Am J Perinatol 2020; 37(07): 731-737
DOI: 10.1055/s-0039-1688819
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Single-Center Experience with a Pregnant Immigrant Population and Zika Virus Serologic Screening in New York City

Audrey A. Merriam
1   Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
,
Chia-Ling Nhan-Chang
1   Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
,
B. Isabel Huerta-Bogdan
1   Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
,
Ronald Wapner
1   Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
,
Cynthia Gyamfi-Bannerman
1   Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
› Author Affiliations
Further Information

Publication History

28 October 2018

02 April 2019

Publication Date:
30 May 2019 (online)

Abstract

Objective Our institution is in an area of New York City with a large population of immigrants from Zika virus endemic areas. With the recent Zika virus outbreak, we sought to examine our center's experience with screening for Zika virus and outcomes among patients who tested positive for the disease during pregnancy.

Study Design We performed a chart review of all pregnant patients who tested positive (positive serum or urine polymerase chain reaction [PCR]) or presumed positive (immunoglobulin M [IgM] enzyme-linked immunosorbent assay [ELISA] positive or IgM ELISA equivocal with positive plaque reduction neutralization test) for Zika virus. All tests were performed by the Department of Health (DOH) and followed Centers for Disease Control and Prevention guidelines in effect at the time of specimen collection. Testing of cord blood, placenta, and/or neonatal blood were/was performed by the DOH for New York County. Prenatal ultrasounds for fetal head size and surveillance for calcifications were performed by maternal–fetal medicine specialists. Infant head ultrasound results were included when available.

Results Between March 2016 and April 2017, 70 pregnant patients were positive or presumed positive for Zika infection during pregnancy. Of those, 16 women had positive urine or serum PCR and the remaining 54 were presumed positive. Among positive cases, five women tested positive via urine PCR only, nine women tested positive via serum PCR only, and two women had both positive urine and serum PCR. Fifteen of 67 infants (22%) born during the study period were born to mothers with positive urine or serum PCR testing. Sixty-five newborns were clinically normal with normal head measurements. Of the intracranial ultrasound performed, one infant had a grade 1 intraventricular hemorrhage, four had incidental choroid plexus cysts, and one had severe ventriculomegaly that was also noted antenatally. There were 2 positive and 15 equivocal infant serum IgM samples and 1 positive placental PCR from these pregnancies. There were four pregnancy terminations and two cases with fetal anomalies in this population that were split evenly between patients who tested positive and those who tested presumed positive for Zika virus during pregnancy.

Conclusion We found no differences in pregnancy or neonatal outcomes between women who tested positive and presumed positive for Zika virus during pregnancy. Testing of infants and placenta tissue after delivery was largely inconclusive. Improvement in testing for Zika virus infection is needed to determine which pregnancies are at risk for congenital anomalies. Further research is still needed to determine which children are at risk for poor neurodevelopmental outcomes related to Zika virus and how to best coordinate care among the immigrant population during a new disease epidemic.

Condensation

Improvement in maternal testing for Zika virus is needed, particularly when working with an immigrant population with unclear timing of exposure during pregnancy.


 
  • References

  • 1 Teixeira MG, Costa MdaC, de Oliveira WK, Nunes ML, Rodrigues LC. The epidemic of Zika virus-related microcephaly in Brazil: detection, control, etiology, and future scenarios. Am J Public Health 2016; 106 (04) 601-605
  • 2 WHO. Zika Virus, Microcephaly, and Guillain Barré Syndrome Situation Report. World Health Organization; 2016. . Available at: https://apps.who.int/iris/handle/10665/250633 . Accessed May 20, 2019
  • 3 Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects--reviewing the evidence for causality. N Engl J Med 2016; 374 (20) 1981-1987
  • 4 Miranda-Filho B, Martelli C, Ximenes R. , et al. Initial description of the presumed congenital Zika syndrome. Am J Public Health 2016; 106: 598-600
  • 5 Parra-Saavedra M, Reefhuis J, Piraquive JP. , et al. Serial head and brain imaging of 17 fetuses with confirmed Zika virus infection in Colombia, South America. Obstet Gynecol 2017; 130 (01) 207-212
  • 6 Sanz Cortes M, Rivera AM, Yepez M. , et al. Clinical assessment and brain findings in a cohort of mothers, fetuses and infants infected with ZIKA virus. Am J Obstet Gynecol 2018; 218 (04) 440.e1-440.e36
  • 7 Department of Health Daily Zika Update. Florida Department of Health 2017 . Available at: http://www.floridahealth.gov/newsroom/2017/01/011217-zika-update.html . Accessed May 21, 2019
  • 8 Zika in Texas. Texas Department of State Health and Human Services 2017 . Available at: https://www.texaszika.org/ . Accessed May 23, 2019
  • 9 Honein MA, Dawson AL, Petersen EE. , et al; US Zika Pregnancy Registry Collaboration. Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy. JAMA 2017; 317 (01) 59-68
  • 10 Madad SS, Masci J, Cagliuso Sr NV, Allen M. Preparedness for Zika virus disease - New York City. Morb Mortal Wkly Rep 2016; 65 (42) 1161-1165
  • 11 Oduyebo T, Igbinosa I, Petersen EE. , et al. Update: interim guidance for health care providers caring for pregnant women with possible zika virus exposure—United States, July 2016. Morb Mortal Wkly Rep 2016; 65 (29) 739-744
  • 12 Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements--a prospective study. Am J Obstet Gynecol 1985; 151 (03) 333-337
  • 13 Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991; 181 (01) 129-133
  • 14 Society for Maternal-Fetal Medicine (SMFM) Publications Committee. Ultrasound screening for fetal microcephaly following Zika virus exposure. Am J Obstet Gynecol 2016; 214 (06) B2-B4
  • 15 Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996; 87 (02) 163-168
  • 16 The Global Health Network. Intergrowth-21st. 2009 . Available at: https://intergrowth21.tghn.org/ . Accessed May 23, 2019
  • 17 Fleming-Dutra KE, Nelson JM, Fischer M. , et al. Update: interim guidelines for health care providers caring for infants and children with possible zika virus infection—United States, February 2016. Morb Mortal Wkly Rep 2016; 65 (07) 182-187
  • 18 Eppes C, Rac M, Dunn J. , et al. Testing for Zika virus infection in pregnancy: key concepts to deal with an emerging epidemic. Am J Obstet Gynecol 2017; 216 (03) 209-225
  • 19 Barbier A, Boivin A, Yoon W. , et al; Canadian Neonatal Network. New reference curves for head circumference at birth, by gestational age. Pediatrics 2013; 131 (04) e1158-e1167
  • 20 Shapiro-Mendoza CK, Rice ME, Galang RR. , et al; Zika Pregnancy and Infant Registries Working Group. Pregnancy outcomes after maternal Zika virus infection during pregnancy - U.S. Territories, January 1, 2016-April 25, 2017. Morb Mortal Wkly Rep 2017; 66 (23) 615-621
  • 21 Rao R, Gaw SL, Han CS, Platt LD, Silverman NS. Zika risk and pregnancy in clinical practice: ongoing experience as the outbreak evolves. Obstet Gynecol 2017; 129 (06) 1098-1103
  • 22 Melo AS, Aguiar RS, Amorim MM. , et al. Congenital Zika virus infection: beyond neonatal microcephaly. JAMA Neurol 2016; 73 (12) 1407-1416