Pregnant with her second child, Stephanie Coad feels much more at ease about the things that made her nervous the first time around.
She drinks the occasional glass of wine (though always with a meal). She'll eat some types of lunch meat. She orders sushi at restaurants that she trusts.
But step on a plane bound for Puerto Rico? No way.
Coad, who is five months pregnant, canceled a "babymoon" trip to San Juan planned for early February after the Centers for Disease Control and Prevention issued a warning about the Zika virus, which is carried by mosquitoes and believed to be linked to significant birth defects.The World Health Organization will hold an emergency meeting next week to address the virus, which officials said is "spreading explosively" in the Americas.
Puerto Rico is among the locations that the CDC has warned pregnant women to avoid, along with Mexico, Samoa, Cape Verde and countries in Central America, South America and the Caribbean.
"It's just too big of a risk for not enough of a payoff," Coad, 31, said. "The stress that you might get this horrible virus that might affect your unborn child just wouldn't make it fun anymore."
Coad, who lives in Chicago's Uptown neighborhood, first heard about the virus from her mother, who called immediately after a report on the national television news in mid-January. Coad presumed that her mother was overreacting, and pledged to consult her doctor and make a rational decision.
But when the CDC issued its advisory the next day, Coad didn't even bother checking in with her doctor. The CDC was clear: Pregnant women should "consider postponing travel to any area where Zika virus transmission is ongoing" due to the possibility of microcephaly, a birth defect in which a fetus' head and brain do not grow to full size. The next day, Coad canceled the six-night trip she had planned to take with her husband and 2-year-old daughter.
Canceled "babymoons" appear to be on the rise as word spreads about Zika and pregnant women think twice about what was intended to be a relaxing warm weather escape before life becomes profoundly hectic. Coad said a pregnant friend in Denver pulled the plug on a trip to Puerto Vallarta, and Karen Howland, manager of business development for Lake Shore Travel in Glencoe, said her agency has had "a few" cancellations due to Zika virus. She speculates that she would have seen even more if travel insurance covered CDC health warnings.
"We will certainly be hesitant to recommend these areas for our honeymooners and young singles in child bearing years when planning upcoming trips," Howland said.
Cases of Zika virus have already been confirmed in residents of Illinois, Florida, Virginia, Arkansas, Hawaii and Texas who have traveled to affected countries. At least one baby was born in Hawaii with signs of microcephaly, and two of the people who have tested positive in Illinois have been pregnant women, according to the state Department of Public Health.
In addition to the CDC, the American College of Obstetricians and Gynecologists has also recommended that pregnant women avoid traveling to countries affected by Zika virus. When such travel can't be avoided, women are urged to try to prevent mosquito bites by using repellent with DEET and wearing long pants, long-sleeved shirts and shoes and socks when outside.
The primary issue, said Jeff Ecker, chair of ACOG's Obstetric Practice Committee and chief of the Department of Obstetrics and Gynecology at Massachusetts General Hospital, is how little is known about the association between Zika and microcephaly. Though there appears to be a connection, it has not yet been proved; further, it is unclear what percentage of women exposed to Zika wind up with affected pregnancies.
"In retrospect, when we have better data, we may know the risk was vanishingly small or in retrospect, maybe people should have been even more worried," he said. "It's the absence of data that makes it difficult."
In the meantime, pregnant women who can avoid traveling to countries with Zika should undoubtedly do so, he said. The possible threat — emphasis on the word "possible" — is not just another prohibition along the lines of soft cheese or sushi (and in fact, Ecker said he doesn't counsel his patients to avoid sushi during pregnancy).
"It's not equivalent at all," he said. "You're talking about different outcomes and data."
Zika is not a new virus, said Robert Amler, a former CDC investigator and the vice president and dean of the School of Health Sciences and Practice at New York Medical College in Valhalla, N.Y. For a healthy nonpregnant adult, the worst outcome is usually a fever, rash, red eyes and joint pain.
"It doesn't seem to be a serious illness," Amler said. "Most people who get it don't even know they have it."
But fueled by record numbers of Zika and microcephaly cases, especially in Brazil, the CDC has "greatly ramped up its attention" to the current outbreak, he said.
"It'll take a while to investigate and tease these things out," Amler said. "Meanwhile, the prudent thing is to be cautious and be careful."
Summer Hull, founder of family travel blog mommypoints.com, said word is spreading quickly about Zika on parenting and pregnancy web sites. In the midst of "babymoon" season — and with several popular "babymoon" destinations affected by Zika outbreaks — the demand for information is growing, she said. A blog post about Zika has been her most popular article for more than a week.
"So many things about pregnancy get hyped or overhyped, but this one hasn't registered on everyone's radar yet," she said. "I think this is the beginning of an upward trajectory."
Hull said many pregnant women discussing Zika online haven't hesitated to cancel trips. The primary hurdle is the disappointment of skipping a warm weather getaway — and money.
"There's a barrier of cancellation fees," she said. "Ultimately, most people who are worried will cancel, but it's harder to pull the plug when you're going to be out hundreds or thousands of dollars."
Coad was fortunate that the CDC recommendation came one day before the deadline to get back most of the money she had spent on a condominium rental on VRBO.com — more than $2,000. American Airlines agreed to refund her three $360 plane tickets, but minus a $200 penalty per ticket.
With Puerto Rico off her list, Coad immediately went to work on finding another "babymoon." She and her husband briefly considered Hawaii, but opted instead to stay close to home: a day at the Shedd Aquarium, a visit to Navy Pier and a couple of nights in Lake Geneva, Wis.
"A little bit of this and that," Coad said. "We'll still get our vacation, but we won't really go anywhere."
The best thing, she said, about not going anywhere: There won't be any mosquitoes.