Zika virus, a close relative of the Dengue virus, is a flavivirus transmitted by mosquitoes. While the disease triggered by this pathogen is often mild, Zika virus and pregnancy is a subject of concern. This agent can pass from mom to fetus, causing a number of development and birth defects.
But should every mosquito bite worry you during the pregnancy? If you’re a concerned expecting mom, here is how to stay away from Zika throughout your pregnancy.
ZIKA VIRUS: A BRIEF HISTORY
Zika virus was first isolated in 1947 in a rhesus monkey in the forest of Zika, in Uganda; hence, the name of the virus. A year later, scientists identified the virus in the Aedes Africanus mosquitoes in the same forest and in 1954 the pathogen was identified in humans, in Nigeria.
However, the virus didn’t draw any attention for years, although it was endemic in some areas of Africa and Asia. But in 2007, after an outbreak in the Yap island in the Federated States of Micronesia, Zika became a subject of debate. In the recent years, numerous cases in South America and North America draw the attention of scientists but also triggered an alarm for all pregnant women.
ZIKA VIRUS: TRANSMISSION
The Zika virus is mainly transmitted by infected mosquitoes. The Aedes species are responsible for the transmission of Zika, Dengue, and Chikungunya viruses.
But the mosquitoes usually act as a transmitter only. They get infected after stinging a subject already infected by the virus and spread the disease by stinging a healthy individual. Since this species of mosquitoes is very aggressive, it can easily spread the virus from individual to individual, or infect through their eggs stagnant water deposits, flower pots, and pet bowls.
Vertical transmission occurs between a mother and fetus or newborn. More often than not, the transmission occurs during the gestational phase and has dramatic consequences on the fetus. The virus can cause microcephaly and a series of other intrauterine developmental issues, but also birth defects.
An infected mother can also infect the newborn during birth, but this is a rare event.
So far, there have been no reports of transmission through breast milk. For this reason, pediatricians and virologists don’t recommend the interruption of breastfeeding when visiting areas where Zika virus is present.
INFECTED BLOOD AND SEXUAL CONTACTS
Zika virus can be transmitted through sexual contact and infected blood. According to scientific research, the RNA of the virus can remain in the semen for up to 6 months after the onset of the first symptoms, and it is, therefore, advisable to use a condom for at least six months if the male partner has visited an endemic area.
If sexual transmission occurs, it can take more than a month before the onset of the symptoms in the infected woman. So far, there were reported no cases of sexual transmission from women to men.
There is also a potential risk of infection through blood transfusion and stem cell transplantation, but there have not been documented cases of transmission through saliva, urine or breast milk.
SYMPTOMS OF ZIKA INFECTION
In most cases, the disease is completely asymptomatic and lasts for up to a week. When symptoms appear, the disease is often mistaken for cold or flu. Some of the symptoms include mild fever, often associated with rashes, muscular and joint pain, headache, ocular pain, and conjunctivitis.
Due to the mildness of the symptoms, the infection may pass unnoticed or it can be misdiagnosed as Dengue.
Most subjects recover without significant complications and medical intervention is rare.
ZIKA VIRUS: INCUBATION PERIOD
The exact incubation of Zika virus has not been defined yet. The disease shows its first symptoms in two to seven days, but that’s not a rule. An interval between two days and two weeks is often accepted by specialists. However, since 80% of the cases are asymptomatic, is hard to determine the onset.
As for the duration, the disease is generally not severe and lasts for an undefined period that goes from a couple of days to a week.
ZIKA VIRUS: ASSOCIATED DANGERS
Because Zika virus epidemics have been limited, it is yet uncertain what complications are associated with the disease.
However, a few epidemic episodes recorded in French Polynesia between 2013 and 2014 coincided with an increase of Dengue fever incidence. The national health authorities have also observed an increase in the incidence of Guillain-Barré syndrome and recent studies confirm that Zika virus infection is a risk factor. A similar observation was also conducted in 2016 in Brazil.
Guillain-Barré syndrome is a rare affection in which one’s immune system attacks the nerve cells, sometimes causing muscle weakness and paralysis. These symptoms may last for a few weeks or several months. In general, most individuals recover, but in some subjects, there is irreversible damage and, in rare cases, the syndrome is fatal.
ZIKA VIRUS AND PREGNANCY
The first connections between the Zika virus and gestational or birth defects have also been observed in Brazil for the first time. The health authorities in the country registered a significant increase of the cases of microcephaly and other severe malformations, and all cases have been linked to the contraction of Zika virus during pregnancy.
Since the first cases were reported, the American Center for Disease Prevention and Control has issued special recommendations to the following groups of subjects:
- Pregnant women, in any trimester. It is recommended to postpone any trips to areas where Zika virus has been identified. If it’s impossible to postpone your travel, consult your physician before your journey and follow all indications to prevent mosquito bites during the trip. This is valid for your partner too, or use a condom for at least six months after the journey.
- Women seeking pregnancy. Getting pregnant during your honeymoon in the Caribbean could be less exciting if you’re getting Zika. If you’re seeking pregnancy, avoid traveling to risk areas or consult your doctor before the journey.
ZIKA VIRUS AND PREGNANCY: FREQUENTLY ASKED QUESTIONS
CAN I USE INSECT REPELLENTS DURING PREGNANCY OR WHILE BREASTFEEDING?
Absolutely yes! Mosquito repellents are safe and effective. However, ask your physician to recommend a trusted repellent to use during pregnancy or while breastfeeding, just to stay on the safe side. Always use the repellent according to the instructions.
IF I CONTRACTED ZIKA VIRUS BEFORE GETTING PREGNANT, ARE THERE ANY RISKS FOR ANY SUBSEQUENT PREGNANCIES?
No. If you had Zika, your future pregnancies are not exposed to any risks. The virus usually remains in the bloodstream for a few days up to a week. As long as you conceive after the virus has been eliminated from your body, a previous infection doesn’t affect the fetus or newborn.
I WAS INFECTED WITH ZIKA VIRUS. HOW LONG DO I HAVE TO WAIT BEFORE GETTING PREGNANT?
Specialists recommend waiting for at least three months before conceiving after an infection. The same rule applies if you have traveled to an endemic area before seeking pregnancy if no symptoms have appeared. In all cases, it is recommended to speak to your gynecologist who can require some blood tests to assess if it’s safe to get pregnant.
WHAT SHOULD I DO IF MY PARTNER IS RETURNING FROM AN ENDEMIC COUNTRY?
Although sexual transmission is rare, it is still possible. For this reason, it is recommended to use a condom for at least six months if you are pregnant and your partner returned from an epidemic area. Semen tests are also available.
SHOULD I UNDERGO A ZIKA VIRUS EXAMINATION REGARDLESS OF WHERE I LIVE?
The American Center For Disease Prevention and Control recommends testing for all pregnant women who live or have visited endemic areas. Otherwise, the examination is unnecessary.
ZIKA VIRUS: DIAGNOSIS
Zika has symptoms similar to Dengue and Chikungunya, two other diseases caused by viruses transmitted by the same mosquitoes.
Since all these diseases have common symptoms, it is recommended to mention to your doctor that you have been in a risk area. Report when and where you went, then your doctor can request a blood test to look for Zika, Dengue, or Chikungunya.
There are various diagnostic methods that include the identification of the nucleic acid of the virus. Both DNA and serological tests can be performed on blood, saliva, or urine samples collected in the first five days from the onset of the symptoms.
ZIKA VIRUS AND PREGNANT WOMEN LIVING IN ENDEMIC AREAS
If you live in an endemic area, it is recommended to consult your doctor as soon as possible and undergo an exam if you notice any symptoms associated with Zika. If the blood test highlights the presence of the virus or in case of doubtful results, your gynecologist may prescribe an ultrasound exam to check for signs of microcephaly.
Ultrasonography is a prenatal test that shows images of the fetus inside the uterus generated by an ultrasound machine and displayed on a monitor. If the results are inconclusive, an amniocentesis can also be indicated for the detection of the virus in the amniotic fluid.
In the absence of signs and symptoms of Zika, the gynecologist can prescribe the test together with the first-trimester prenatal check. If this is negative, a control blood test should be performed in the second trimester. Again, in case of positive or doubtful results, the doctor may prescribe further investigations.
In case of a negative result, if the ultrasound reveals microcephaly or calcium deposits in the fetal brain, the doctor could indicate further investigations that look for Zika virus in the placenta and umbilical cord.
Microcephaly could or could not affect the future development of the baby; in some subjects, the condition predisposes to intellectual disabilities and mental delays, balance and coordination difficulties, hyperactivity, seizures, and dwarfism.
ZIKA VIRUS AND PREGNANCY: WOMEN WHO RECENTLY VISITED AN ENDEMIC AREA
No matter how careful you are, mosquito bites happen. If you’re pregnant and the mosquito bite happened in an endemic area, consult your doctor promptly after your journey. In the lack of any bites, if you notice any unusual symptoms, report to your doctor what areas you’ve visited and take some blood tests to check for an infection.
Like above, if the blood test is positive or doubtful, the doctor may prescribe an ultrasound and further investigations to detect intrauterine malformations.
Even in the absence of symptoms, it’s still good practice to have a blood test between two and twelve weeks after returning home.
In the event of a Zika infection during pregnancy, the doctor may request a specialist examination of the mother and fetus to assess risks.
ZIKA VIRUS CARE AND THERAPY
It is believed that once the disease is contracted, the subject acquires immunity. Because of the mild manifestation of the symptoms, treatment involves rest, hydration, and assumption of fever and pain treatment, such as paracetamol.
It is recommended to avoid taking aspirin or other non-steroidal anti-inflammatory drugs such as ibuprofen until Dengue infection is excluded. If an infection occurs while you’re under medication for another disease, consult your doctor before carrying on with your usual treatment.
Also, use mosquito repellents if you’re infected to avoid transmitting the infection to other individuals through mosquito bites.
ZIKA VIRUS PREVENTION
At the moment, there are no vaccines to prevent Zika virus disease. The mosquitoes that spread the disease are diurnal, at least in the current endemic areas that include the Caribbean, some countries in South America, Africa, and Asia.
In Europe and parts of the USA, the tiger mosquitoes act as vectors and can spread the disease from an infected individual to another.
The prevention strategy currently involves protection against mosquito bites. Insect repellents containing DEET, lemon, and eucalyptus oils provide long-lasting protection. In the case of using both sunscreens and insect repellents at the same time, apply first the sunscreen and then the repellent.
Avoid using insect repellents under the clothes and treat your clothes with appropriate substances. It is also recommended to wear long-sleeved shirts and trousers if traveling to tropical areas.
Always use fly screens on windows and doors, or just turn on the air conditioning, to keep mosquitoes outside of your room. Also, avoid leaving glasses full of water on a balcony or veranda.
In the event you contracted Zika virus, use insect repellents to avoid spreading it to other individuals.
We hope this Zika Virus and Pregnancy guide will help you stay safe while pregnant. And remember, if you’re seeking pregnancy or are pregnant, avoid traveling to endemic areas to minimize all associated risks.