Ebola Virus Disease and Pregnancy: Perinatal Transmission and Epidemiology

Abstract

The 2013–2015 Ebola virus disease (EVD) outbreak in West Africa devastated local health systems and caused thousands of deaths among pregnant women, unborn fetuses, and children. Reports from historical Zaire Ebola virus outbreaks suggested pregnancy was associated with high mortality rates between 74 and 100%. In contrast, data collected during the 2013–2015 West Africa outbreak suggested mortality in pregnancy may be lower than previously reported, with 11 of 25 (44%) reported EVD-infected pregnant women dying. Fetal and neonatal outcomes are more consistent across EVD epidemics, with the vast majority of EVD-affected pregnancies ending in fetal loss. Though no fetal autopsy data or placental histology is available from the 2013–2015 outbreak, vertical transmission of Ebola virus across the placenta and into fetal tissue and amniotic fluid is likely, as high titers of Ebola virus have been detected in placental tissue both during acute infection and after recovery. To date, outcomes data have been published for 60 confirmed or suspected Zaire Ebola virus cases in pregnancy, which resulted in 47 stillbirths or miscarriages (78%) and 13 live births (22%), of whom all except one died within 19 days of life. There is little data on pregnancy outcomes among EVD survivors. One case series of 70 Liberian survivors reported that 15 (22%) pregnancies ended in miscarriage, 4 (6%) in stillbirth, and 2 (3%) in elective pregnancy terminations. Overall, 28% of women had an adverse pregnancy outcome, suggesting a long-lasting negative impact of prior EVD on future pregnancies. More research is needed to confirm these findings.