Adverse fetal and neonatal outcomes in pregnancies with confirmed Zika Virus infection in Rio de Janeiro, Brazil: A cohort study.

Juliana P Souza,Laura Medeiros De Andrade,Maria Elisabeth Lopes Moreira,Saint Clair Gomes Junior,Maria Dalva B B Méio,Mirza R Figueiredo,Jose Paulo Pereira Junior,Elizabeth Brickley,Marcus Vinícius Guimarães Lacerda

doi:10.1371/journal.pntd.0008893

Abstract

ObjectiveTo analyze adverse fetal and neonatal outcomes of Zika virus infection by the timing of infection during pregnancy. Method: Cohort study of 190 pregnancies with 193 offspring with a positive RT-PCR test for Zika virus (March/2016 to April/2017).ResultsDeath or defects related to congenital Zika virus infection were identified in 37.3% of fetuses and newborns, and microcephaly in 21.4% of the newborns. The proportion of small for gestational age newborns was 21.9%. Maternal symptoms in the first trimester were significantly associated with the birth of newborns with microcephaly/cerebral atrophy, small for gestational age and with the deaths (one abortion, one stillbirth and the two neonatal deaths). Maternal infection during the second trimester was further associated with asymptomatic newborns at birth. The study showed that 58.5% of the offspring with microcephaly and / or cortical atrophy were small for gestational age, with an evident decrease in symptomatic offspring without microcephaly, 24.1%, and with only 9.1% in the asymptomatic group.ConclusionThis study showed that the earlier the symptoms appear during gestation, the more severe the endpoints. We found a higher percentage of small for gestational age newborns exposed to Zika virus early in gestation. We also found a group of apparently asymptomatic newborns with proven Zika infection, which highlights the importance of follow up studies in this population.

Highlights

Congenital Zika virus (ZIKV) infections have the potential to severely affect fetal development and can lead to a wide range of adverse pregnancy and neonatal outcomes, including spontaneous abortion, fetal loss, low birth weight, and congenital malformations, especially in the central nervous system [1]
Death or defects related to congenital Zika virus infection were identified in 37.3% of fetuses and newborns, and microcephaly in 21.4% of the newborns
Maternal symptoms in the first trimester were significantly associated with the birth of newborns with microcephaly/cerebral atrophy, small for gestational age and with the deaths

Summary

Introduction

Congenital Zika virus (ZIKV) infections have the potential to severely affect fetal development and can lead to a wide range of adverse pregnancy and neonatal outcomes, including spontaneous abortion, fetal loss, low birth weight, and congenital malformations, especially in the central nervous system [1]. Several studies to date have provided evidence that higher risks of adverse outcomes are associated with early, as compared to later, ZIKV infections during pregnancy [2,4,5]. Based on these findings, we hypothesized that earlier maternal infections may cause more deleterious embryonic or fetal compromise and, more severe repercussions for prenatal development.

Methods

Results

Discussion

Conclusion