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. If she travels, she should be counseled to strictly follow steps to avoid mosquito bites and prevent sexual transmission during the trip.
If a pregnant woman has a partner who lives in or has traveled to an area with Zika, she should use a condoms or other barrier protection every time she has sex or should not have sex with that partner for the duration of her pregnancy. Sex includes vaginal, anal and oral sex, and the sharing of sex toys. Barrier protection includes male or female condoms for vaginal or anal sex, as well as dental dams for oral sex.
For symptomatic pregnant women with exposure to Zika virus, rRT-PCR testing of serum and urine is recommended up to 2 weeks after symptom onset. In addition, for asymptomatic pregnant women who live in areas without active Zika virus transmission, rRT-PCR testing of serum and urine is recommended < 2 weeks after the last possible exposure and for women who are evaluated 2-12 weeks after exposure and have been found to be Zika virus IgM-positive.
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 rRT-PCR testing of women who are IgM-positive; a positive rRT-PCR test provides a definitive diagnosis of ZIKV 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 real-time Reverse Transcriptase Polymerase Chain Reaction rRT-PCR laboratory 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 better care for their pregnant patients with confirmed or possible Zika virus infection. More specifically, the updated interim guidelines:

Extend the rRT-PCR testing window from <1 week to <2 weeks from symptom onset in symptomatic pregnant women.
Add a new recommendation to implement Zika-specific rRT-PCR testing of serum and urine among asymptomatic pregnant women with possible exposure.
Add a new recommendation for immediate rRT-PCR 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.”.