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Clinical Guidance for Healthcare Providers Caring for Pregnant Women

Summary

Key Points:

  • CDC recommends that pregnant women not travel to an area with active Zika virus transmission. If a pregnant woman must travel to one of these areas, she should talk to her healthcare provider prior to traveling and when she returns. If she travels, she should be counseled to strictly follow steps to avoid mosquito bites and prevent sexual transmission during the trip.
  • Pregnant women with partners who live in or traveled to an area with Zika should use a condom to prevent sexual transmission every time they have sex, or not have sex for the duration of the pregnancy. Sex includes vaginal, anal and oral sex, and the sharing of sex toys. Condoms include male or female condoms for vaginal and anal sex. Dental dams (latex or polyurethane sheets) may also be used during oral sex.
  • For symptomatic pregnant women with exposure to Zika virus, RNA NAT (nucleic acid testing) of serum and urine is recommended up to 2 weeks after symptom onset. In addition, RNA NAT testing of serum and urine is recommended < 2 weeks after the last possible exposure for asymptomatic pregnant women who live in areas without active Zika virus transmission and for those who are evaluated 2-12 weeks after exposure and have been found to be Zika virus IgM-positive. Whole blood can also be tested for Zika RNA alongside serum and urine.
  • For asymptomatic pregnant women within 2-12 weeks after the last date of possible exposure who live in areas without active Zika virus transmission, RNA NAT testing of serum and urine is recommended up to 2 weeks after the last possible exposure and, for those evaluated 2-12 weeks after symptom onset, if they have been found to be Zika virus IgM-positive. Whole blood can also be tested for Zika RNA alongside serum and urine.
  • Asymptomatic pregnant women with exposure to Zika may be offered screening with serologic testing within 2-12 weeks after the last date of possible exposure. Asymptomatic women who live in areas with active Zika virus transmission should have Zika virus IgM testing as part of routine obstetric care during the 1st and 2nd trimesters, with immediate RNA NAT testing of women who are IgM-positive; a positive RNA NAT test provides a definitive diagnosis of Zika virus infection. Local health officials should determine when to implement testing of asymptomatic pregnant women on the basis of information about levels of Zika virus transmission and laboratory capacity.

Latest Changes: The new recommendations expand RNA NAT testing for Zika RNA with the goal of increasing the number of pregnant women with Zika virus infection who receive definitive diagnosis. In addition, the new guidance includes clinical management recommendations to help healthcare providers deliver better care for their pregnant patients with confirmed or possible Zika virus infection. More specifically, the updated interim guidelines:

  • Extend the RNA NAT testing window from <1 week to <2 weeks from symptom onset in symptomatic pregnant women.
  • Add a new recommendation to implement Zika-specific RNA NAT testing of serum and urine among asymptomatic pregnant women with possible exposure.
  • Add a new recommendation for immediate RNA NAT testing after a pregnant woman has a positive or equivocal -Zika IgM antibody test.
  • Update the guidelines to emphasize testing of infant blood rather than “infant blood or cord blood.”


Guidance

Related Publications

Counseling Patients

For Pregnant Women
Zika Virus Testing for Pregnant Women Living in an Area with Zika

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For Pregnant Women
Zika Virus Testing for Pregnant Women not Living in an Area with Zika

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