Chikungunya Fever Obstetric Considerations on an Emerging Virus

Chikungunya fever is an increasingly common viral infection transmitted to humans by species of the Aedes mosquitoes. Characterized by fevers, myalgias, arthralgias, headache, and rash, the infection is endemic to tropical areas. However, identification of disease vectors to Europe and the Americas has raised concern for possible spread of chikungunya to these areas. More recently, these concerns have become a reality; with more than 500,000 new cases in the Western hemisphere in the last 2 years, questions have arisen about the implications of infection during pregnancy and delivery. A literature review was performed using MEDLINE in order to gather information regarding the obstetric implications of this infection. It appears that although this virus can cross the placenta in the first and second trimester leading to fetal infection and miscarriage, this is a very rare occurrence. In contrast, active maternal infection within 4 days of delivery conveys a high risk of vertical transmission. Maternal infection during pregnancy does not appear to be more severe than infection on the nonpregnant female. Given the increasing incidence of chikungunya, obstetric providers should be aware of the disease and its implication for the gravid female. Target Audience Obstetricians and gynecologists, family physicians, emergency medicine physicians, nurse midwives Learning Objectives After completing this activity, the learner should be better able to: describe the presentation, symptoms, and diagnosis of chikungunya fever; describe the risks of chikungunya fever to fetus and to the mother in each trimester and at the time of delivery; and outline the management considerations for pregnant women with active chikungunya infection.