Women’s Knowledge of Zika Virus Drives Decisions on Prenatal Screening and Invasive Testing

Pregnant women demonstrate varied levels of knowledge regarding the risks of Zika virus infection and maternal-fetal transmission, according to findings from a new patient survey. Furthermore, knowledge of Zika virus appears to influence choices about prenatal screening, invasive testing, and pregnancy termination.

Margaret Villers, MD, a fellow in the Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology at Duke University, presented results from the survey at the 37th Annual Pregnancy Meeting of the Society for Maternal Fetal Medicine held January 23 to 28, 2017, in Las Vegas, NV.

“When pregnant women hear ‘Zika virus,’ they are incredibly worried,” Villers said. “Even so, we found that women understand the difference between high and low risk of infection and transmission, and they will make different decisions about their care based on that knowledge,” she added.

Pregnant women have been inundated with information on Zika virus from sources beyond the medical community, including the Internet, mass media outlets, and popular culture. However, it is unclear whether these waves of information translate into true knowledge and informed decision-making. The study was designed to assess women’s knowledge of Zika virus and how this may correlate with preferences around prenatal screening and testing for Zika virus.

Pregnant women were recruited to participate in the survey via electronic invitations after attending routine prenatal visits at Duke University Medical Center. The survey participants provided basic demographic information and answered 8 true/false questions designed to assess their baseline knowledge about Zika virus infection and its transmission risks. The total scores ranged from 0 (low knowledge) to 7 (high knowledge).

The survey posed 4 hypothetical scenarios representing increasing levels of risk for Zika virus infection. Each scenario began with travel to an area of ongoing Zika virus transmission and described different combinations of serum and ultrasonographic results. Based on this information, women were asked about their desires for additional prenatal screening, invasive testing, and pregnancy termination.

A total of 491 women completed the survey between June and July 2016. Most women were born in the United States (87%), were college graduates (80%), Caucasian (71%), and aged between 26 and 35 years (67%). The median baseline knowledge score was 6 (interquartile range, 2-7).

Results showed a significant correlation between knowledge of Zika virus and patient preferences (Table). In general, women with higher knowledge scores were less likely to desire amniocentesis in the setting of normal findings on ultrasonography, regardless of whether serum values were unavailable (P = .005) or positive (P = .01). Conversely, women with lower knowledge scores were more likely to choose invasive testing when the risk of Zika virus transmission was low or absent.

Table. Patient Preferences Following Hypothetical Travel Exposure, Preliminary Test Findings,
and Corresponding Knowledge Scores

Patient Preference Mean Knowledge Scoreª P Value
Yes No
Scenario 1: Normal findings on US; serum results unavailable
Desires amniocentesis 5.7 6.0 .005
Desires repeat US 5.9 5.6 NS
Desires no further testing 5.5 5.9 .01
Considers pregnancy termination 6.0 5.8 NS
Scenario 2: Microcephaly seen on US; serum results unavailable
 Desires amniocentesis 5.8 6.0 NS
 Desires repeat US 5.8 5.8 NS
 Desires no further testing 5.9 5.5 .01
 Considers pregnancy termination 6.0 5.7 .001
Scenario 3: Normal findings on US; positive finding on serum study
 Desires amniocentesis 5.7 6.0 .01
 Desires repeat US 5.8 5.4 .04
 Desires no further testing 5.5 5.9 NS
 Considers pregnancy termination 5.8 5.8 NS
Scenario 4: Microcephaly seen on US; positive finding on serum study
 Desires amniocentesis 5.8 6.0 NS
 Desires repeat US 5.8 5.9 NS
 Desires no further testing 5.6 5.8 NS
 Considers pregnancy termination 6.0 5.6 .0005

aTotal scores range from 0 (low knowledge) to 7 (high knowledge).
NS = nonsignificant, US = ultrasonography.

Women with higher knowledge scores were also more likely to consider pregnancy termination when results on ultrasonography showed microcephaly, irrespective of whether serum test results were unavailable (P = .001) or positive (P = .0005).

These findings support the critical role of educating patients to help them make informed decisions about their pregnancy care, Villers said. “We usually direct patients to the Centers for Disease Control and Prevention’s website, which is a great resource for patient-friendly information,” she added.

Source: Villers MS, Edwards JM, Heine RP, Small MJ. Knowledge of Zika virus and patient prenatal screening and testing preferences. Presented at: Society for Maternal-Fetal Medicine 37th Annual Pregnancy Meeting; January 23-28, 2017; Las Vegas, NV. Abstract 340.