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What you need to know about Zika before you conceive
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In Texas, dozens of women are showing up to be tested each Friday at a Zika clinic. In South Carolina, one county sprayed so vigorously for mosquitoes that it killed thousands of honeybees. And in Florida, young mothers douse themselves in bug spray, even if they're staying inside.

Welcome to the United States of Zika, where a virus few people had heard of a year ago has a country on edge even though most infected people wouldn't even know they were sick.

If it didnt affect pregnant women, Zika wouldnt be an issue. It's such a mild illness, four out of five people (who contract it) have no symptoms," said Dr. Karen Harris, an ob-gyn in Gainesville, Florida, and chairwoman of the American College of Obstetricians and Gynecologists' Florida district.

For expectant couples and young families, however, Zika is a scourge that can't be ignored. "There's a great deal of appropriate anxiety there," Harris said, even though the odds of catastrophe are relatively small.

If a pregnant woman has Zika, there's a one in 100 chance that her baby will contract it too, according to the Centers for Disease Control and Prevention. A recent study published in The New England Journal of Medicine suggests that up to 13 percent of infected babies will develop the abnormally small head and maldeveloped brain that is the horrific calling card of microcephaly. By comparison, in a normal pregnancy, the risk of having a baby born with Down syndrome or another anomaly is usually less than 1 percent.

Whether you're pregnant now, or thinking about having a baby in the next couple of years, Zika should figure into your planning, just as it did for Heidi Murkoff, the author of What to Expect When Youre Expecting." She just added a section on Zika in the latest edition of the iconic pregnancy handbook.

As of Aug. 31, there were 2,722 confirmed cases of Zika in the continental U.S. and 624 pregnant women showing evidence of infection, according to the CDC. Health officials expect Zika cases to wane as winter sets in, but the virus can be passed from adult mosquitoes to their larvae, meaning a new generation of Zika-infected mosquitoes will hatch next year.

And even if Zika never transcends geographical pockets to become a full-bodied threat on the continental U.S., it's not likely to disappear completely.

"I don't think Zika is going to leave the our consciousness anytime soon. There have been very few times in recent history where we have been witness to something that has affected the lives of women and children so vividly and profoundly, said Dr. Anne Drapkin Lyerly, a North Carolina obstetrician and bioethicist and author of the book "A Good Birth."

How to lower the risk

Chelsea Platas, 29, is the mother of a 1-year-old girl named Aria and lives with her husband near Jupiter, Florida. The couple has been thinking about having another child, but thats on hold for now. I have to say, Zika changes everything. The birth defects caused by Zika sound overwhelming.

Platas said her best friend, who lives in New York, recently found out she was pregnant and was told by her doctor not to travel to Florida, where more than 20 million Americans live. What are people living in South Florida supposed to do? Platas asked.

The CDC has answers to that question, just not a treatment or cure. If youre pregnant, and contract Zika, details about your pregnancy will be collected and sent to government researchers, and the CDC advises you to have an ultrasound every three or four weeks. Otherwise, theres not anything else you can do but wait, hope and pray. The risks of birth defects are highest if the virus is contracted in the first trimester.

For people who dont have Zika, however, there are things you can do to lower your risk, which is greatest if you or your partner travel to areas with active cases.

The World Health Organization recently announced that both men and women who have visited areas with active Zika should refrain from intimacy or use a condom for six months since you can have Zika without showing symptoms and the cirus can remain in semen for months after it's left the bloodstream.

Also, couples who have traveled to areas with Zika should use insect repellent containing DEET upon their return. Ironically, this is to protect not you, but the local mosquitoes, which could catch Zika from you and then spread it locally.

Dont let your mosquitoes get Zika. Protect your mosquitoes, Harris, the Gainesville obstetrician, said.

An hour away from where the first American mosquitoes were found carrying Zika, Brenda Hockman, operations manager for Island Environmental Pest Control in West Palm Beach, is headed to work in short sleeves.

Unlike Miami mothers who go outside only when necessary, Hockman and her friends, all young mothers, are still wearing shorts outside and still using their backyard pools, albeit with a layer of bug spray.

Were going on with everyday life; its not like everyone is inside, said Hockman, who has a 3-year-old daughter. If we paid attention to every threat we heard, wed all be living in a bubble.

That said, Hockman instructs her customers (and coaches her friends) on how to make their homes unfriendly to mosquitoes: Rid your yard of standing water, even in containers as small as a bottle cap. And as you dump out the water, clean the container: eggs might be attached to the side.

Residents of South Florida don't often experience what the rest of the country calls winter, but even in states where it snows, mosquitoes can lie dormant for months and hatch in the spring, still carrying Zika passed on by their mothers.

Remembering rubella

Although no mosquitoes carrying Zika have been found outside of Florida, Texas is ready for them. The state government has set up a website devoted to the disease (Texaszika.org), and Baylor Universitys School of Medicine has opened a clinic exclusively for Zika testing and information at Texas Childrens Pavilion for Women.

Dr. Catherine Squire Eppes works there on Friday mornings. About 30 women come every week for testing and ultrasounds, but the number has been climbing every week since the clinic opened in March.

Typically, an expectant mother has two ultrasounds during her pregnancy: one in the first trimester to date the pregnancy, another in the second to look for abnormalities. The CDC, however, is recommending that women at risk for Zika have one every three or four weeks. Its one of the ways Zika is changing how women manage risk during pregnancy. Another is the recommendation to liberally apply bug spray, something that some women shunned until recently.

There have been two randomized control trials of DEET in pregnancy that dont show adverse effect. And clearly, Zika can have adverse effects, Eppes said. The complete story on DEET and risks is a complicated one that we cant easily answer. Its all about balancing risk.

Anne Drapkin Lyerly, the North Carolina obstetrician who also teaches at the University of North Carolina at Chapel Hill, has noted that many people are divided on what constitutes an acceptable risk in pregnancy, in part because researchers are reluctant to conduct studies with pregnant women. This may also hinder current research on a virus that most affects developing babies.

Regardless of how the hunt for a vaccine plays out, Lylerly said the current epidemic has the potential to change medical mores and practices like the thalidomide tragedy and rubella did in the 1950s and 1960s.

Like Zika, rubella (also called German measles) can cause birth defects when a baby contracts it in utero; like Zika, most people infected never know they are sick. With widespread immunization, the disease has now been nearly wiped out. But at its peak, rubella changed how people thought about pregnancy because they realized the risks of infections during pregnancy.

On the heels of the thalidomide tragedy, pregnancy, in the context of rubella, became a time you had to worry about what you put in your mouth, where you went, and who you interacted with. It marked a shift in risk assessment and perception, Lyerly said.

Zika, too, stands to change peoples attitudes about pregnancy and conception. In high-risk areas in Latin America, health officials are urging women not to get pregnant until after the epidemic has passed. Since many of the affected countries are largely Roman Catholic, that means they are asking Catholic women to use birth control, which their church banned in 1930.

As heart-wrenching photographs of Zika babies with microcephaly circulate on the internet, attitudes about abortion are also starting to shift.

Polls conducted by STAT News and Harvard University's T.H. Chan School of Public Health found that people asked about late-term abortion were largely opposed to it until the question was framed to include babies who may have microcephaly caused by Zika. Then, 59 percent of respondents said they would support abortion after 24 weeks. When microcephaly wasnt mentioned, only 23 percent said they did.

In her book, Lyerly interviewed 100 mothers across the country and found that many shared ideas about what comprised a good birth. Zika threatens many of these, including the desire for control, for safety and for knowledge. New and often worrisome information emerging about Zika can disrupt a womans sense of security, both in her own pregnancy and the process of birth, she said.

Lyerly is dismayed by governments' emphasis on women postponing pregnancy because of Zika. Writing with two other physicians in The Baltimore Sun, she called this unfair and unrealistic.

This may be the right time for someone to get pregnant. There are a lot of reasons women choose to get pregnant in the face of risk. It turns out, we all do, she said in an interview. As the late anthropologist Mary Douglas said, Dangers are manifold and omnipresent, she noted.

If we insisted on risk-free pregnancy, our populations would be a lot smaller," Lyerly said.

New data from researchers at the University of Florida project that Zika will wane in November, and in the U.S., will be limited to Florida and a few other large cities in the South, such as Tampa and Orlando.

Were talking about small clusters here and there, one of the researchers told The Miami Herald. The study suggests that eight babies in the U.S. will be exposed to Zika, and that infections in other Southern states will number no more than 16.

Even if those projections hold true, that doesnt mean weve seen the last of Zika, as travelers will ferry it around continents in clusters. In Texas, Eppes hopes for the best, but warns that modeling can be tricky.

Nobody, in the beginning of this, would have projected what occurred in Brazil, she said.
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