The Ministry of Health (MOH) yesterday released a detailed FAQ on Zika and pregnancy, tackling the concerns of expectant mothers and couples wanting to start a family. This comes as MOH and the Clinical Advisory Group on Zika and Pregnancy revised guidelines for pregnant women here in the wake of an outbreak of the virus in the Aljunied Crescent-Sims Drive area.
FOR COUPLES PLANNING PREGNANCY
Q If a woman who is not pregnant is bitten by a mosquito and infected with the Zika virus, will her future pregnancies be at risk?
A The Zika virus infection does not pose a risk of birth defects for future pregnancies.
Q If a couple is planning for pregnancy, what is the MOH's advice if either one lives, works or studies in an affected area?
A If both the man and woman are well, they should take strict precautions against mosquito bites, and if they have further questions, they should consult their doctor.
If the woman develops fever and rash, and shows other symptoms such as red eyes or joint pain, she should seek medical attention promptly. If she tests positive for Zika, she should practise safer sex or abstain from sexual intercourse for at least eight weeks after recovery, before trying to conceive.
If the man shows symptoms, he should seek medical attention promptly. If he is found to have the Zika virus, he should practise safer sex through the use of condoms or abstain from sexual intercourse for at least six months after recovery.
FOR PREGNANT WOMEN AND THEIR PARTNERS
Q Are there any tests that can be done to determine if a pregnant woman is infected with Zika?
A Currently, the only reliable test is the reverse transcriptase-polymerase chain reaction (RT-PCR) test, which looks for genetic material of the virus in blood or urine.
However, the test is able to detect Zika infection in blood only within five to seven days of the onset of symptoms, and in urine within 14 days of onset. Therefore, the timeframe in which a pregnant woman can be tested using RT-PCR is very short.
Currently, there is no reliable serological test (which looks for antibodies in the blood) for Zika.
Q If I am pregnant and my male partner tests positive for Zika, do I need to get tested if I do not have any symptoms?
A If you have had sexual intercourse with your partner, you should consult a doctor and inform the doctor of possible exposure to Zika so that he/she can arrange for Zika testing.
Q If I am pregnant and asymptomatic, but worried about possible exposure to Zika, where should I go to get tested?
A The World Health Organisation's (WHO) May 2016 guidelines and MOH's August 2016 clinical guidelines on Zika virus infection and pregnancy do not recommend routine Zika testing for asymptomatic pregnant women. If you are concerned, you should discuss this further with your doctor.
Q Should a woman who is pregnant get regular blood/urine tests for Zika, to make sure that she is not infected?
A No, unless she has symptoms of a possible Zika infection such as fever and rash and other symptoms such as red eyes or joint pain.
Q Is it safe for pregnant women to use insect repellent?
A Yes, insect repellents sold in Singapore are safe for use by pregnant women.
You can also prevent mosquito bites by wearing long-sleeved clothing and long trousers, and sleeping under mosquito nets or in rooms with wire-mesh screens or in air-conditioned rooms to keep out mosquitoes.
Q If I am pregnant and have recently visited a Zika-affected area in Singapore, what should I do?
A There is no need to see a doctor if you are well. You should continue to take strict precautions against mosquito bites. If you have symptoms of possible Zika virus infection, you should seek medical attention immediately, and consult your obstetrics and gynaecology (O&G) doctor.
Q If I am pregnant and live, work or study in a Zika-affected area in Singapore, what should I do?
A You should take steps to prevent mosquito bites and consult a doctor if you develop a fever and rash and other symptoms such as red eyes or joint pain after possible exposure to Zika. You should tell the doctor where you live, work or study.
FOR PREGNANT WOMEN/ MOTHERS WITH ZIKA
Q What is being done in other countries to manage pregnant women with Zika? Is Singapore doing the same?
A In countries with community transmission of Zika virus infection and in line with WHO's guidelines, pregnant women with Zika are advised to follow up closely with healthcare practitioners to detect any foetal abnormalities. Singapore has adopted similar recommendations.
Q If I am pregnant and my blood tests positive for Zika, will I need to be hospitalised?
A Like other patients who test positive for Zika, you should be referred to a hospital and managed by an O&G doctor.
Q If I am pregnant and test positive for the Zika virus infection, will my baby have microcephaly?
A Currently, even if a pregnant woman is confirmed to be infected with the Zika virus, there is no test that will predict the future occurrence of microcephaly. We advise that you follow up closely with your doctor.
Q If a pregnant woman tests positive for Zika virus infection, should she consider termination of pregnancy?
A A pregnant patient with confirmed Zika infection will be admitted to a public hospital with a referral to an O&G doctor for further management. Serial ultrasounds and amniotic fluid testing may be considered after the potential risks and interpretation of results are discussed.
The termination of pregnancy is a personal choice that should be made carefully by the parents in consultation with their doctor.
Q Can mothers with Zika infection breastfeed their baby?
A The Zika virus has been detected in breast milk, but there is currently no evidence that it is transmitted to babies through breastfeeding.