BACKGROUND: There are limited data on the natural history of antenatal Zika virus (ZIKV) exposure in twin pregnancies, especially regarding intertwin concordance of prenatal, placental, and infant outcomes. METHODS: This prospective cohort study included twin pregnancies referred to a single institution from September 2015 to June 2016 with maternal ZIKV. Polymerase chain reaction (PCR) testing of maternal, placental, and neonatal samples was performed. Prenatal ultrasounds were completed for each twin, and histomorphologic analysis was performed for each placenta. Abnormal neonatal outcome was defined as abnormal exam and/or abnormal imaging. Two- to three-year follow-up of infants included physical exams, neuroimaging, and Bayley-III developmental assessment. RESULTS: Among 244 pregnancies, 4 twin gestations without coinfection were identified. Zika virus infection occurred at 16-33 weeks gestation. Zika virus PCR testing revealed discordance between dichorionic twins, between placentas in a dichorionic pair, between portions of a monochorionic placenta, and between a neonate and its associated placenta. Of the 8 infants, 3 (38%) had an abnormal neonatal outcome. Of 6 infants with long-term follow-up, 3 (50%) have demonstrated ZIKV-related abnormalities. CONCLUSIONS: Neonatal PCR testing, placental findings, and infant outcomes can be discordant between co-twins with antenatal ZIKV exposure. These findings demonstrate that each twin should be evaluated independently for vertical transmission.
BACKGROUND: There are limited data on the natural history of antenatal Zika virus (ZIKV) exposure in twin pregnancies, especially regarding intertwin concordance of prenatal, placental, and infant outcomes. METHODS: This prospective cohort study included twin pregnancies referred to a single institution from September 2015 to June 2016 with maternal ZIKV. Polymerase chain reaction (PCR) testing of maternal, placental, and neonatal samples was performed. Prenatal ultrasounds were completed for each twin, and histomorphologic analysis was performed for each placenta. Abnormal neonatal outcome was defined as abnormal exam and/or abnormal imaging. Two- to three-year follow-up of infants included physical exams, neuroimaging, and Bayley-III developmental assessment. RESULTS: Among 244 pregnancies, 4 twin gestations without coinfection were identified. Zika virusinfection occurred at 16-33 weeks gestation. Zika virus PCR testing revealed discordance between dichorionic twins, between placentas in a dichorionic pair, between portions of a monochorionic placenta, and between a neonate and its associated placenta. Of the 8 infants, 3 (38%) had an abnormal neonatal outcome. Of 6 infants with long-term follow-up, 3 (50%) have demonstrated ZIKV-related abnormalities. CONCLUSIONS: Neonatal PCR testing, placental findings, and infant outcomes can be discordant between co-twins with antenatal ZIKV exposure. These findings demonstrate that each twin should be evaluated independently for vertical transmission.
Authors: M Elisabeth Lopes Moreira; Karin Nielsen-Saines; Patricia Brasil; Tara Kerin; Luana Damasceno; Marcos Pone; Liege M A Carvalho; Sheila M Pone; Zilton Vasconcelos; Ieda P Ribeiro; Andrea A Zin; Irena Tsui; Kristina Adachi; Stephanie L Gaw; Umme-Aiman Halai; Tania S Salles; Denise C da Cunha; Myrna C Bonaldo; Claudia Raja Gabaglia; Leticia Guida; Jociele Malacarne; Roozemerie P Costa; S Clair Gomes; A Beatriz Reis; Fernanda V M Soares; Renata H Hasue; Carolina Y P Aizawa; Fernanda F Genovesi; Mitsue Aibe; Christa Einspieler; Peter B Marschik; J Paulo Pereira; Elyzabeth A Portari; Carla Janzen; James D Cherry Journal: N Engl J Med Date: 2018-12-13 Impact factor: 91.245
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Authors: Patrícia Brasil; José P Pereira; M Elisabeth Moreira; Rita M Ribeiro Nogueira; Luana Damasceno; Mayumi Wakimoto; Renata S Rabello; Stephanie G Valderramos; Umme-Aiman Halai; Tania S Salles; Andrea A Zin; Dafne Horovitz; Pedro Daltro; Marcia Boechat; Claudia Raja Gabaglia; Patrícia Carvalho de Sequeira; José H Pilotto; Raquel Medialdea-Carrera; Denise Cotrim da Cunha; Liege M Abreu de Carvalho; Marcos Pone; André Machado Siqueira; Guilherme A Calvet; Ana E Rodrigues Baião; Elizabeth S Neves; Paulo R Nassar de Carvalho; Renata H Hasue; Peter B Marschik; Christa Einspieler; Carla Janzen; James D Cherry; Ana M Bispo de Filippis; Karin Nielsen-Saines Journal: N Engl J Med Date: 2016-03-04 Impact factor: 91.245
Authors: Daynia E Ballot; Tanusha Ramdin; David Rakotsoane; Faustine Agaba; Victor A Davies; Tobias Chirwa; Peter A Cooper Journal: Int Sch Res Notices Date: 2017-08-01
Authors: Elena Marbán-Castro; Laia J Vazquez Guillamet; Percy Efrain Pantoja; Aina Casellas; Lauren Maxwell; Sarah B Mulkey; Clara Menéndez; Azucena Bardají Journal: Int J Environ Res Public Health Date: 2022-06-14 Impact factor: 4.614
Authors: Annelies Wilder-Smith; Elizabeth B Brickley; Ricardo Arraes de Alencar Ximenes; Demócrito de Barros Miranda-Filho; Celina Maria Turchi Martelli; Tom Solomon; Bart C Jacobs; Carlos A Pardo; Lyda Osorio; Beatriz Parra; Suzannah Lant; Hugh J Willison; Sonja Leonhard; Lance Turtle; Maria Lúcia Brito Ferreira; Rafael Freitas de Oliveira Franca; Louis Lambrechts; Johan Neyts; Suzanne Kaptein; Rosanna Peeling; Deborah Boeras; James Logan; Helen Dolk; Ieda M Orioli; Andreas Neumayr; Trudie Lang; Bonny Baker; Eduardo Massad; Raman Preet Journal: Glob Health Action Date: 2021-10-26 Impact factor: 2.640