What You Need To Know About Zika And Pregnancy.

The arrival of the Zika virus in a Miami neighborhood has left many pregnant women with questions about the mosquito-borne virus, which can cause catastrophic brain damage in fetuses. USA TODAY's Liz Szabo asked experts to answer some of them.

Q. How does Zika affect pregnancy?
A. Zika can cause a range of devastating birth defects, including microcephaly, in which babies are born with abnormally small heads and, in most cases, incomplete brain development, according to the World Health Organization. Some babies affected by Zika have vision loss, clubfoot or joints that won't unbend. Other fetuses don't grow at the normal rate. Zika is also linked to miscarriage and stillbirth.

Q. Should all pregnant women be tested for Zika?
A. Not according to the Centers for Disease Control and Prevention. 

 The federal health agency recommends that doctors assess all pregnant women for possible Zika exposure during every prenatal visit, such as by asking women if they or their sexual partners have traveled recently. That conversation can determine whether women should be tested for Zika.

Q. If a girl or woman is infected with Zika today, will the virus harm a future pregnancy?
A. Probably not. Scientists believe that people infected by Zika develop immunity to it, just as with any other virus, such as chickenpox or measles, said William Schaffner, a professor at Vanderbilt School of Medicine in Nashville.

"If a woman happens to get infected with Zika right now, her body will clear the virus completely and, years from now, there will be no Zika-related complications to her pregnancy," Schaffner said.

Q. How can doctors predict Zika's affect on future pregnancies, given that scientists know so little about Zika?
A. Zika appears to behave very much like the rubella virus, also known as German measles, which caused large outbreaks in the 1960's, Schaffner said.

While both Zika and rubella cause a mild illness in adults and children, both viruses can be catastrophic in pregnant women are infected, causing children to be born with a range of disabilities, Schaffner said. Rubella can cause developmental delays, blindness, deafness and other problems. Rubella has been eliminated in the Americas through vaccines.

Q. Do men need to worry about Zika?
A. Both men and women can transmit Zika virus sexually to their partners. 

 So men who have been exposed to Zika, such as by traveling to an affected area, should avoid infecting female partners who are pregnant or might become pregnant, Schaffner said. 

Men can do this by abstaining from sex or using condoms for the duration of the woman's pregnancy, according to the CDC.

Q. What percentage of Zika-infected pregnant women have babies with birth defects?
A. Scientists don't know for sure how common these birth defects are. 

The CDC has estimated that 1% to 13% of pregnant women infected with Zika in the first trimester will have a fetus with microcephaly.

 A March study of 88 women in Brazil suggested that problems could be more common. Ultrasounds found that 29% of fetuses from Zika-infected moms had significant problems, compared to none of the fetuses from uninfected women.

Q. Could Zika have long-term effects on babies?
A. Many doctors are worried that Zika could harm a baby's brain in ways that aren't obvious at birth. These problems might appear only when children age and try to walk, talk or learn to read.

Q. Should women delay pregnancy because of Zika?
A. Although some experts disagree, federal health officials have avoided issuing blanket recommendations about avoiding pregnancy because of Zika.

However, the CDC does recommend that women who've had Zika wait eight weeks before trying to get pregnant. Men with Zika should wait at least six months before fathering a child, because the virus can live in semen for weeks or months.

Both men and women who live in or travel frequently to areas with ongoing Zika outbreaks, including the Wynwood neighborhood of Miami, should wait at least eight weeks before trying to conceive.

Q. Which point in pregnancy is the most dangerous time to be infected with Zika?
A. Research suggests that Zika can harm a fetus at any stage of development, although several studies have found that infections in early pregnancies could be the most damaging.

In an April study The BMJ, formerly known as The British Medical Journal, most babies with microcephaly were infected in the first trimester — the first three months of a nine-month pregnancy. 

But authors noted that 23% of mothers of babies with microcephaly in the study were infected with Zika in the second trimester, however. Two of 23 mothers were infected in the sixth month of pregnancy. None were infected in the third trimester.

In a March study in The New England Journal of Medicine,  doctors described a baby boy born through an emergency C-section because there was no amniotic fluid left in the uterus, a potentially life-threatening problem. The baby, a boy, recovered and appears to be healthy. His mother was infected with Zika in her 35th week of pregnancy.

"We are seeing problems in every stage of pregnancy,"  said Karin Nielsen, an author of that study and a professor of clinical pediatrics and director of the Center for Brazilian Studies at UCLA.
Q. Can we assume that babies without microcephaly are healthy?
A. No. Doctors have found evidence of brain damage even in babies whose heads are of average size.

 CDC director Thomas Frieden has noted that it could take years to know how Zika will affect babies as they grow and reach the age at which they should reach major milestones of development, such as walking, talking and learning to read.

Q. At what point in pregnancy can Zika-related birth defects be detected?
A. Zika-related birth defects don't seem to be detectable until about halfway through a 40-week pregnancy or even later. Doctors have noticed fetal brain abnormalities as early as 19 to 20 weeks into pregnancy, Nielsen said. But damage can take months to become visible on prenatal scans.

In one report in The New England Journal of Medicine, a Slovenian women infected at 13 weeks of pregnancy had normal ultrasound exams until her 28th week. Doctors spotted problems in her 29th week of pregnancy and detected microcephaly three weeks later. The woman chose to have an abortion at 32 weeks.
Q. What options do pregnant women have if their fetus is affected?
A. There are no treatments for Zika virus infection or microcephaly. Women can choose to continue the pregnancy, put a baby up for adoption or, in certain cases, terminate the pregnancy.

Forty-three states ban abortion after a certain stage of pregnancy or at the point of viability, when a fetus could be expected to survive outside the womb, with exceptions to protect the life or health of the woman, according to the Guttmacher Institute, which researches reproductive health.

Only six states — Georgia, Louisiana, South Carolina, Texas, Utah and West Virginia — allow abortions in late pregnancy because of “lethal fetal anomalies,” said Elizabeth Nash, senior state issues associate at the Guttmacher Institute. Maryland also allows abortion in late pregnancy due to a genetic fetal anomaly.

 None of those exceptions are likely to apply microcephaly or congenital Zika virus syndrome, as the spectrum of Zika-related birth defects has become known, Nash said.

Arina Grossu of the Family Research Council, which advocates for conservative causes, notes that several adoption agencies specialize in helping families interested in adopting children with disabilities.

Source - USA TODAY

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