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Zika and Pregnancy: Here's What You Should Know

The total number infected with Zika in Singapore now stands at 189, with 38 more cases confirmed on 2 September 2016, 34 of which were linked to the Aljunied Crescent/Sims Drive/Kallang Way/Paya Lebar Way cluster. The Ministry of Health (MOH) and National Environment Agency (NEA) both reported that the best way to control the spread of Zika is through vector control and continued efforts are being made to detect and destroy breeding habitats.

Zika is transmitted primarily via Aedes mosquitoes. The common symptoms of infection with Zika include fever, rash, joint pain and conjunctivitis (red eyes) that can last from 2 days to one week. For the majority of people, Zika is not life-threatening and many patients do not show any symptoms of infection. Therefore, many people are unaware that they may have contracted Zika.

However for pregnant ladies, infection may lead to microcephaly – a serious birth defect. We spoke to Dr Lim Kai Hung, Family Physician at Lifescan Medical Centre, on Zika, microcephaly and pregnancy. He also gives tips on safety considerations while using mosquito repellants. 

Please tell us more about the link between Zika, pregnancy and microcephaly.

Dr Lim: For pregnant women infected with the Zika virus, they are highly at risk of birth defects like microcephaly. There has been a startling increase of microcephaly in Brazil, with close to 4,000 cases reported since January 2016. Research is ongoing to confirm the causal link between Zika during pregnancy and microcephaly.

Microcephaly is a rare neurological condition where an infant’s head is significantly smaller than other children of the same gender and age. Data has also suggested that newborns of mothers who are infected with Zika during their first trimester of pregnancy have an increased risk of microcephaly.

How can pregnant ladies avoid mosquito bites? What measures can they take?

Dr Lim: The measures taken to avoid mosquito bites are the same for pregnant ladies and everyone else:

  1. Wear long-sleeved clothing and long pants, if possible
  2. Stay indoors with air-conditioning, and with windows and door screens that can keep mosquitoes out
  3. Place a mosquito bed net before you sleep if you are unable to protect yourself from mosquito bites
  4. Use insect repellent recommended by health authorities and re-apply as directed                                                        
  5. Take steps to prevent mosquitoes from breeding inside and outside your home.

    To eliminate and control mosquitoes from breeding, it is recommended to: 

  • Remove stagnant water in outdoor containers (flower pots, bottles, and containers that collect water)
  • Cover domestic water tanks so that mosquitoes cannot get in 
  • Avoid accumulating garbage: Put them in closed plastic bags and keep them in closed containers 
  • Declog drains that could cause accumulation of standing water
  • Use screens and mosquito nets in windows and doors to reduce contact between mosquitoes and people

Can a mother diagnosed with Zika infection still breastfeed her child?

Dr Lim: Zika virus has been detected in breast milk, but there is currently no clear evidence nor indication that the virus can be transmitted to babies through breastfeeding. 

Are there any tests that can detect microcephaly early?

Dr Lim: Ultrasound scans during pregnancy may be able to detect microcephaly, but that is not always the case. Currenlty, even if a pregnant woman is confirmed to be infected with the Zika virus, there is still no specific test to predict the future occurrence of microcephaly.

Other than through a mosquito vector, can Zika be passed on to someone else through other means?

Dr Lim: Yes, apart via a mosquito, Zika can sexuallly transmitted to someone else.

If an expectant mother suspects she has been infected, what processes will she be put through by her doctor?

Dr Lim: The expectant mother will be required to undergo testings to confirm the Zika virus infection. Once the infection is confirmed, ​the patient should discuss with their OB-GYN doctor with regard to further management. 

What kind of repellents are safe and effective for pregnant women to use?

Dr Lim: Most repellents are safe for pregnant women and there are many commercial brands available that can be easily purchased from any pharmacy.

Some safety measures that you can take when using repellents are as follow:

  • Only apply repellents onto exposed skin or clothing as recommended on the product label. Do not apply under your clothing.
  • Do not apply repellents on cuts, wounds or irritated skin.
  • Do not apply repellents to your eyes or mouth.
  • Avoid spraying repellent directly on your face. If necessary, spray on your hands and then apply the repellent on your face.
  • Use an adequate amount of repellent to cover exposed skin and clothing. Heavy application does not provide thicker nor longer-lasting protection.
  • After returning indoors, wash away the repellent with soap and water or take a shower. This is important to take note of especially when you use repellents repeatedly in a day or on consecutive days.
  • If you notice a rash or other reactions from the repellent, stop using it immediately and wash with mild soap and water. Seek immediate medical attention if your rash worsens.

It is important to read the product labels on repellents very carefully to understand how often and where to apply, especially for pregnant women.