By Melanie Evans and Jennifer Calfas in the Wall Street Journal
Joey England, a physician specializing in maternal and fetal medicine in Houston, was at her optometrist’s office waiting for an exam when an employee there abruptly asked her, “Should I get pregnant?” The employee, hoping for a child, was anxious about the Zika virus.
Such encounters are increasingly common for physicians in the U.S. amid devastating reports of Zika’s harm to fetuses and its rapid emergence in the Americas. Worried women are inundating doctors with questions about the virus, physicians say, pressing for answers about the risk of infection, symptoms of illness and when to test for the disease. Women who hope to get pregnant want to know if they should wait. Those with travel plans are asking whether to avoid trips to places where Zika may emerge or where it can already be found.
In Houston, located in a county with one of the nation’s highest birthrates, anxiety is “pretty high,” said Dr. England, a maternal-fetal specialist with Children’s Memorial Hermann Hospital.
Public-health officials say the city is among a few areas in the U.S. they are watching for possible local transmission by mosquitoes.
Dr. England said she encourages healthy women ready for a baby not to wait, unless they expect to travel where Zika is spreading, such as Central or South America or the Caribbean. Ultimately, the decision to have a child is one for a woman and her family, Dr. England told the employee.
Zika hasn’t been found circulating in the U.S. mainland, but public-health experts expect it to reach the States. The mosquitoes that can carry Zika, Aedes aegypti and Aedes albopictus, are found from California to the Gulf Coast and along the Eastern Seaboard as far north as southern Maine.
“I spend a lot of time every day talking about Zika,” said Neil Silverman, a clinical professor of obstetrics and gynecology at the University of California, Los Angeles School of Medicine.
He said he is asked daily about canceling trips to Florida or New York by patients who incorrectly believe the virus has been found in the U.S. Others ask to be tested for Zika though they or their partners (Zika can be transmitted sexually) haven’t traveled anywhere where an outbreak is under way.
Dr. Silverman said he spends “a good amount of time” offering reassurance to patients, stressing that Zika hasn’t been found circulating in the U.S. His three-physician practice in Los Angeles has seen 170 women for travel-related Zika concerns since January. One pregnant woman tested positive. He is monitoring fetal development every three to four weeks. An amniocentesis for fetal infection was negative, he said.
The Centers for Disease Control and Prevention recommends pregnant women avoid travel where Zika is spreading. Women who aren’t pregnant should avoid conception for at least eight weeks after travel where Zika is circulating. A woman should wait six months if her male partner has traveled in Zika-endemic areas and has symptoms, or eight weeks if he doesn’t get sick.
A strain of Aedes aegypti mosquito. Photo: Jeff Miller/UW-Madison/Associated Press
Miriam Zavala, a 27-year-old mother of two in Houston, became pregnant in February. Zika’s emergence in Mexico prompted her to skip her husband’s family reunion there in April. He developed pinkeye after his return. Red eyes can be a symptom of Zika, though her husband didn’t recall a mosquito bite and didn’t get tested for the virus.
The couple followed CDC recommendations to use condoms, but Ms. Zavala grew anxious. This month, her doctor referred her for an ultrasound and the results found no worrisome signs, which was a relief, she said.
The CDC has reported 12 babies and fetuses in the U.S. with birth defects tied to travel-related Zika infections. In the U.S., 287 pregnant women have tested positive for infections.
The wait for results of Zika tests can be several weeks, doctors say. The CDC has increased the number of laboratories certified to conduct Zika confirmation tests, from a single Colorado lab in January to 59 labs in 39 states, Washington, D.C., and Puerto Rico as of early June. Dr. Silverman said waits have decreased.
The virus is known to cause birth defects, including microcephaly—an abnormally small head that is associated with brain damage. But the rate at which Zika causes defects and the full range of possible complications are unknown, said Dana Meaney-Delman, a member of the pregnancy and birth-defects task force for the CDC Zika virus response.
The CDC estimates the risk of microcephaly to be 1% to 13% for women infected during the first trimester. Other research published in March found abnormalities in fetuses of 29% of pregnant women with a Zika infection in Rio de Janeiro who received an ultrasound.
Doctors caring for pregnant women with Zika say they offer closer monitoring, performing ultrasound every three to four weeks to check for head circumference and other abnormalities associated with Zika, such as intracranial calcification.
Tania Esakoff, an obstetrician-gynecologist and clinical director of the Prenatal Diagnosis Center at Cedars-Sinai Medical Center in Los Angeles, said she has screened almost 10 patients a week since January. One who had traveled where Zika is circulating tested positive.
There are no sign of birth defects thus far, and the baby is due soon, Dr. Esakoff said, which has made the news easier for the patient.
“She’s definitely nervous but is reassured by how things look on the scan,” Dr. Esakoff said.