Florida Doctors Outline Zika Risks In Treating Pregnant Patients
KELLY MCEVERS, HOST:
Being pregnant can be stressful. There's all the stuff you're not supposed to eat, the medications you should avoid, figuring out whether to do genetic tests, and all kinds of conflicting advice. And now, some women and their partners have to consider the risks of Zika, especially in Florida where local mosquitoes have transmitted the virus. Elizabeth Etkin-Kramer is hearing more and more questions about Zika from her patients. She is an OB-GYN whose office is in Miami Beach which is one of the affected areas. And she is with us now. Hi there.
ELIZABETH ETKIN-KRAMER: Hi, how are you?
MCEVERS: Good. So when you meet with a pregnant patient or someone who's thinking about getting pregnant, what do you tell them about Zika? I mean, how do you talk about this threat now?
ETKIN-KRAMER: The first thing I make sure to do in a patient who's trying to get pregnant or who already is pregnant is you've got to assess their risk. We always want to make sure to know if they have traveled or live in or work in areas where local Zika is being transmitted. And once you've established that risk, then you can test and see if they've been affected.
MCEVERS: And so once someone has been diagnosed as being affected, then what happens next? I mean, is there, like, a regular schedule of testing that happens?
ETKIN-KRAMER: Sure. The woman can choose to do additional tests such as an amniocentesis to see if a fetus is infected or she can follow the fetus with sequential serial ultrasounds to check for birth defects that can affect a fetus.
MCEVERS: I mean, one of the frustrating things about Zika must be that, you know, this fetal brain damage might not be visible until far into a pregnancy.
ETKIN-KRAMER: Correct, and that's one of the scarier thoughts, that we don't know the success rate of picking up all the potential complications of Zika virus to a fetus. Microcephaly is just one of them. We're finding more calcifications in fetal brain or an effect on vision or perhaps hearing. But we have no idea. This is completely new to us.
MCEVERS: So you've never dealt with something like this.
ETKIN-KRAMER: Correct, this is a game changer in the United States.
MCEVERS: You know, say something doesn't appear until 20 weeks into pregnancy. That's what could happen, right?
ETKIN-KRAMER: Even later, and then what does the patient do? Options are limited.
MCEVERS: Explain why.
ETKIN-KRAMER: Well, they can choose to continue a pregnancy or they can choose termination.
MCEVERS: But Florida law prohibits termination after 24 weeks, isn't that correct?
ETKIN-KRAMER: Uh-huh, correct...
MCEVERS: So if something isn't determined until after that, that wouldn't be an option for the woman.
ETKIN-KRAMER: No, unless they choose to go elsewhere.
MCEVERS: As an OB-GYN in the middle of this, do you feel like people are coming to you scared and you're in a position to try to kind of talk them down?
ETKIN-KRAMER: Absolutely. But when you're dealing with - there's an emotional component that you can't - no matter what you say, it's frightening. I saw a patient today who is seven weeks pregnant. And her husband said to me, should we move? Should we go away? I said, do you have the resources? And he said yes. And I said, well, if you want to decrease your chances of getting infected with a mosquito carrying Zika, then sure. But the majority of my patients don't have that option.
MCEVERS: Right, and so for people who, you know, don't have that option...
MCEVERS: ...The best advice you can give is stay away from mosquitoes.
ETKIN-KRAMER: Well, prevention - avoiding mosquito bites, wearing long sleeves, insect repellent, keeping in air conditioning, keeping windows closed - all those things can decrease transmission of the virus.
MCEVERS: Beyond the advice to wear insect repellent and avoid mosquitoes, how do you counsel people about sexual transmission?
ETKIN-KRAMER: It's ironic that patients are trying to get pregnant or are already pregnant and we're telling them to use condoms. But that's exactly what we're telling them to do.
MCEVERS: So for someone who's thinking of having a child, do you say, wait until winter?
ETKIN-KRAMER: You know, that's something that is very easy to say to a young patient, to a 20-year-old. But how do you say that to a 40-year-old who's dealing with decreasing ovarian reserve and who wanted to get pregnant yesterday - because every minute for them counts.
MCEVERS: Dr. Elizabeth Etkin-Kramer is an OB-GYN in Miami Beach. Thanks so much for your time today.
ETKIN-KRAMER: Thank you. Transcript provided by NPR, Copyright NPR.