COMMENTARY

How to Advise a Pregnant Patient Who Tests Positive for Zika

Arthur L. Caplan, PhD

Disclosures

May 27, 2016

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Hi. I am Art Caplan. I'm at the Division of Medical Ethics at NYU Langone Medical Center in New York City.

Zika is on its way to the mainland United States. It has already appeared—and been a problem—in Puerto Rico, with additional reports of outbreaks in Central and South America, and there's no reason to doubt that as summer comes to the US, the mosquito that carries the Zika virus is going to be here as well.

You can expect—whatever your line of work in medicine is—to get questions about Zika, mainly, "How can I protect myself?"

Keep in mind that the mosquitos carrying this particular disease carry other diseases as well, and they are domesticated, meaning that they like to live indoors. These mosquitos are going to be hard to kill by outdoor spraying—for instance, spraying parks and streets.

You're probably going to have to recommend to your patients that they get screens for windows and doors and that they use insect repellent. They may want to spray inside their homes, although that raises safety questions for many people.

Other means of protection include wearing long-sleeved clothing, which is very important, and getting rid of standing water wherever you see it. These are mosquitos that can breed in a bottle cap of water, so you have to be vigilant in getting rid of standing water.

There are steps that people can take to protect themselves. They're not foolproof, but those are steps that patients can be advised to take.

For women thinking about getting pregnant who are having unprotected sex, I would say that when Zika reaches your part of the United States, it's time to advise women to use contraception or be abstinent. I'd rather bet on contraception than abstinence, because we fail at abstinence and I'm not afraid to advise contraception. But if you're of childbearing age and Zika is around, it is important to remember that it's associated with some very bad birth defects. We've seen them in South America, including microcephaly, among other problems. You don't want to be pregnant with this virus being present. So, putting off childbirth, deciding to be careful, and asking men to wear condoms—as well as the various protection methods I mentioned earlier—are very important if we are going to try to minimize the threat to babies that Zika poses.

I also think there's going to have to be some discussion about being pregnant with the possibility of being infected with the Zika virus. We've had this huge ongoing debate in our society about abortion. Is abortion something that a woman should be told about, be aware of, if she is pregnant and gets a positive test for Zika or if she thinks she's been exposed?

I think that option does have to be presented. It's difficult to say and to offer, but some women are going to say, "I can't take that chance," or "If this baby's going to have a very burdensome birth defect, I don't want to bear it."

Zika is not only going to challenge us in terms of how we try to keep distance between us and the mosquitos that carry it, but it's also going to challenge our views about contraception and abortion, as well as some of our views about how we talk to our patients about their sexual activity.

You're going to have to discuss these issues with your patients when Zika arrives, because that's the only way we're going to have the best shot of minimizing any burden that this disease might cause.

I'm Art Caplan at the Division of Medical Ethics at the NYU Langone Medical Center. Thanks for watching.

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