A monthly newsletter from the office of Dr Mary Kirk
May 2016
The Zika Virus

With any disease outbreak, especially one that causes concern for the wellbeing of mothers-to-be, our office begins receiving calls for information. Here's some current information to help you stay educated about this developing issue:

The Zika Virus was first isolated by scientists at the East African Virus Research Institute in Entebbe, Uganda in 1952. 1 Since then, it has mostly been observed in monkeys infected by mosquitos carrying the virus. Confirmed incidents of Zika in humans were relatively rare up until 2007 when an island in Micronesia suffered an epidemic of it. The next major outbreak occurred in French Polynesia in 2013-2014. The virus then began to spread more rapidly as it was carried by infected tourists/travelers. There has been a lot of debate around when it first entered South America, but its rapidity of transmission has caught the attention of world leaders and, of course, the media. 

The Zika virus was considered to be relatively benign before it began its great spread in the past few years. Those with the Zika virus are often unaware that they have it due to its mildness. Possible symptoms include a mild fever, joint/muscle pain, eye irritation, skin spots, lymph node enlargement, and/or a headache lasting only a few days to a week.2,3 It is also considered likely that once a person has been infected, they will be protected from future reinfection. 

The danger of the Zika virus lies in its likely effects on developing babies. In 2015, Brazilian scientists began noticing an increased mortality rate for infants, due to neurological problems, in women who had tested positive for the virus during pregnancy.2 Once alerted, scientists from other infected regions began paying special attention to pregnant women, pregnancy records, and infant outcomes. The data collected appears to show a significant increase in several neurological issues in expectant mothers infected with the Zika virus. Although other agents have been investigated as possible causes for the sudden increase in malformations, the growing mass of evidence points to the virus as the common denominator.

The CDC recommends that women who are pregnant or may become pregnant avoid traveling near infected areas and for all people to take extra precautions against mosquito bites although mosquitos carrying the virus are not yet believed to exist in this country. If travel to affected regions is unavoidable, it is imperative that you take measures to safeguard your health. Specific guidelines for traveling pregnant women can be found here: CDC - Interim Guidlines for Pregnant Women

According to the CDC, as of April 20 th , 2016, there have been no reported cases of locally acquired Zika virus within the United States. All known cases have been associated with travel to high-risk areas. Of these 388 cases, 33 infected individuals were pregnant, and 1 baby was diagnosed with neurological malformations.4

The Zika virus is a mosquito borne pathogen, however, as a result of recent studies, scientists believe it can also be sexually transmitted. In several cases, Zika has been found present in semen samples collected after men infected with the virus complained of hematospermia (blood in their semen). Viruses with a similar nature to Zika have been known to be transmissible by urine and semen from infected individuals even after the virus was cleared from the bloodstream.5 Further studies are needed, but until then, sexual abstinence is recommended if there is a chance of infection.

If you have been at risk during travel and experience any of the symptoms above, it is important that you report to your doctor regardless of whether you are pregnant. Testing for the virus is performed through CDC facilities and some state health departments as there is not yet a commercially available test. So far, there is not a vaccine for this virus and avoiding high-risk areas and monitoring your symptoms after possible exposure is the surest way to protect yourself and others. For more information, as well as maps of the areas currently reporting outbreaks, please see the links below.

1. "Zika Virus." Emerging Infectious Diseases 20.6 (2014): 1090. Print.

2. Lopes MH, Miyaji KT, and Infante V. "Zika Virus." Revista Da Associação Médica Brasileira (1992) 62.1 (2016): 4-9. Print.

3. "Symptoms, Diagnosis, & Treatment." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 11 Mar. 2016. Web. 26 Apr. 2016. http://www.cdc.gov/zika/symptoms/index.html

4. Zika Virus Disease in the United States, 2015-2016." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 30 Mar. 2016. Web. 26 Apr. 2016. http://www.cdc.gov/zika/geo/united-states.html

5. Musso, Didier, et al. "Potential Sexual Transmission Of Zika Virus." Emerging Infectious Diseases 21.2 (2015): 359-361. Military & Government Collection. Web. 28 Apr. 2016.

Folic Acid

This vitamin's name was derived from the Latin word folium, meaning leaf, having first been isolated from spinach in 1941. It is also known as folate or Vitamin B9 as it is in the B vitamin family. It can be found in leafy vegetables, citrus, beans, and whole grains, although it is usually recommended that supplements be taken to ensure proper levels are maintained. For pregnant women, the CDC recommends a supplement of 400mcg of folic acid each day. 2 

This vitamin is important for all individuals, but it is especially significant in women's health. Folic acid plays an important part the production of new cells and is vital for fetal neurological development during pregnancy. Although fetal neurological defects have been the most studied with respect to folic acid levels, heart, face, and urinary tract defects have also been linked to deficiency. 3,4 Because some of these birth defects develop very early in pregnancy, by the time a woman knows she is pregnant, it is too late to begin supplementation to prevent them. Therefore, any woman of childbearing age or wishing to become pregnant should take special care to supplement.

Pregnancy can be draining on a woman's folic acid levels and cessation of prenatal vitamins after delivery puts many at risk for deficiency. It is important that a mother's body be able to recover after delivery, and folic acid is important in this respect. Fertility may increase during this time as well, which leads to a higher risk for birth defects in subsequent pregnancies. Furthermore, some studies have noted significantly low levels of folic acid in people with depressive disorders. 5 This has led to speculation that folic acid supplementation may be a means to help prevent postpartum depression. New mothers should be careful to either continue taking their prenatals just after delivery or switch straight to a multivitamin.

Folic acid is mostly known for aiding the adult body in its cellular replication process which helps with organ repair, blood cell production, and skin, hair, and nail health. However, although studies are ongoing, it has been linked to the prevention of a wide variety of diseases. Recent studies have even found it helpful in alleviating some postmenopausal symptoms, like hot flashes! 6

More information can be found here: 

1.  "EPublications - Folic Acid Fact Sheet" US Department of Health & Human Services, Office on Women's Health, 16 Jan. 2012. Web. 28 Apr. 2016. http://www.womenshealth.gov/publications/our-publications/fact-sheet/folic-acid.html

2. "Facts About Folic Acid" Centers for Disease Control and Prevention, 24 Dec. 2014 . Web. 28 Apr. 2016. http://www.cdc.gov/ncbddd/folicacid/about.html

3. Bazzano LA. "Folic acid supplementation and cardiovascular disease: the state of the art". Am. J. Med. Sci. 338 (1) (2009): 48-9. Print.

4. Kadir, Rezan A., and Demetrios L. Economides. "Neural Tube Defects and Periconceptional Folic Acid" Canadian Medical Association.Journal 167.3 (2002): 255-6. ProQuest. Web. 28 Apr. 2016.

5. Behzadi AH, Behbahani AS, and Ostovar N. "Therapeutic Effects of Folic Acid on Ante Partum and Postpartum Depression" Medical Hypotheses 71.2 (2008): 313-4. Print.

6. Gaweesh S., and Ewies AA. "Folic Acid Supplementation Cures Hot Flushes in Postmenopausal Women" Medical Hypotheses 74.2 (2010): 286-8. Print.

Fun Fact:

Mosquitoes have been around much longer than humans. The oldest known specimen with anatomy similar to the mosquitos of today was found in Canadian amber that is about 79 million years old. 

These insects are pretty efficient when looking for a host. They observe movement and find hosts by detecting infra-red radiation and chemical signals emitted by warm bodies up to 75 feet away!

There's an app for that!

BabyBump Pregnancy Pro

This comprehensive app allows you to keep track of just about everything that happens 
 during your pregnancy and even includes 25,000+ baby names.

Dr Mary C Kirk | 918-508-2200 | www.kirkobgyn.com