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S
imões
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et
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108
R
ev
A
ssoc
M
ed
B
ras
2016; 62(2):108-115
GUIDELINES IN FOCUS
Zika virus infection and pregnancy
I
nfecção
pelo
vírus
Z
ika
e
gravidez
Authorship:
Associação Médica Brasileira
Final Draft:
March 18, 2016
Participants:
Ricardo Simões
1,2
, Renata Buzzini², Wanderley Bernardo², Florentino Cardoso², Antônio Salomão¹,
Giovanni Cerri²
1
Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo)
2
Guidelines Project, Associação Médica Brasileira
http://dx.doi.org/10.1590/1806-9282.62.02.108The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standard-
ize procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, de-
pending on the conditions and the clinical status of each patient.
D
escription
of
the
evidence
colection
method
The literature review of scientific articles in this guideline
was held in the databases Medline, Embase and Cochrane,
using the terms (MeSH terms) individually or grouped,
structured according to P.I.C.O. (“Patient”, “Interven-
tion”, “Control” and
“
Outcome
”
) methodology. After
carefully reading the titles and abstracts, only articles con-
taining relevant information to the components of P.I.C.O.
were included. The studies were analyzed for relevance
and level of evidence according to the Oxford Centre for
Evidence Based Medicine
1
(
D
) table.
G
rade
of
recommendation
and
strength
of
evidence
A.
Experimental or observational studies of higher con-
sistency.
B.
Experimental or observational studies of lower con-
sistency.
C.
Case reports/non-controlled studies.
D.
Opinions without critical evaluation, based on con-
sensus, physiological studies, or animal models.
O
bjective
This guideline is intended for physicians, nurses, public
health officials and patients at risk of Zika virus infec-
tion, with the purpose of assessing the effects on the pe-
riod of pregnancy and postpartum.
C
onflict
of
interest
No conflict of interest was declared by the participants
in the development of this guideline.
I
ntroduction
The Zika virus, first isolated in 1947 in rhesus monkeys in
the Zika forest in Uganda, is an arbovirus, member of the
Flaviviridae family and the flavivirus genus. First found in
humans in Nigeria in 1954, for 50 years the virus was de-
scribed as a cause of sporadic human infections in Africa
and Asia, until in 2007 an epidemic took place in
Micronesia.
2,3
(
C
) More recently, outbreaks were identified
in 15 different islands of Polynesia. The Ministry of Health
of Brazil, as verified by the data provided by the Live Births
Information System (SINASC), has recorded substantial
increase in the number of cases of microcephaly (Chart 1)
in the country after a high incidence of infection. The clin-
ical features and natural history of Zika infection are based
on a limited number of case reports; however, it is clear
that vertical transmission of the virus can occur during
pregnancy, as seen in a series of reports of cases of micro-
cephaly among children whose mothers were infected with
Zika virus.
4,5
(
C
)
6
(
D
)
According to an epidemiological report for monitor-
ing cases of microcephaly in Brazil, until February 6, 2016,
75.8% of the cases reported (3,852/5,079) remained under
investigation, of which 62.5% (n=3,174) were reported in
2015 and 37.5% (n=1,905) in 2016.
7
(
D
) According to the
final classification, 24.2% of the total cases were investigat-
ed and classified and, of these, 15.1% (n=765) were discard-
ed for the presence of microcephaly and/or changes in the
central nervous system suggestive of congenital infection.
Of the remaining, 9.1% (462/5,079) were confirmed accord-
ing to specific protocol definitions (Charts 1 and 2, and
Annex) and, of these, only 8.9%, i.e., 41 out of 462, were
confirmed as associated with infection with Zika virus by