Go ask WHO: Questions and answers about Zika and pregnancy

On Wednesday the World Health Organization published an online Q&A entitled Women in the context of microcephaly and Zika virus disease. Even though “there are many unknowns regarding the possible causes of microcephaly… the  risk of babies born with microcephaly has raised understandable concerns among women… who are pregnant or planning to become pregnant.” As to whether that concern is justified, the text says that “symptoms associated with Zika are generally mild” but “a possible association has been observed between the unusual rise of Zika cases and microcephaly cases in Brazil since 2015.”

Q&A: Women, pregnancy, and the Zika virus

How can women protect themselves from Zika infection?

·         Applying insect repellent – preferably containing DEET – to exposed skin or clothing. Repellents must be according to label instructions. They can be safely used by pregnant women.

·         Wearing light-colored clothes to cover as much of the body as possible.

·         Using screens, closed doors, windows, and other physical barriers.

·         Sleeping under mosquito nets, especially during the day (the Zika-carrying Aedes aegypti mosquito is a day biter.)

·         Emptying, cleaning or covering buckets, flower pots, tires, and other mosquito breeding sites.

Should pregnant women travel to areas with active Zika transmission?

·         The WHO is not recommending travel restrictions.

·         Women who are pregnant or planning to become pregnant must determine the level of risk they wish to take and plan accordingly. In particular, they should:

·         Stay up-to-date on the Zika virus and other mosquito-borne diseases.

·         Protect themselves from mosquito bites as described above.

·         Ask their doctor about traveling to an area where Zika virus is present.

·         Mention their planned travel during prenatal check-ups.

·         Talk to a healthcare provider about close monitoring of their pregnancy when they return from travel.

What should women do if they wish to postpone pregnancy due to concerns about microcephaly?

·         Whether and when to become pregnant should be an individual choice based on full information and access to affordable, quality health services.

·         Women should have access to a broad spectrum of contraceptive options, including long- and short-acting and permanent methods such as diaphragm, cervical cap, male condom, female condom, spermicidal foam, sponges and film.

·         There are no known safety concerns regarding the use of hormonal or barrier contraceptive methods for women or adolescent girls at risk of Zika virus, women diagnosed with Zika virus infection, or women and adolescents being treated for Zika virus infection.

What should pregnant women do if they wish to terminate their pregnancy because of a fear of microcephaly?

·         Most women in Zika-affected areas will give birth to normal children.

·         Early ultrasound does not dependably predict microcephaly except in extreme cases.

·         Women who wish to terminate a pregnancy should have access to safe abortion services to the full extent of the law. They should consult a healthcare provider for information on obtaining safe abortion services.

·         In countries with restricted access to and/or limited availability of safe abortion, women should be provided information and counseling about their alternatives, including information about reducing harms from unsafe abortion and accessing treatment for subsequent complications.


Additionally, the WHO recommends that “all all men and women living in or returning from an area where Zika is present should be counselled on the potential risks of sexual transmission and ensure safer sexual practices,” given that Zika has been found in human semen and at least one study has described a case of sexually-transmitted Zika virus. However, “more evidence is needed to confirm whether sex commonly transmits the Zika virus.” Similarly, “Zika virus infection close to term could potentially be transmitted during childbirth,” but “this has not been proven to date.” In general, pregnant women should see their doctor to have their pregnancy closely monitored. Moreover, “Zika virus has been detected in breast milk but there is currently no evidence that the virus is transmitted to babies through breastfeeding.” Therefore, the WHO stands by its current breastfeeding recommendations.

These WHO guidelines only refer to the risk of microcephaly, but a new study published in JAMA Ophthalmology on Tuesday suggests that Zika-related microcephaly can cause visions problems – such as bilateral macular and perimacular lesions, and optic nerve abnormalities – that could eventually result in blindness. Brazilian researchers examined 29 infants with congenital Zika virus infection in the Roberto Santos General Hospital of Salvador and found that 34.5% (10 children) had ocular abnormalities. “Because the rate of ocular abnormalities is very high in this age group and the retinal lesions differ from other congenital infections described previously in the literature,” the scientists wrote, “we hypothesized that a cause and effect relationship between ZIKV (the Zika virus) infection and ocular abnormalities was possible.” The study “provides evidence that the effects of Zika are not limited to the brain,” Yale Professor of Epidemiology and Medicine Dr. Albert Ko, who also participated, said.

Related: Zika outbreak: A tale of mosquitoes, blood, sex, and vaccines