The spread of the Zika virus throughout the Americas has public health teams in multiple countries working to better understand the epidemic, including its impact on pregnancy. With Zika's rise, a noticeable increase in babies born with small heads and brains, a condition known as microcephaly, have been documented.
While circumstantial, the association is strong enough that on Feb. 19, the World Health Organization announced that "... a growing body of clinical and epidemiological data points towards a causal role for Zika virus."
The mosquito that transmits Zika is not present in Alaska, but Alaskans who travel to tropical regions risk exposure. As of Friday, 107 people in the United States have experienced confirmed travel-associated cases of the illness, including nine pregnant women.
Anchorage mom Laura Avellaneda-Cruz found herself confronted with potential risks and heightened worries after a trip to Colombia in late 2015, early in her second pregnancy. She had not known about Zika, transmitted primarily by mosquitos, during her travels. But she had been warned about and prepared to minimize the risk of other mosquito-borne illnesses -- dengue fever, chikungunya, yellow fever, West Nile virus.
Avellaneda-Cruz chronicled her worries in a collection of letters to her baby, emails to her husband, texts to friends and her personal diary. All are filled with loving thoughts for the child she is carrying, and with the unwelcome intrusion of a Zika scare on her developing pregnancy.
Excerpts from her writing appear in italics.
Week 4 (letter to baby): Dear baby, I am so glad, so grateful, so honored, that you have joined our family within my body.
Avellaneda-Cruz, who has spent much of her career working in maternal and child public health, traveled with her family to Colombia last fall. Zika arrived in Colombia by October 2015, but it wasn't yet on the radar for U.S. travel advisories.
Week 11 (letter to baby): Baby, we are now leaving Colombia, your papi's tierra natal. You, via me, got lots of local meat, eggs, vegetables, and fruit -- oh the fruit! We spent lots of time with your abuelos, your bisabuelo, and your distant cousins and aunties. It was fun, but it also took nearly constant vigilance to protect you -- from listeria, e-coli, and salmonella in food and water (I had to forgo cheese on the farm because I couldn't find any made with pasteurized milk) and from malaria, dengue, typhoid, chikonguña and yellow fever. I did still manage to get four mosquito bites somehow. I felt so much more relaxed when we returned to Bogotá, where the mosquitoes don't transmit diseases and the water is potable. I worry about you baby and want you to be safe because I love you.
By November 2015, Brazil and French Polynesia begin to connect Zika outbreaks to an increase in newborns with microcephaly and other central nervous system malformations.
Week 13 (diary): Finding out about Zika on Saturday and reading everything I can about it since then has been … hard. Finding out how little is known and how non-definitive the tests are is harder. I don't know if a positive result will be real or false because I don't know if I have other flavivirus antibodies. I don't know if a negative result is really negative because maybe I wasn't symptomatic enough to mount a response that would produce antibodies. I don't know enough to know that I can make the right decision. These decisions, this ethical weighing is what's hardest -- that I could make a decision/guess and could end up with a baby with microcephaly, or that I could act too hastily from my fear. I don't want all this fear and stress for baby. I'm sorry, baby.
As scientists begin to document mother-to-child transmission, they find Zika in exposed mothers' saliva, urine, blood, amniotic fluid and in the tissue of infants and fetuses with microcephaly. Similar associations are showing up in Zika-infected adults who later developed Guillain-Barre syndrome, an autoimmune disease that attacks the nervous system.
Week 13 (letter to baby): I want you to feel cradled there in your amniotic sac. I want you to feel warmth and love, hear the raspberries your big sister blows on my belly, feel nurtured by the blood I send you. But I know I've also sent you a lot of cortisol recently. I know it's been too much stress. I'm sorry, baby. All I want for you is calm. I surround you with the golden glow of warmth, nurturance, hope and anticipation. My strong body holds you. My arms await you.
Zika takes the form of a mild flu-like illness in adults. There may be fever, rash and eye irritation. Yet only one in five people who are infected are symptomatic.
Week 14 (text to a friend), Jan. 20: I just had the biostatistician at work calculate my odds based on the case numbers in the states in Colombia I was in. My odds are about one in a hundred million. ? This puts me at ease. I think baby will be okay.
Frequent sonograms are recommended during pregnancy to look for signs of developmental problems. Meanwhile, blood and other tests can be performed to detect Zika exposure. Only women meeting the exposure criteria can have the tests, which are conducted in coordination with the U.S. Department of State.
Week 14 (text to a friend), Jan. 22: Midwife called -- test results negative! I'm pretty sure this means baby will be okay. Gonna get 18 week ultrasound to make sure baby is developing well. They can't diagnose microcephaly until third trimester, but I think (hope?) that a normal ultrasound at 18 will put me at ease, take some of this weight off. And I think we're fine. Odds are on our side.
If Zika can travel from mother to baby, what about from man to woman? Is sex safe? By early 2016, researchers are scrambling to answer important questions.
Week 16 (email to husband), Feb. 4: Sexual transmission in Texas (?) F. This is what I have been trying to get answers on and haven't. I wrote the CDC a while back about prevention of sexual transmission and got only a vague response because they don't know much yet. I wish they'd issue guidelines.
Zika's presence in and transmission through semen has been confirmed. The Centers for Disease Control and Prevention recommend abstinence or consistent and correct use of condoms for sexually active men who reside in or travel to Zika-affected areas. Men's role in protecting women and babies is to not spread the disease to their sexual partners.
Week 16 (email to husband), Feb. 5: Here are the new guidelines on prevention of sexual transmission. Wish CDC had issued these a few weeks ago. It is terrifying that we didn't know [how long Zika can live in sperm]. The infectious disease specialist said since you didn't have a real fever or any other Zika symptoms while we were in Colombia that we probably shouldn't be too worried. I guess that's good. But I am scared again, amor. I really am.
Prenatal ultrasounds offer an opportunity to see if the baby appears to be developing normally.
Week 18 (letter to baby): The long-awaited date of the ultrasound has finally arrived and I feel so much better. Seeing you move around, my sweet baby boy Rio, seeing you bringing your thumb to your mouth and your hands to your eyes, seeing your healthy little organs and beautifully-formed spine and your healthy brain and normal-sized head with no calcifications -- this all makes me relax into my body and into this pregnancy, and therefore relax your tiny little body. You are so sweet and perfect, my Rio Esteban. I am excited to prepare your sister for her role in helping care for you. I am so excited to prepare my mind and body to give birth to you, to bring you into the world peacefully. This is probably not the complete end of my worry, but … but I think we're okay, little love … No, I am confident that we're okay. I am happy and at ease.
Zika and its exact impact on pregnancy is best described as a "complicated and evolving discussion," as explained by genetic counselor Dee Quinn with MotherToBaby-Arizona, a nonprofit organization that provides information and outreach to health care professionals and the public about pregnancy exposures and breastfeeding.
"Really, prevention is our only tool at this point," Quinn said.
Travel notices recommending increased precautions remain in place for both women and men who might travel to Zika-affected countries. Women of reproductive age are encouraged to postpone pregnancy. Pregnant women are encouraged to postpone travel.
More research is needed to rule out other reasons for the increased number of microcephaly cases, such as environmental causes, genetic factors, exposures to toxins and other illnesses. However, a causal link is strongly suspected. Brazil has documented 5,640 cases of microcephaly, with 120 deaths, between October 2015 and February 2016. In prior years, there were an average of 163 cases annually. Of the nine known Zika cases among pregnant women in the United States, the CDC reported last week that two pregnancies resulted in early miscarriages, two women chose to terminate their pregnancies, and one woman delivered a nearly full-term baby with severe microcephaly. All of these women with impacted pregnancies were exposed to Zika in or near the first trimester. Of the three women who were exposed later in their pregnancies, two have delivered healthy babies. Two women, one from both groups, have not yet given birth.
Avellaneda-Cruz, who by all accounts appears to be Zika-free, expects to welcome a healthy newborn later this summer.
Resources for Zika and pregnancy
Here are some resources where you can get your questions about the Zika virus and pregnancy answered.
MotherToBaby
Fact Sheet: mothertobaby.org/fact-sheets/zika-virus-pregnancy/pdf/
Phone: 866-626-6847
Text: 855-999-3525
Online chat also available on the main website
Centers for Disease Control and Prevention
Travel Info.: wwwnc.cdc.gov/travel/page/zika-travel-information
World Health Organization
www.who.int/features/qa/zika-pregnancy/
Pan American Health Organization
Laura Avellaneda-Cruz lives, writes and works in Anchorage where she resides with her young family.
Jill Burke is a longtime Alaska journalist writing from the center of a busy family life. Her father swore by "Burke's Law No. 1 -- never take no for an answer." Meaning, don't give up in the face of adversity. The lesson stuck. Share your ideas with her at jill@alaskadispatch.com, on Facebook or on Twitter.
The views expressed here are the writer's and are not necessarily endorsed by Alaska Dispatch News, which welcomes a broad range of viewpoints.