Clinical Guidance for Healthcare Providers Caring for Pregnant Women
- 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.”
- HAN Advisory: CDC Updates Guidance for Pregnant Women and Women and Men of Reproductive Age for Zika Virus Infection Related to the Ongoing Investigation of Local Mosquito-borne Zika Virus Transmission in Miami-Dade County, Florida (October 19, 2016)
- HAN Advisory: CDC Guidance for Travel and Testing of Pregnant Women and Women of Reproductive Age for Zika Virus Infection Related to the Investigation for Local Mosquito-borne Zika Virus Transmission in Miami-Dade and Broward Counties, Florida (HAN, Aug. 1, 2016)
- UPDATE: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2016 (MMWR, Jul. 25, 2016)
- Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure – United States, 2016 (MMWR, Mar. 25, 2016)
- Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure – United States, 2016 (MMWR, Feb. 5, 2016)
- Interim Guidelines for Pregnant Women During a Zika Virus Outbreak—United States, 2016 (MMWR, Jan. 22, 2016)
- Projecting Month of Birth for At-Risk Infants after Zika Virus Disease Outbreaks (EID, May 2016)
- Zika virus and birth defects – Reviewing the evidence for causality (NEJM, 2016)
- Preventing Transmission of Zika Virus in Labor and Delivery Settings Through Implementation of Standard Precautions — United States, 2016 (MMWR, March 25, 2016)
- Zika Virus Infection Among US Pregnant Travelers – August 2015-February 2016 (MMWR, Mar. 4, 2016)
- HAN Advisory: Recognizing, Managing, and Reporting Zika Virus Infections in Travelers Returning from Central America, South America, the Caribbean, and Mexico (HAN, Jan. 15, 2016)
Questions & Answers
- Zika and Pregnancy
- Asymptomatic Pregnant Travelers
- Pregnant Women Residing in Areas with Active Zika Virus Transmission
- Pregnant Women Living Near the US-Mexico Border
- Prenatal Diagnosis of Microcephaly
- Testing Pregnant Women
- Postnatal Management of Pregnant Women with Laboratory Evidence of Confirmed or Probable Zika Virus Infection
- Page last reviewed: January 9, 2017
- Page last updated: January 9, 2017
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