Zika-related microcephaly has been confirmed in Puerto Rico, the US territory's health department has said.
It is the first local transmission of the congenital condition - that causes babies to be born with abnormally small heads - in the United States.
Puerto Rico Health Secretary Dr Ana Rius said that a woman had given a foetus to hospital officials who discovered it had severe microcephaly.
It tested positive for Zika.
Ms Rius declined to say whether the woman had an abortion or miscarried, or provide any other details.
Puerto Rico has had 925 cases of mosquito-borne Zika, including 128 pregnant women, but this is the only case so far linked to microcephaly.
At least one Zika-related death has been reported and more than a dozen others have been taken to hospital.
In January, health officials said a baby was born with microcephaly in Hawaii to a woman who had become infected with Zika in Brazil.
US Centers for Disease Control and Prevention spokeswoman Erin Sykes said: "This case of Zika virus disease in a pregnancy saddens and concerns us as it highlights the potential for additional cases and associated adverse pregnancy outcomes."
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