Zika virus infection in pregnancy and adverse fetal outcomes in SAo Paulo State, Brazil: a prospective cohort study

Author(s)

Clemente, Nuria Sanchez ^{[1, 2]} ; Brickley, Elizabeth B. ^[2] ; Paixao, Enny S. ^[2] ; De Almeida, Marcia F. ^[1] ; Gazeta, Rosa E. ^[3] ; Vedovello, Danila ^[3] ; Rodrigues, Laura C. ^[2] ; Witkin, Steven S. ^{[4, 5]} ; Passos, Saulo D. ^[3]

Affiliation

^[1] Univ Sao Paulo, Dept Epidemiol, Sao Paulo - Brazil

^[2] London Sch Hyg & Trop Med, Dept Infect Dis Epidemiol, Keppel St, London WC1E 7HT - England

^[3] Jundiai Univ, Jundiai Med Sch, Sao Paulo - Brazil

^[4] Weill Cornell Med, Dept Obstet & Gynecol, New York, NY - USA

^[5] Univ Sao Paulo, Inst Trop Med, Med Sch, Sao Paulo - Brazil

• Document type: Journal article
• Source: SCIENTIFIC REPORTS; v. 10, n. 1 JUL 29 2020.
• Web of Science Citations: 0

Abstract

Robust epidemiological and biological evidence supports a causal link between prenatal Zika Virus (ZIKV) infection and congenital brain abnormalities including microcephaly. However, it remains uncertain if ZIKV infection in pregnancy also increases the risk for other adverse fetal and birth outcomes. In a prospective cohort study we investigated the influence of ZIKV on the prevalence of prematurity, low birth weight, small-for-gestational-age, and fetal death as well as microcephaly (i.e., overall and disproportionate) in the offspring of women attending a high-risk pregnancy clinic during the recent ZIKV outbreak in Brazil. During the recruitment period (01 March 2016-23 August 2017), urine samples were tested for ZIKV by RT-PCR from all women attending the high-risk pregnancy clinic at Jundiai University Hospital and from the neonates after delivery. Of the 574 women evaluated, 44 (7.7%) were ZIKV RT-PCR positive during pregnancy. Of the 409 neonates tested, 19 (4.6%) were ZIKV RT-PCR positive in the first 10 days of life. In this cohort, maternal ZIKV exposure was not associated with increased risks of prematurity, low birth weight, small-for-gestational-age, or fetal death. However, relative to ZIKV-negative neonates, ZIKV-positive infants had a five-fold increased risk of microcephaly overall (RR 5.1, 95% CI 1.2-22.5) and a ten-fold increased risk of disproportionate microcephaly (RR 10.3, 95% CI 2.0-52.6). Our findings provide new evidence that, in a high-risk pregnancy cohort, ZIKV RT-PCR positivity in the neonate at birth is strongly associated with microcephaly. However, ZIKV infection during pregnancy does not appear to influence the risks of prematurity, low birth weight, small-for-gestational-age or fetal death in women who already have gestational comorbidities. The results suggest disproportion between neonatal head circumference and weight may be a useful screening indicator for the detection of congenital microcephaly associated with ZIKV infection. (AU)

• FAPESP's process: 16/08578-0 - Vertical infection by the virus Zika and its impact on the mother-child area
• Grantee: Saulo Duarte Passos
• Support Opportunities: Research Projects - Thematic Grants