By Roni Caryn Rabin

New York Times

Amanda Paradiz is 16 weeks pregnant, and she has a mission: to get through her entire pregnancy without a single mosquito bite.

It hasn’t been easy. Ever since health officials in July announced that four cases of Zika transmission by local mosquitoes were detected in a Miami-area neighborhood, Paradiz and her husband, Alex, have largely secluded themselves in their Broward County home.

They canceled a vacation, and have stopped taking evening strolls around the lake and swimming in the neighborhood pool. To walk the dog, Paradiz, 35, wears long pants and a hoodie, even though, at times, it’s 90 degrees outside. She has debated quitting her job as a sales representative to avoid coming into contact with a mosquito that might carry the Zika virus, which can lead to devastating birth defects — including an abnormally small head, called microcephaly.

“All it takes is one mosquito bite to change the entire course of our lives,” Paradiz said.

Now that a second zone of Zika transmission has been found in the Miami area — this one in Miami Beach — pregnant women say they feel vulnerable and frightened, and they wonder how to keep mosquitoes at bay in a state swarming with insects.

Some expectant mothers are choosing confinement indoors to avoid mosquitoes. Women who before wouldn’t dream of drinking coffee while pregnant are now coating exposed limbs in bug spray, a tactic recommended by health officials. Some women have even considered temporary moves: leaving their homes, families and doctors to stay with relatives or friends far from a Zika transmission zone until they give birth.

“Patients are very anxious, and they bring up the subject of Zika with me before I even get a chance,” said Dr. Elizabeth Etkin-Kramer, an obstetrician-gynecologist who is a past president of the Dade County Medical Association. “Before, this was an ocean away. Now it’s in their backyard.”

At a regional meeting of obstetricians and gynecologists in Orlando last week, Zika was the main topic of conversation, said Dr. Karen Harris, an obstetrician-gynecologist in Gainesville, Florida, who heads the Florida arm of the American Congress of Obstetricians and Gynecologists.

“It’s hard on the patients, but it’s also hard on the staff, because we don’t have anything to offer but prevention,” Harris said. “We can’t answer their questions. If you get Zika a month before you’re due, does that affect the baby? We don’t know. There’s total uncertainty.”

The latest guidelines direct obstetricians to assess every pregnant patient for exposure to Zika at each prenatal visit, and to counsel patients to use insect repellent and condoms, because Zika can be transmitted sexually.

Dr. Aaron Elkin, a Broward County obstetrician-gynecologist who treats a diverse group of patients from Miami and surrounding areas, keeps a basket of free condoms on the counter in his office’s reception area, along with containers of Off! bug repellent. Elkin spent every visit last week discussing Zika precautions.

“Every pregnant woman who comes in for prenatal care wants Zika testing,” Elkin said. “I’m doing 15 tests a day.”

One patient, Idit Zalouf, 37, who lives in Sunny Isles Beach just north of Miami Beach, is five months pregnant. She showed Elkin a bracelet she bought that she thinks will protect her from mosquitoes. Elkin advised her to use insect repellent that contains DEET.

“Do you think it would be good for me to go to New York for a while?” she asked him. “If a pregnant woman gets the Zika, what does she do?”

Elkin tried to explain to her that preventing mosquito bites and other forms of Zika transmission should be her focus.

Later, Zalouf said she may move anyway. “I think it’s better to be away from here,” Zalouf said.

Another patient, Unique Robinson, 22, a licensed practical nurse who is not currently working and lives in Broward County, said she rarely ventures outside her home, except to go to either the mall or the movies.

“I’ve looked it up and seen the babies, how they come out. I don’t think I could handle that,” she said, her voice breaking. She often looks up information online. “The internet makes it worse.”

Some patients are worried about Zika, but find it difficult to take precautions. Malorie Fitzgerald, 29, a part-time secretary who is 33 weeks pregnant with her third child, has been living in a homeless shelter near Wynwood, the first area of Miami identified as a Zika transmission zone.

Fitzgerald shares a room with 25 other people, and she said they are lax about leaving the doors closed. She also said she hangs blankets around her bunk bed to keep flies and mosquitoes out, to no avail. “I get bit a couple of times a day,” she said. ” But the mosquitoes and flies are horrible there.”

Elkin runs an ultrasound, and reassures Fitzgerald that the measurements are normal. It’s not a perfect guarantee, however. Infections can occur at later stages of pregnancy, and the scan won’t pick up more subtle abnormalities caused by Zika.

“That is the head of the baby, see? It’s completely normal,” Elkin said. Fitzgerald smiled with relief. But he repeated his advice about prevention. “Wear long clothes and use the Off!.”