In:

The New England Journal of Medicine

Authors:

Margaret A. Honein, Ph.D., M.P.H., and Denise J. Jamieson, M.D., M.P.H.

The devastating fetal and infant outcomes associated with thalidomide use and rubella infection during pregnancy were key factors in the establishment of population-based surveillance for birth defects in the United States and globally to better monitor and address the effect of teratogens.1,2 This year, the recognition that Zika virus (ZIKV) infection during pregnancy can cause microcephaly and serious brain abnormalities and growing evidence of its association with other birth defects has similar potential to transform our approach to global surveillance for, research on, and prevention of birth defects.3 ZIKV infection during pregnancy highlights the challenges of adequately monitoring and documenting adverse effects in fetuses and infants. For example, the excess microcephaly after a ZIKV disease outbreak in French Polynesia that has now been documented was identified only by retrospective assessment.4 To ensure consistency in both pregnancy registries and ongoing birthdefect surveillance, the Centers for Disease Control and Prevention (CDC) has established surveillance case definitions to monitor birth defects potentially related to ZIKV infection during pregnancy: brain abnormalities with or without microcephaly, neural tube defects and other early brain malformations, eye abnormalities, and other consequences of central nervous system dysfunction (www.cdc.gov/zika/geo/pregnancy-outcomes.html).

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