Modifying Prenatal Care for Pregnant Women with Antenatal Microcephaly

One of the factors that makes the Zika virus so worrisome is the threat that it poses for pregnant women and their unborn fetuses. Pregnant women who are infected with Zika risk transmitting the virus to their fetus, and this transmission can have a number of severe consequences. This global problem has researchers worldwide dedicating their efforts on studies that seek to further understand all related factors of this devastating virus.

In a presentation at the First International Zika Conference, Carmen Zorrilla, MD, professor of obstetrics and gynecology, University of Puerto Rico, School of Medicine, provided session attendees with some insight into the Zika epidemic in Puerto Rico, sharing that as of February 17, 2017, there were 38,733 confirmed cases of the virus; 3,076 of these cases were pregnant women. In fact, overall, the epidemic is estimated to actually affect about 25% of pregnant women in Puerto Rico.

In addition to her session presentation, Dr. Zorrilla and her team presented a poster for another study that delved into the decision-making of pregnant women with “antenatal Zika-related microcephaly.”

When it comes to testing for Zika in Puerto Rico, the Puerto Rico Health Department follows the Center for Disease Control’s guidelines that state prenatal testing of asymptomatic women should be offered to all women during the 1st and 2nd trimesters; testing is also offered to all symptomatic women as well, at any time throughout their pregnancy.

Through this testing, those women who have fetuses “with fetal abnormalities,” such as microcephaly, are able to be identified. This is important because microcephaly is a condition that calls for “special maternal and infant care needs.” These women are also faced with “ethical dilemmas” when it comes to pregnancy options after they are informed of these abnormalities.

For this study, Dr. Zorilla and her team evaluated pregnant women at the University Hospital in San Juan, Puerto Rico, who tested positive for Zika virus infection. After testing positive for the Zika virus, the women went for regular prenatal visits, which occurred bi-weekly after diagnosis.

After evaluation, Dr. Zorrilla and her team found that of the 80 pregnant women who were infected with the Zika virus (ages ranging from 18 to 31) in the prenatal clinic, seven “have been diagnosed with fetal microcephaly and other brain abnormalities [in the fetus], consistent with Zika embryopathy.” Five of the seven women, or 71%, experienced symptoms during their 1st trimester and two of them were asymptomatic. According to the research, “Microcephaly was diagnosed <20 weeks gestational age (GA) in 5 women (71%), and >22 weeks GA in 2 women (29%).”

The researchers provided these women with counseling that provided information on pregnancy options, such as pregnancy termination, as well as potential neonatal outcomes. Four of seven women, or 57%, chose to terminate their pregnancy and 3 (43%), decided to have their babies due to “religious beliefs and considerations of fate: ‘This is my destiny.’” Furthermore, these women “agreed with allowing nature to take its course in case of decreasing fetal heart rate during labor.” The researchers concluded that, “three of the four pregnancy terminations had fetal Zika infection by pathology examination” and one is still pending.

The researchers pointed out that these women were nervous about the stigma associated with Zika virus and they expressed “fears of isolation.” In an effort to help these women, the researchers offered them “to be followed in a special group of three, or to continue with their group prenatal care,” what Dr. Zorrilla refered to as “Centering.” The researchers also noted that the mothers of the pregnant women served as “their main support system.” The women were more comfortable receiving group care “with other Zika-infected women without microcephaly.”

In an exclusive interview with Contagion®, Dr. Zarrillo explained further what “Centering” prenatal care consisted of.

When it comes to the implications of these findings, the researchers feel that “prenatal care should be modified to include conversations and options regarding pregnancy termination and about labor and delivery.” They also stressed, “the need for maternal and family psychological support; the use of antidepressants, if needed, as well as contraceptive advice; the need for neonatal subspecialty consultations [on] infant special care needs; economic burden; [and] how to deal with public knowledge of the birth outcome via photos and media exposure and with curiosity of people in public places.”