Deli meat. Weight gain. Back pain. Every little cramp or wiggle. Pregnant women have plenty to worry about. And now they can add one more big one: the Zika virus.
For anybody expecting a child - or thinking about having one - the headlines this past year likely have been scary. Zika primarily spreads through infected mosquitoes, but it's not the only way. Some have gotten Zika from having sex with a person who has the virus.
It's easy for most people to shake off Zika if they get it. In fact, many people with Zika have no symptoms or very mild ones, such as a fever, rash or joint pain. But, if the person with Zika is pregnant, the result can be devastating.
A pregnant woman infected with Zika can pass the virus to her unborn baby, according to the Centers for Disease Control and Prevention. Some mothers who were infected with Zika while pregnant have given birth to babies who have microcephaly, a serious birth defect where a baby's head is smaller than expected when compared to babies of the same sex and age. Often, the smaller brains haven't developed properly. Other pregnancy problems include eye defects, hearing loss and impaired growth.
So far, there have been 624 reports of pregnant women in U.S. states and Washington, DC., with any laboratory evidence of a possible Zika virus infection. Another 971 have been identified in U.S. territories.
"It's a common concern because it’s a disease that’s not occurred in the Western Hemisphere before," State Public Health Veterinarian Carl Williams said in an interview. "It’s something that people don't know much about. There is legitimate concern and people want to know if they are at risk in their home state."
Thankfully, here in North Carolina, there's a lot of good news for women who are expecting or hope to become pregnant. The mosquito most commonly associated with the Zika virus, called Aedes aegypti, has not been identified in North Carolina this year, according to the N.C. Division of Public Health. The agency is working with local health departments, Western Carolina University, East Carolina University and N.C. State University to collect and identify mosquitoes across the state. So far, they've tagged more than 30,000 mosquitos in 16 counties.
While there have been some cases identified in North Carolina, none of those infected people picked up the virus here.
"Pregnant women in North Carolina need to know that all of the cases of Zika that have been identified in North Carolina to date were from patients who travelled to Zika endemic areas," said Dr. Elizabeth Stringer, associate professor of Obstetrics and Gynecology at UNC's Maternal-Fetal Medicine department. "There have been no locally transmitted cases."
Stringer has been following the headlines and working to contribute her own expertise to the issue. When the Zika outbreak was first reported, Stringer collaborated with other researchers at UNC who work with arborviruses, such as Zika, in both Central and South America. They brainstormed key research ideas and published a commentary in the Journal of the American Medical Association. Stringer also has been able to take advantage of her prior experience in Africa and her expertise in maternal-fetal medicine to contribute to our knowledge of Zika and pregnancy.
"I think that the threat at this point is very low considering that the mosquito most commonly associated with the Zika virus has not been identified in North Carolina this year," she said.
"We never say anything is zero risk with a biological system, but, historically, if we look at other diseases that are transmitted similarly, ... there's no historical presentation for transmission of a virus like that by mosquitos in North Carolina," he said.
But that doesn't mean the mosquitos won't travel to our state. Last month, North Carolina was one of 40 U.S. states and territories to receive more than $16 million from the Centers for Disease Control and Prevention to establish, enhance and maintain information-gathering systems to quickly detect microcephaly and other problems caused by the Zika virus. The money was provided to states and territories based on their risk of Zika virus transmission, population need and availability of funds, according to a press release.
"I think pregnant women do need to prepare for the potential for Zika in North Carolina, but I also think that the cases will likely be fewer than in states like Florida, Texas, and California," Stringer said.
Still, there are important steps that Stringer and Williams said pregnant women in North Carolina can take to protect themselves.
Watch for travel warnings: "Pregnant women need to stay abreast of the CDC issued travel warnings which are constantly being updated," Stringer said. "Florida is the only state to date to confirm locally acquired cases and I would advise patients who are attempting pregnancy or pregnant to find a vacation spot that does not involve southern Florida."
Play it safe: The Centers for Disease Control recommends that women who are pregnant and traveled to southern Florida on or after June 15 should be tested for the Zika virus and use condoms during the rest of pregnancy. If you've been to the affected area in Florida on or after June 15, you should wait at least eight weeks before trying to get pregnant. For women and men who have traveled to an active Zika virus transmission area and have a pregnant partner, it's best to abstain from sex or always use a condom during the rest of the pregnancy to avoid transmission.
Repel mosquitos: Pregant women, Stringer said, need to take normal precautions against mosquito bites such as wearing mosquito repellant. Commonly used brands such as Off!, Cutter and Cutter Advanced, Skin So Soft, Sawyer and and Ultrathon are safe to use. When used as directed, DEET-containing insect repellants are proven to be safe and effective for pregnant women as well, Stringer said. Wear long sleeve shirts and pants when you are outside.
Prevent bites: As the weather cools, be sure screens are securely in place in your windows before you open them, Williams said, or just stick with air conditioning. Practice the "tip and toss" method, getting rid of standing water that attracts mosquitos. As little as a quarter of cup of standing water is all mosquitos need to multiply, according to Mecklenburg County government. Check outdoor toys, tarps, buckets and other things that might be in your yard.
Even if you aren't concerned about Zika, Williams notes that there are other mosquito-borne illnesses in North Carolina that can cause serious illness - the West Nile virus, eastern equine encephalitis and La Crosse encephalitis. It's always best to prevent mosquito bites to avoid these other viruses.
And, thankfully, mosquito season, for the year, is wrapping up. The peak comes in August and early September, Williams said.
"We're at the end. The peak is probably behind us," Williams said. "We'll see a steady decline now as the weather cools."
But, Williams said, officials and researchers will be out on the watch again next spring to look for those pesky Aedes aegypti and the virus that they might bring.
The CDC has a website designed for women who are pregnant or thinking about becoming pregnant with more information and precautions.