A prospective matched study on symptomatic dengue in pregnancy.

Célia Basurko,Mathieu Nacher,Hélène Hildéral,Séverine Matheus,Jean-Pierre Duvernois,Gabriel Carles,Sibille Everhard,Véronique Lambert,Larissa Valmy,Anne Favre,Marion Restrepo,Rachida Boukhari

doi:10.1371/journal.pone.0202005

Abstract

Dengue fever is an increasing problem worldwide, but consequences during pregnancy remain unclear. Much of the available literature suffers from methodological biases that compromise the validity of clinical recommendations. We conducted a matched cohort study during an epidemic in French Guiana to compare events and pregnancy outcomes between two paired groups of pregnant women: women having presented with symptomatic dengue during pregnancy (n = 73) and women having had neither fever nor dengue during pregnancy (n = 219). Women in each arm were matched by place of follow up, gestation weeks at inclusion, and place of residence. Dengue infection was considered to be confirmed if viral RNA, N S1 antigen, the seroconversion of IgM antibodies or the presence of IgM was detected in collected samples. According to the 2009 WHO classification, 27% of the women with symptomatic dengue had at least one clinical or biological warning sign. These complications occurred after the 28th week of gestation in 55% of cases. The medical history, socioeconomic status and demographic characteristics were included in multivariate analysis. Exposure to dengue during pregnancy was not significantly associated with prematurity, small for gestational age infants, hypertension or emergency caesarian section. Maternal dengue with warning signs was a risk factor for peripartum hemorrhage with adjusted relative risk = 8.6(95% CI = 1.2–62). There was a near significant association between dengue and in utero death (p = 0.09). This prospective comparative study underlined the importance of taking into account potential confounders between exposure to dengue and the occurrence of obstetrical events. It also confirms the need for increased vigilance for pregnant women with dengue, particularly for women who present with severe dengue.

Highlights

The incidence of dengue was multiplied by 30 over the last 50 years, few rigorous investigations of the consequences of this disease during pregnancy have been published
For 39 women who should have been included in non exposed group (NEG), there was no sample taken at inclusion or/and at delivery
We studied the consequences of symptomatic dengue in pregnant women by applying a matched cohort methodology

Summary

Introduction

The incidence of dengue was multiplied by 30 over the last 50 years, few rigorous investigations of the consequences of this disease during pregnancy have been published. The main obstetrical pathologies reported during dengue in pregnant women are premature labor, a high risk of miscarriage, low birth weight and deliverance hemorrhage [1,3,4,5,6]. In 2012–2013, a dengue epidemic struck French Guiana: it was estimated that 13,240 people were infected (5.7% of the population), 4% presented dengue with warning signs, and the severity rate was 0.5% according to the WHO’s 2009 classification. During this epidemic, there were five deaths attributable to the dengue virus, and four of them were women. The major agent (95% of cases) was dengue virus serotype 2 (DENV-2), other serotypes cocirculated (DENV-4 < 5%; DENV-1 and DENV-3 < 1% each)

Methods

Results

Discussion

Conclusion