Vital Signs: Zika-Associated Birth Defects and Neurodevelopmental Abnormalities Possibly Associated with Congenital Zika Virus Infection - U.S. Territories and Freely Associated States, 2018.

INTRODUCTION: Zika virus infection during pregnancy causes serious birth defects and might be associated with neurodevelopmental abnormalities in children. Early identification of and intervention for neurodevelopmental problems can improve cognitive, social, and behavioral functioning. METHODS: Pregnancies with laboratory evidence of confirmed or possible Zika virus infection and infants resulting from these pregnancies are included in the U.S. Zika Pregnancy and Infant Registry (USZPIR) and followed through active surveillance methods. This report includes data on children aged ≥1 year born in U.S. territories and freely associated states. Receipt of reported follow-up care was assessed, and data were reviewed to identify Zika-associated birth defects and neurodevelopmental abnormalities possibly associated with congenital Zika virus infection. RESULTS: Among 1,450 children of mothers with laboratory evidence of confirmed or possible Zika virus infection during pregnancy and with reported follow-up care, 76% had developmental screening or evaluation, 60% had postnatal neuroimaging, 48% had automated auditory brainstem response-based hearing screen or evaluation, and 36% had an ophthalmologic evaluation. Among evaluated children, 6% had at least one Zika-associated birth defect identified, 9% had at least one neurodevelopmental abnormality possibly associated with congenital Zika virus infection identified, and 1% had both. CONCLUSION: One in seven evaluated children had a Zika-associated birth defect, a neurodevelopmental abnormality possibly associated with congenital Zika virus infection, or both reported to the USZPIR. Given that most children did not have evidence of all recommended evaluations, additional anomalies might not have been identified. Careful monitoring and evaluation of children born to mothers with evidence of Zika virus infection during pregnancy is essential for ensuring early detection of possible disabilities and early referral to intervention services.

Gestational Diabetes Mellitus Prevalence, Screening, and Treatment Practices in American Samoa, 2016.

Gestational diabetes mellitus (GDM) is a serious pregnancy complication and understudied public health issue in American Samoa. The goals of this study were to (1) estimate the prevalence of GDM in American Samoa, (2) evaluate current screening practices for GDM, and (3) evaluate obtainment of GDM treatments in 2016. This cross-sectional study used 3 data sources: electronic health records, a labor and delivery logbook, and the American Samoa Department of Health (ASDOH) Maternal and Children's Health (MCH) Postpartum database. Out of 995 women with a singleton birth in American Samoa during the study period, 60.1% (n=598) completed a glucose tolerance test for GDM. Of these women, 41.8% (n=250) completed the testing within the recommended 24-28 weeks gestation timeframe. The estimated prevalence of GDM was 14.0% (95% confidence interval: 11.2-16.8) but has many limitations due to missing data. There were 4 treatments analyzed: nutrition counseling, insulin, metformin, and diabetes counseling. Of all women diagnosed with GDM (n=84), 76% were prescribed any of the 4 treatments. However, only 52% of those women obtained the treatment prescribed. Access to testing and treatment needs to be expanded to provide adequate prenatal care to women in American Samoa.