The Ministry of Health (MOH) and the Clinical Advisory Group (CAG) on Zika and Pregnancy advise all pregnant women in Singapore with symptoms of Zika (fever and rash and other symptoms such as red eyes or joint pain), as well as those (with or without symptoms) with male partners who are Zika-positive, to be tested for Zika virus infection, regardless of whether they have been to Zika-affected areas.
As for those women who are pregnant but do not have symptoms of the Zika infection and the male partners are not Zika positive, the testing is not recommended.
MOH states that pregnant women who meet this criteria should take the test referred by the doctors, the fee will be provided free at public healthcare institutions. The practice is the same as Zika testing for those with symptoms and who live, work or study in a Zika-affected area.
The guidelines had been updated following the localised community spread of Zika virus infection in the Aljunied Crescent/ Sims Drive area. The guidelines are being shared with obstetricians and gynaecologists (O&G), and neonatology and paediatric specialists in our Public Hospitals, as well as all polyclinics and general practitioners.
Microcephaly
The consequences of pregnant woman who is infected can be more serious, as Zika virus infection can cause microcephaly in the unborn foetus of pregnant women.
Microcephaly is a congenital condition in which the head size is much smaller than usual for a baby of the same age, race and sex.
A variety of genetic and environmental factors, such as Down Syndrome, exposure to drugs, alcohol or other toxins in the womb, rubella and a few other infections during pregnancy can be the cause of this condition. However, there is no specific treatment for this condition.
Care for Pregnant Women
MOH said that pregnant with no symptoms of Zika will be monitored as part of their routine prenatal care. O&G doctor may offer regular foetal ultrasounds to further check on the foetus’ health for those who are concerned.
While pregnant women who are confirmed to have Zika infection will be referred to a maternal foetal medicine (MFM) specialist for counselling and advice. Regular ultrasounds may be recommended to monitor for foetal growth and abnormalities. MOH will also arrange for her to be admitted to a public hospital for further management and care if necessary.
Pregnant woman with 15 weeks of pregnancy or more may be offered amniotic fluid testing for Zika. However, there is currently not enough research to ascertain the effectiveness of testing for Zika in amniotic fluid, therefore, a positive Zika test in amniotic fluid does not always mean that the foetus will have birth defects.
Members of public should take note that a positive Zika test does not mean that the foetus is infected or harmed. A recent study published in the New England Journal of Medicine found that the risk of an infected mother giving birth to a child with microcephaly is between one to 13 percent.
Prevention of Infection
Pregnant women should undertake strict precautions against mosquito bites since prevention of Zika virus infection is the best protection for both the pregnant woman and her foetus. They should seek medical attention immediately if they become symptomatic.
A small number of cases of sexual transmission have been documented, therefore, potentially exposed males with female partners who are pregnant should practise safe sex through the correct and consistent use of condoms, or abstinence, for the duration of their female partner’s pregnancy.
Women with confirmed Zika virus infection should abstain from sexual intercourse for at least eight weeks after recovery. While men with confirmed Zika virus infection but whose female partner is not pregnant should also adopt safe sexual practices or consider abstinence for six months after recovery.