What do we need to know about Zika and pregnancy?

Zika is not a new virus, it has been around since 1947 with numerous outbreaks throughout the years since. Prior to 2015 no association of Zika outbreaks and adverse pregnancy outcome had ever been noticed.

This Zika outbreak started in May 2015, with an epicentre  in Brazil. It has since spread throughout Latin America and further afield with over 48 countries having cases of Zika infection. When it was reported in January, there were over a million confirmed cases in Brazil alone! In October 2015 Brazil’s birth census analysis recorded a spike in microcephalic babies being born, above the typical rate expected for the country. This raised for the first time, the question of could Zika infection during pregnancy be associated with risk of congenital anomaly.

Should women pregnant or planning to get pregnant be worried about the Zika?

For any woman pregnant or planning to get pregnant as the Zika story was (and is) unfolding this information is of course worrying. That worry is not helped by what was very sensational reporting by the media. Granted babies being born with anomalies is a serious concern.

Thankfully as data begins to become more and more available, many of the questions become answered. Such as what percentage of women who contract Zika in pregnancy will have a baby with microcephaly or other adverse outcome? Does it matter when in pregnancy the woman contracts Zika? These important questions will be best answered in time when the large cohort studies of pregnant women who got Zika during pregnancy in Columbia and Brazil are published. But for the moment the latest current mathematical remodeling data indicates a risk of approximately 1%. Meaning that for 99% of women even if they do get Zika during their pregnancy they will have a healthy baby! One study recently released showed no cases of microcephaly in a large group of women who got Zika in the third trimester.

How can the spread of Zika be limited, or a person avoid Zika? And what approaches were taken in Barbados?

There are currently 48 countries with cases of the virus, it is not isolated to Brazil. It is now considered a worldwide disease. Of course some of these countries are further north, and the vector has been a human, with true population prevalence and risks of being infected in northern countries being very low.

The major concentration of the active transmission cases have been in Latin America. An important fact, to take into consideration when looking at the geography is this: mosquitoes do not travel very far (they only fly about 100m), it is the person transmitting the infection. If you don’t get bitten you are not at risk – mosquito prevention using DEET is safe in pregnancy. Active mosquito control is very important for this reason to limit the spread of infection. That goes for the governmental action and indeed is a community responsibility too. Clean up yards, trash and any vessel which can hold water and provide breeding grounds for mosquitos.

In Barbados huge focus was given to educating the public on Zika and the importance in limiting its spread. Active vector control was continued even into the dry season when it would typically have stopped. The Ministry of Health published a statement at the end of July stating that there had been no confirmed cases of Zika infection on the island for 12 weeks.

Has the media representation of the Zika virus been accurate?

There was a fair amount of non-responsible reporting in January, when we saw microcephaly plastered across newspapers. This was because it was new and yes alarming. Since then tremendous efforts in research and data collection have allowed governing bodies like the CDC and WHO to release guidelines, and we have seen a rise in balanced reports about the topic. These bodies have been able to gather data and generate statistics on the matter, whether it be to prove or disprove the dangers of the disease.

Has there been an obvious impact on the centre following the media reports?

A patient chooses their clinic for a number of different reasons. BFC pride ourselves with offering individualized top quality care, at an affordable cost. It is possible that Zika has tipped the balance for some people who would have ordinarily come here. What we saw was a huge number of questions from people. There is definitely a reassurance in facts now available.

Initially we saw our role as trying to provide information as best we could, before it was widely available. From March onwards, following the CDC’s most recent guidelines, there has been a lot more relief from patients. Now it is very much about presenting patients with the published credible information that is out there, as otherwise they would have to rely on google and the media frenzy. We enable access to this information and are able to explain areas not understood sometimes. This is the useful in guiding women when they are expecting, or planning to become pregnant.

What would you say to people thinking about pregnancy and Zika and coming to BFC?

If you are pregnant, or planning to become pregnant, use mosquito repellent and avoid being bitten. DEET is safe in pregnancy and the WHO has come out in support of women using repellents to prevent Zika.

Really, people need to make their own decisions. The potential risk is not minor, it is entirely their decision to come or not. What we have is a lot more clarification about Zika and risk now. With the mathematical remodelling, suggesting 1% risk this must be weighed for each person or couple. For women who are young living in high prevalent destination maybe deferring the wish of a family may be sensible. But for most of our patients, who are older and have diminished ovarian reserve, a delay in treatment is far more likely to have devastating consequences, of not fulfilling the dream of a family.