016.
    PubMedGoogle Scholar
  • 12 CDC. CDC Emergency Operations Center moves to highest level of activation for Zika response. February 3, 2016. Available at: http://www.cdc.gov/media/releases/2016/s0208-zika-eoca-activation.html . Accessed February 10, 2016
    PubMedGoogle Scholar
  • 13 Kuhn JH, Peters CJ. Arthropod-borne and Rodent-borne virus infections. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 19th ed. New York, NY: McGraw-Hill; 2015
    Google Scholar
  • 14 Ioos S, Mallet HP, Leparc Goffart I, Gauthier V, Cardoso T, Herida M. Current Zika virus epidemiology and recent epidemics. Med Mal Infect 2014; 44 (7) 302-307
    CrossrefPubMedGoogle Scholar
  • 15 Hayes EB. Zika virus outside Africa. Emerg Infect Dis 2009; 15 (9) 1347-1350
    CrossrefPubMedGoogle Scholar
  • 16 Duffy MR, Chen TH, Hancock WT , et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 2009; 360 (24) 2536-2543
    CrossrefPubMedGoogle Scholar
  • 17 Dick GW. Zika virus. II. Pathogenicity and physical properties. Trans R Soc Trop Med Hyg 1952; 46 (5) 521-534
    CrossrefPubMedGoogle Scholar
  • 18 Cao-Lormeau VM, Roche C, Teissier A , et al. Zika virus, French polynesia, South pacific, 2013. Emerg Infect Dis 2014; 20 (6) 1085-1086
    PubMedGoogle Scholar
  • 19 Kuno G, Chang GJ. Full-length sequencing and genomic characterization of Bagaza, Kedougou, and Zika viruses. Arch Virol 2007; 152 (4) 687-696
    CrossrefPubMedGoogle Scholar
  • 20 Faye O, Freire CC, Iamarino A , et al. Molecular evolution of Zika virus during its emergence in the 20(th) century. PLoS Negl Trop Dis 2014; 8 (1) e2636
    CrossrefPubMedGoogle Scholar
  • 21 Lanciotti RS, Kosoy OL, Laven JJ , et al. Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis 2008; 14 (8) 1232-1239
    CrossrefPubMedGoogle Scholar
  • 22 Enfissi A, Codrington J, Roosblad J, Kazanji M, Rousset D. Zika virus genome from the Americas. Lancet 2016; 387 (10015) 227-228
    CrossrefPubMedGoogle Scholar
  • 23 Oehler E, Watrin L, Larre P , et al. Zika virus infection complicated by Guillain-Barre syndrome—case report, French Polynesia, December 2013. Euro Surveill 2014; 19 (9) 2072
    PubMedGoogle Scholar
  • 24 Musso D, Nhan T, Robin E , et al. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveill 2014; 19 (14) 20761
    CrossrefPubMedGoogle Scholar
  • 25 Marano G, Pupella S, Vaglio S, Liumbruno GM, Grazzini G. Zika virus and the never-ending story of emerging pathogen and transfusion medicine. Blood Transfus 2015; 1-6
    PubMedGoogle Scholar
  • 26 Besnard M, Lastère S, Teissier A, Cao-Lormeau V, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill 2014; 19 (13) 20751
    CrossrefPubMedGoogle Scholar
  • 27 Foy BD, Kobylinski KC, Chilson Foy JL , et al. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis 2011; 17 (5) 880-882
    CrossrefPubMedGoogle Scholar
  • 28 Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM. Potential sexual transmission of Zika virus. Emerg Infect Dis 2015; 21 (2) 359-361
    CrossrefPubMedGoogle Scholar
  • 29 Musso D, Roche C, Nhan TX, Robin E, Teissier A, Cao-Lormeau VM. Detection of Zika virus in saliva. J Clin Virol 2015; 68: 53-55
    CrossrefPubMedGoogle Scholar
  • 30 Prince HE, Matud JL. Estimation of dengue virus IgM persistence using regression analysis. Clin Vaccine Immunol 2011; 18 (12) 2183-2185
    CrossrefPubMedGoogle Scholar
  • 31 CDC. Surveillance and control of Aedes aegypti and Aedes albopictus in the United States. Available at: http://www.cdc.gov/chikungunya/resources/vector-control.html . Accessed on February 8, 2016
    PubMedGoogle Scholar
  • 32 Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg?. Ultrasound Obstet Gynecol 2016; 47 (1) 6-7
    CrossrefPubMedGoogle Scholar
  • 33 Calvet G, Aguiar RS, Melo ASO , et al. Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study. Lancet Infect Dis 2016; (e-pub ahead of print). doi:10.1016/S1473-3099(16)00095-5
    PubMedGoogle Scholar
  • 34 Bell TM, Field EJ, Narang HK. Zika virus infection of the central nervous system of mice. Arch Gesamte Virusforsch 1971; 35 (2) 183-193
    CrossrefPubMedGoogle Scholar
  • 35 Tetro JA. Zika and microcephaly: causation, correlation, or coincidence?. Microbes Infect 2016; (e-pub ahead of print). doi:10.1016/j.micinf.2015.12.010
    PubMedGoogle Scholar
  • 36 Ventura CV, Maia M, Bravo-Filho V, Góis AL, Belfort Jr R. Zika virus in Brazil and macular atrophy in a child with microcephaly. Lancet 2016; 387 (10015) 228
    PubMedGoogle Scholar
  • 37 de Paula Freitas B, de Oliveira Dias JR, Prazeres J , et al. Ocular findings in infants with microcephaly associated with presumed Zika virus congenital infection in Salvador, Brazil. JAMA Ophthalmol 2016; (e-pub ahead of print). doi:10.1001/jamaophthalmol.2016.0267
    PubMedGoogle Scholar
  • 38 Mlakar J, Korva M, Tul N , et al. Zika virus associated with microcephaly. N Engl J Med 2016; (e-pub ahead of print)
    PubMedGoogle Scholar
  • 39 Martines RB, Bhatnagar J, Keating MK , et al. Notes from the field: evidence of Zika virus infection in brain and placental tissues from two congenitally infected newborns and two fetal losses – Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016; 65 (6) 159-160
    CrossrefPubMedGoogle Scholar
  • 40 Pan American Health Organization, World Health Organization. Question and Answers: Zika and pregnancy. Available at: http://www.paho.org/Hq/index.php?option=com_content&view=article&id=11552%3Aquestion-and-answers-zika-and-pregnancy&catid=8424%3Acontent&Itemid=41711&lang=en . Accessed January 22, 2016
    PubMedGoogle Scholar
  • 41 Schuler-Faccini L, Ribeiro EM, Feitosa IM , et al; Brazilian Medical Genetics Society–Zika Embryopathy Task Force. Possible association between Zika virus infection and microcephaly – Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016; 65 (3) 59-62
    CrossrefPubMedGoogle Scholar
  • 42 Dontigny L, Arsenault MY, Martel MJ , et al; Society of Obstetricians and Gyneacologist of Canada. Rubella in pregnancy. J Obstet Gynaecol Can 2008; 30 (2) 152-168
    PubMedGoogle Scholar
  • 43 Lipitz S, Yinon Y, Malinger G , et al. Risk of cytomegalovirus-associated sequelae in relation to time of infection and findings on prenatal imaging. Ultrasound Obstet Gynecol 2013; 41 (5) 508-514
    CrossrefPubMedGoogle Scholar
  • 44 Meaney-Delman D, Hills SL, Williams C , et al. Zika Virus Infection Among U.S. Pregnant Travelers—August 2015-February 2016. Morb Mortal Wkly Rep 2016; (epub ahead of print). doi: http://dx.doi.org/10.15585/mmwr.mm6508e1er
    PubMedGoogle Scholar
  • 45 AABB. Association Bulletin #16–03. Zika, dengue, and chikungunya viruses. Available at: https://www.aabb.org/programs/publications/bulletins/Documents/ab16-03.pdf . Accessed February 23, 2016
    PubMedGoogle Scholar
  • 46 Spenser BR, Stramer SL, Dodd RY , et al. Survey to estimate donor loss to 14- or 28-day travel deferral for mitigation of CHIKV, DENV and other acute infections. Presented at: AABB Annual Meeting; October 24–27, 2015; Anaheim, CA
    PubMedGoogle Scholar
  • 47 Ashwal S, Michelson D, Plawner L, Dobyns WB ; Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Practice parameter: evaluation of the child with microcephaly (and evidence based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2009; 73 (11) 887-897
    CrossrefPubMedGoogle Scholar
  • 48 Passemard S, Kaindl AM, Verloes A. Microcephaly. In: Dulac O, Lassonde M, Sarnat HB, eds. Handbook of Clinical Neurology, Vol III, Pediatric Neurology Part I. Amsterdam, the Netherlands: Elsevier; 2013: 129-141
    CrossrefGoogle Scholar
  • 49 Pilu G. Ultrasound evaluation of the fetal neural axis. In: Callen PW, ed. Ultrasound in Obstetrics and Gynecology. 5th ed. Philadelphia, PA: Saunders; 2008: 382-383
    Google Scholar
  • 50 Microcephaly In: Bianchi DW, Crombleholme TM, D'Alton ME, Malone FD. , eds. Fetology: Diagnosis and Management of the Fetal Patient. 2nd ed. New York, NY: McGraw Hill; 2010: 166-171
    Google Scholar
  • 51 SMFM. SMFM statement: ultrasound screening for fetal microcephaly following Zika virus exposure. Am J Obstet Gynecol 2016 (e-pub ahead of print). doi:10.1016/j.ajog.2016.02.043. Available at: http://www.ajog.org/pb/assets/raw/Health%20Advance/journals/ymob/SMFM%20Statement_Fetal%20microcephaly.pdf . Accessed February 18, 2016
    PubMedGoogle Scholar
  • 52 Chervenak FA, Jeanty P, Cantraine F , et al. The diagnosis of fetal microcephaly. Am J Obstet Gynecol 1984; 149 (5) 512-517
    CrossrefPubMedGoogle Scholar
  • 53 Chervenak FA, Rosenberg J, Brightman RC, Chitkara U, Jeanty P. A prospective study of the accuracy of ultrasound in predicting fetal microcephaly. Obstet Gynecol 1987; 69 (6) 908-910
    PubMedGoogle Scholar
  • 54 Kurmanavicius J, Wright EM, Royston P , et al. Fetal ultrasound biometry: 1. Head reference values. Br J Obstet Gynaecol 1999; 106 (2) 126-135
    CrossrefPubMedGoogle Scholar
  • 55 Buck Louis GM, Grewal J, Albert PS , et al. Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J Obstet Gynecol 2015; 213 (4) 449.e1-449.e41
    CrossrefPubMedGoogle Scholar
  • 56 Leibovitz Z, Daniel-Spiegel E, Malinger G , et al. Microcephaly at birth - the accuracy of three references for fetal head circumference. How can we improve prediction?. Ultrasound Obstet Gynecol 2015; (e-pub ahead of print). doi:10.1002/uog.15801
    PubMedGoogle Scholar
  • 57 Jampol LM, Goldstein DA. Zika virus infection and the eye. JAMA Ophthalmol 2016; (e-pub ahead of print). doi:10.1001/jamaophthalmol.2016.0284
    PubMedGoogle Scholar
  • 58 Leite JM, Granese R, Jeanty P, Herbst SS. Fetal syndromes. In: Callen PW, ed. Ultrasound in Obstetrics and Gynecology. 5th ed. Philadelphia, PA: Saunders; 2008: 133-135
    Google Scholar
  • 59 Barthel A, Gourinat AC, Cazorla C, Joubert C, Dupont-Rouzeyrol M, Descloux E. Breast milk as a possible route of vertical transmission of dengue virus?. Clin Infect Dis 2013; 57 (3) 415-417
    CrossrefPubMedGoogle Scholar
  • 60 Chen LH, Wilson ME. Transmission of dengue virus without a mosquito vector: nosocomial mucocutaneous transmission and other routes of transmission. Clin Infect Dis 2004; 39 (6) e56-e60
    CrossrefPubMedGoogle Scholar
  • 61 Sirinavin S, Nuntnarumit P, Supapannachart S, Boonkasidecha S, Techasaensiri C, Yoksarn S. Vertical dengue infection: case reports and review. Pediatr Infect Dis J 2004; 23 (11) 1042-1047
    CrossrefPubMedGoogle Scholar
  • 62 Basurko C, Carles G, Youssef M, Guindi WE. Maternal and fetal consequences of dengue fever during pregnancy. Eur J Obstet Gynecol Reprod Biol 2009; 147 (1) 29-32
    CrossrefPubMedGoogle Scholar
  • 63 Tan PC, Rajasingam G, Devi S, Omar SZ. Dengue infection in pregnancy: prevalence, vertical transmission, and pregnancy outcome. Obstet Gynecol 2008; 111 (5) 1111-1117
    CrossrefPubMedGoogle Scholar
  • 64 Dotters-Katz SK, Grace MR, Strauss RA, Chescheir N, Kuller JA. Chikungunya fever: obstetric considerations on an emerging virus. Obstet Gynecol Surv 2015; 70 (7) 453-457
    CrossrefPubMedGoogle Scholar
  • 65 Gérardin P, Sampériz S, Ramful D , et al. Neurocognitive outcome of children exposed to perinatal mother-to-child Chikungunya virus infection: the CHIMERE cohort study on Reunion Island. PLoS Negl Trop Dis 2014; 8 (7) e2996
    CrossrefPubMedGoogle Scholar
  • 66 Centers for Disease Control and Prevention (CDC). Possible West Nile virus transmission to an infant through breast-feeding—Michigan, 2002. MMWR Morb Mortal Wkly Rep 2002; 51 (39) 877-878
    PubMedGoogle Scholar
  • 67 Nguyen Q, Morrow C, Novick L , et al; Centers for Disease Control and Prevention (CDC). Intrauterine West Nile virus infection—New York, 2002. MMWR Morb Mortal Wkly Rep 2002; 51 (50) 1135-1136
    PubMedGoogle Scholar
  • 68 O'Leary DR, Kuhn S, Kniss KL , et al. Birth outcomes following West Nile Virus infection of pregnant women in the United States: 2003-2004. Pediatrics 2006; 117 (3) e537-e545
    CrossrefPubMedGoogle Scholar
  • 69 Nasci RS, Wirtz RA, Brogdon WG. Protection against mosquitos, ricks, and other arthropods. In: CDC Health Information for International Travel, 2016. New York, NY: Oxford University Press; 2015: 94-99 . Available at: http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/protection-against-mosquitos-ticks-other-arthropods
    Google Scholar
  • 70 Oduyebo T, Petersen EE, Rasmussen SA , et al. Update: interim guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika virus exposure - United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 (5) 122-127
    CrossrefPubMedGoogle Scholar
  • 71 Bromley B, Benacerraf BR. Difficulties in the prenatal diagnosis of microcephaly. J Ultrasound Med 1995; 14 (4) 303-306
    CrossrefPubMedGoogle Scholar
  • 72 Staples JE, Dziuban EJ, Fischer M , et al. Interim guidelines for the evaluation and testing of infants with possible congenital Zika virus infection – United States, 2016. MMWR Morb Mortal Wkly Rep 2016; 65 (3) 63-67
    CrossrefPubMedGoogle Scholar
  • 73 Heymann DL, Hodgson A, Sall AA , et al. Zika virus and microcephaly: why is this situation a PHEIC?. Lancet 2016; 387 (10020) 719-721
    CrossrefPubMedGoogle Scholar