Zika Outbreak: A Call to Attention on Reproductive Health

The news images are startling: babies born with abnormally small heads, which may leave them with long-term developmental problems. In recent weeks, these images of babies with microcephaly have drawn international attention because of a possible link to a Zika virus outbreak in parts of Latin America and the Caribbean. The World Health Organization (WHO) has called the surge in microcephaly cases in Brazil a “public health emergency of international concern.”

Around the time that WHO made this announcement, I saw my last patient of the day, a young pregnant woman beginning her second trimester. She had just returned from a family vacation in Brazil. Despite using insect repellant and other protective measures, she had mosquito bites. She asked me the same questions many are asking their health care professionals: What should I do? How worried should I be? Will my baby be born with a small head? What are my options?

Zika virus is testing our abilities as health officials to react to another global health emergency in a measured and effective way. As an obstetrician/gynecologist and scientist with a focus on maternal-fetal medicine, I am concerned about the risks Zika virus may pose to pregnant women. The sudden spike in cases of structural brain defects and other congenital malformations in babies born to infected mothers is alarming. How do I counsel my patients? What answers can we—physicians and scientists—offer the public?

First, we need to establish beyond a doubt what role, if any, Zika virus has played in the spike in suspected microcephaly cases. It is possible that these cases could have another cause, or that a contributing factor in addition to Zika virus—another virus, for example—could be leading to the condition. While we work toward establishing a clear cause-and-effect, the most prudent strategy is to assume Zika is the culprit and develop ways to manage pregnancies and counsel couples, as well as women likely to become pregnant.

We cannot overlook the importance of reproductive counseling. We should work to increase knowledge among women and their partners in Zika-affected areas about the most effective contraceptives and their use. While this may be a challenge in countries where access to contraceptives is difficult or prohibited, given recent reports that Zika may be sexually transmitted, the need to stem virus transmission to pregnant women and women of childbearing age should be among our highest priorities.

Pregnant women have many questions that need to be answered quickly. If we prove a definitive causal connection between Zika virus infection and microcephaly or other problems, more questions will arise: Is the infection more risky at certain points in pregnancy? How does the virus spread from mother to fetus? Are symptomatic women more likely to transmit the virus than those who are asymptomatic? How should we monitor and care for affected children after they are born?

The research community, including the U.S. National Institutes of Health (NIH), is mobilizing to address these and many other Zika-related questions. For example, NIH recently issued a funding opportunity to expedite research on Zika virus and its complications, including how the infection may affect reproduction, pregnancy, and the developing fetus.  

Entities across national governments also are pulling together to coordinate their activities. I recently participated in a meeting between high-level delegations from the U.S. Department of Health and Human Services and the federal government of Brazil to develop an action plan for collaborations related to this public health emergency. In only a short time it became clear that there are many opportunities to expand on existing collaborations between the two countries to unravel the many unanswered questions about the effects of Zika virus.

In the meantime, for pregnant women who have traveled to areas with Zika virus outbreaks, health recommendations are being updated regularly. In the United States, testing for exposure is now recommended for women who are at risk.  

Until we learn more, my best advice to women nearing delivery who may have been exposed to Zika virus—or who have been told by their doctors that their babies may have microcephaly or other malformations—is to give birth in a hospital where specialists are best suited to evaluate and care for the baby. In the coming weeks and months, I expect more evidence to help guide discussions with my patients and the public on what they should do in the wake of this public health emergency.

Originally posted: February 23, 2016

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