Updated Zika Guidance

ACOG and SMFM have revised sections of their Practice Advisory on Zika Virus

Critical updates include:

• Obstetric health care providers should continue to consult CDC’s World Map of Areas with Risk of Zika when assessing patients. In many countries the epidemic is over, however Zika is still likely to be endemic in various regions of the Americas.
• New data on currently available IgM tests shows that IgM antibodies persist at least four months following acute infection, thus making it difficult to determine if IgM detected during pregnancy represents an infection that is recent (during pregnancy) or one that occurred before pregnancy. IgM can also persist for a prolonged period of time potentially making timing of infection with subsequent pregnancies difficult to determine.
• The number of false positive Zika tests has risen as the prevalence of Zika has decreased, and this compounds some of the limitations of the IgM test.
• CDC no longer recommends routine Zika virus testing for asymptomatic pregnant women withpossible Zika exposure that is not ongoing*. However, testing of asymptomatic pregnant women without ongoing* possible exposure should be considered using shared decision making. See more in the Assessment and Testing section.
• Some jurisdictions (e.g. those at increased risk for local transmission) will continue to recommend Zika testing for asymptomatic pregnant women due to increased risks of transmission. Therefore, obstetric providers should check regularly with their state and local health departments for information on testing asymptomatic pregnant women without ongoing* possible exposure.
• The CDC now recommends concurrent IgM and NAT testing for symptomatic pregnant women with possible Zika exposure up to 12 weeks after symptom onset. Ideally, testing should be performed as soon as possible after symptoms begin. Revised testing Figure 1 & Figure 2 can be found in theAssessment and Testing module.

*Ongoing exposure is defined as currently living in or frequent travel (e.g. daily or weekly) to areas with Zika virus transmission
Regardless of location, providers should evaluate all pregnant women in the United States for possible Zika virus exposure during each prenatal care visit. This evaluation should include an assessment of signs and symptoms of Zika virus disease, a travel history, and a woman’s sexual partner’s potential exposure.
More Information

Obstetrician-gynecologists and other obstetric providers are encouraged to visit the following resources for detailed guidance and information regarding Zika, including breaking developments:

• ACOG’s Zika webpage
• CDC Zika Virus Website
• US Zika Pregnancy Registry: Obstetrician-gynecologists can contact the CDC Zika Pregnancy Hotline at 770-488-7100 or email ZikaPregnancy@cdc.gov for any concerns related to clinical management or the US Zika Pregnancy Registry.
• State Health Department Contact list for ob-gyns (members only) for questions on CDC’s Zika Registry and Testing

ACOG now recommends hemoglobinopathy analysis for all women 

ACOG now recommends hemoglobinopathy analysis for all women, with DNA-based testing following screening through complete blood count and hemoglobin electrophoresis, in their Committee Opinion #691 released in March 2017. DNA confirmation of sickle cell, hemoglobin AS, beta thalassemia carrier status is available through Horizon.

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Gain greater clarification of alpha thalassemia carrier status

Screening for hemoglobinopathies with Horizon provides clarification of alpha thalassemia carrier status when MCV is low and hemoglobin electrophoresis results are normal.