Dengue in pregnancy and maternal mortality: a cohort analysis using routine data

Enny S Paixao,Maria Glória Teixeira,Oona Campbell,Maria Da Conceição N Costa,Mauricio L Barreto,Katie Harron,Laura C Rodrigues

doi:10.1038/s41598-018-28387-w

Abstract

Dengue is a mosquito-borne disease with major public health importance due to its growing incidence and geographical spread. There is a lack of knowledge on its contribution to maternal death. We conducted a population-based cohort study to investigate the association between symptomatic dengue during pregnancy and deaths in Brazil from 2007 to 2012. We did this by linking routine records of confirmed dengue cases to records of deaths of women who had a live birth. Using the Firth method, we estimated odds ratios for maternal deaths associated with dengue during pregnancy. Dengue increased the risk of maternal death by 3 times (95%CI,1.5–5.8) and dengue haemorrhagic fever increased the risk of maternal death by 450 times (95%CI,186.9–1088.4) when compared to mortality of pregnant women without dengue. The increase in risk occurred mostly during acute dengue 71.5 (95%CI,32.8–155.8), compared with no dengue cases. This study showed an increased risk of adverse outcomes in pregnant women with dengue. Therefore in areas where dengue is circulating, the health of pregnant women should be not only a public health priority, but health professionals attending pregnant women with dengue should more closely observe these patients to be able to intervene in a timely way and avoid deaths.

Highlights

Dengue is a mosquito borne disease with a major importance in the public health arena due to a growing incidence (30-fold rise in the past 50 years)[1] and an expanding geographical range[2]
There is some evidence that the risk of severe dengue and of hospitalization due to dengue is higher among pregnant compared with non-pregnant women[5] and a number of case series have reported maternal deaths, and other complications such as bleeding and iincreased caesarean section rates as being associated with dengue[6], Two small cohorts comparing pregnant women exposed to dengue or in Brazil and Colombia to those not exposed found more maternal deaths among the dengue exposed group[7,8]
Ourstudy we analysed a large population-based retrospective cohort to investigate these issues in greater detail, and with greater power to explore the association between symptomatic dengue during pregnancy, and maternal mortality

Summary

Introduction

Dengue is a mosquito borne disease with a major importance in the public health arena due to a growing incidence (30-fold rise in the past 50 years)[1] and an expanding geographical range (endemic in more than 100 countries, mostly in South America and Southeast Asia and still spreading to new areas, including Europe)[2]. Physiological changes that occur during pregnancy (such as hemodilution) can mask the thrombocytopenia, leucopoenia, or hemoconcentration associated with dengue, and common obstetric problems can cause haematological and hepatic issues, masking the disease. These may make it difficult to differentiate dengue haemorrhagic fever from common obstetric conditions, leading to misdiagnosis[3,4]. Dengue during pregnancy has been associated with poor fetal and maternal outcomes. Ourstudy we analysed a large population-based retrospective cohort to investigate these issues in greater detail, and with greater power to explore the association between symptomatic dengue during pregnancy, and maternal mortality

Methods

Results

Conclusion