Zika virus infection in pregnancy: a systematic review of disease course and complications

Ezinne C Chibueze,Veronika Tirado,Olufemi T Oladapo,Yo Takemoto,Amarjargal Dagvadorj,Olukunmi O Balogun,Erika Ota,Clara Menendez,Rintaro Mori,Chie Nagata,Katharina Da Silva Lopes,Naho Morisaki,Toshiyuki Swa

doi:10.2471/blt.16.178426

Abstract

To characterize maternal Zika virus (ZIKV) infection and complement the evidence base for the WHO interim guidance on pregnancy management in the context of ZIKV infection. We searched the relevant database from inception until March 2016. Two review authors independently screened and assessed full texts of eligible reports and extracted data from relevant studies. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS) and the National Institute of Health (NIH) tool for observational studies and case series/reports, respectively. Among 142 eligible full-text articles, 18 met the inclusion criteria (13 case series/reports and five cohort studies). Common symptoms among pregnant women with suspected/confirmed ZIKV infection were fever, rash, and arthralgia. One case of Guillain-Barre syndrome was reported among ZIKV-infected mothers, no other case of severe maternal morbidity or mortality reported. Complications reported in association with maternal ZIKV infection included a broad range of fetal and newborn neurological and ocular abnormalities; fetal growth restriction, stillbirth, and perinatal death. Microcephaly was the primary neurological complication reported in eight studies, with an incidence of about 1% among newborns of ZIKV infected women in one study. Given the extensive and variable fetal and newborn presentations/complications associated with prenatal ZIKV infection, and the dearth of information provided, knowledge gaps are evident. Further research and comprehensive reporting may provide a better understanding of ZIKV infection in pregnancy and attendant maternal/fetal complications. This knowledge could inform the creation of effective and evidence-based strategies, guidelines and recommendations aimed at the management of maternal ZIKV infection. Adherence to current best practice guidelines for prenatal care among health providers is encouraged, in the context of maternal ZIKV infection.

Highlights

Since the late 1940s, there have been reports of Zika virus (ZIKV) isolated from rhesus monkeys in Uganda, and human cases in Tanzania and Nigeria [1, 2]
Complications reported in association with maternal ZIKV infection included a broad range of fetal and newborn neurological and ocular abnormalities; fetal growth restriction, stillbirth, and perinatal death
This review highlights key evidence gaps that need to be urgently prioritized by the international community, more so, with the wide variations in fetal and newborn presentations/complications associated with prenatal ZIKV infection

Summary

Introduction

Since the late 1940s, there have been reports of Zika virus (ZIKV) isolated from rhesus monkeys in Uganda, and human cases in Tanzania and Nigeria [1, 2]. ZIKV belongs to the Flaviviridae family of viruses and is transmitted by Aedes mosquitoes. ZIKV infection is often mild or asymptomatic. An exponential increase in the number of symptomatic or suspected cases across continents has intensified international concern [4]. Prior to 2007, few cases of ZIKV infection were reported [5]. In the latest outbreak in 2015, up to 1.3 million suspected cases were identified in Brazil over a 9-month period [9, 10]. In addition to transmission by Aedes mosquitoes, sexual transmission has been reported [11, 12]

Objectives

Methods

Results

Discussion

Conclusion