Abstract
BackgroundWe aim to investigate possible maternal- and pregnancy-related factors associated with the development of Congenital Zika Syndrome (CZS) in children of mothers with probable gestational infection.MethodsThis case-control study, we recruited mother-infant pairs between May 2015 and October 2017 in a pediatric infectious disease clinic in Rio de Janeiro. Inclusion criteria required either that the mother reported Zika infection symptoms during pregnancy or that the infant presented with clinical or imaging features of the CZS. Exclusion criteria included detection of an alternative cause for the patient’s presentation or negative polymerase chain reaction assays for Zika in all specimens tested within 12 days from the beginning of maternal symptoms. Infants with CZS (CDC definition) were selected as cases and infants without CZS, but with probable maternal Zika virus infection during pregnancy, were selected as controls. Maternal and pregnancy-related informations were collected and their relationship to the presence of congenital anomalies due to CZS was assessed by Fisher exact or Mann-Whitney test.ResultsOut of the 42 included neonates, 24 (57.1%) were diagnosed with CZS (cases). The mean maternal age at the birth was 21 years old. The early occurrence of maternal symptoms during pregnancy was the only variable associated with CZS (odds ratio = 0.87, 95% CI: 0.78–0.97).Case’s mothers presented symptoms until the 25th week of gestational age (GA), while control’s mothers presented until 36th weeks of GA. Income; illicit drug, alcohol, or tobacco use during pregnancy; other infections during pregnancy (including previous dengue infection) were not associated with CZS.ConclusionsOur study corroborates the hypothesis that Zika virus infection earlier in pregnancy is a risk factor to the occurrence of congenital anomalies in their fetuses.
Highlights
We aim to investigate possible maternal- and pregnancy-related factors associated with the development of Congenital Zika Syndrome (CZS) in children of mothers with probable gestational infection
We enrolled mother-infant pairs if they satisfied at least one of two criteria: 1) the mother had a history of gestational symptoms compatible with Zika virus infection, defined as a skin rash with or without other characteristic findings, or 2) the infant was referred to our clinic due to clinical and/or radiologic findings of CZS
Patients were excluded if they failed to provide informed consent or if their clinical manifestations could be better explained by an etiology other than Zika virus infection
Summary
We aim to investigate possible maternal- and pregnancy-related factors associated with the development of Congenital Zika Syndrome (CZS) in children of mothers with probable gestational infection. There is only a paucity of studies designed to elucidate which maternal- and pregnancy-related factors may be associated with the development of congenital abnormalities among infected pregnant women [9,10,11]. The identification of such factors might allow the development of interventions aiming to prevent the Congenital Zika Syndrome (CZS). We hypothesized that factors associated with the prenatal period (co-infections, trimester of Zika virus infection, and maternal health variables) would be associated with development of CZS
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