C M Coutinho1, Sfbm Negrini2, Dca Araujo3, S R Teixeira4, F R Amaral2, McR Moro1, Jdcp Fernandes2, Msf da Motta2, Bvm Negrini2, Cact Caldas5, Art Anastasio6, J M Furtado7, Aat Bárbaro2, A Y Yamamoto2, G Duarte1, M M Mussi-Pinhata2. 1. Department of Gynaecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. 2. Department of Paediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. 3. Epidemiology and Disease Control Division, Department of Public Health and Surveillance, Secretary of Health, Ribeirão Preto, Brazil. 4. Department of Imaging, Haematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. 5. Rehabilitation Centre of Clinics Hospital at the Ribeirão Preto School of Medicine, Ribeirão Preto, Brazil. 6. Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. 7. Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Abstract
OBJECTIVE: To define the prevalence of adverse outcomes of maternal infection in a large cohort of ZIKV-infected Brazilian women and their infants. DESIGN: Prospective population-based cohort study. SETTING: Ribeirão Preto's region's private and public health facilities. POPULATION: Symptomatic ZIKV-infected mothers and their infants. METHODS: Prenatal/early neonatal data were obtained for all mother-child pairs. A subgroup of infants had cranial ultrasonography, eye fundoscopy, hearing and neurological examinations and Bayley III screening tests within 3 months of age. MAIN OUTCOME MEASURES: Prevalence of pregnancy losses and anomalies detected at birth or within 3 months according to the gestational age of infection. RESULTS: Overall, 511 ZIKV-infected women were identified from a total of 1116 symptomatic women; as there were two twins, there were a total of 513 fetuses included. Of these, 13 (2.5%; 95% CI 1.5-4.3) presented with major signs of congenital Zika syndrome (CZS). Of the 511 women, there were 489 livebirths and 24 (4.7%) pregnancy losses (20 miscarriages and four stillbirths). ZIKV-related anomalies occurred in the offspring of 42/511 (8.2%) mothers. Microcephaly or other CNS malformations were diagnosed in 1/4 (25.0%) stillbirths and in 19/489 (3.9%; 95% CI 2.5-5.9) of the liveborn infants. Fetal abnormalities were 14.0 (95% CI 7.6-26.0) times more likely with gestational infection occurring in ≤11 weeks. On follow up of 280 asymptomatic infants, 2/155 (1.3%) had eye abnormalities, 1/207 (0.5%) had CNS imaging findings and 16/199 (8%) presented neurological alert signs. CONCLUSIONS: This prospective population-based study represents the largest Brazilian cohort study of ZIKV in pregnancy. Congenital anomalies potentially associated with CZS are less frequent than previously thought. There is a strong association between the gestational age of infection (≤11 weeks) and a poorer early infant prognosis. A notable proportion of apparently asymptomatic newborns can present with subclinical findings within 3 months of age. TWEETABLE ABSTRACT: ZIKV and pregnancy: adverse outcomes are less common, more prevalent for first-trimester infections, and potentially subclinical.
OBJECTIVE: To define the prevalence of adverse outcomes of maternal infection in a large cohort of ZIKV-infected Brazilian women and their infants. DESIGN: Prospective population-based cohort study. SETTING: Ribeirão Preto's region's private and public health facilities. POPULATION: Symptomatic ZIKV-infected mothers and their infants. METHODS: Prenatal/early neonatal data were obtained for all mother-child pairs. A subgroup of infants had cranial ultrasonography, eye fundoscopy, hearing and neurological examinations and Bayley III screening tests within 3 months of age. MAIN OUTCOME MEASURES: Prevalence of pregnancy losses and anomalies detected at birth or within 3 months according to the gestational age of infection. RESULTS: Overall, 511 ZIKV-infectedwomen were identified from a total of 1116 symptomatic women; as there were two twins, there were a total of 513 fetuses included. Of these, 13 (2.5%; 95% CI 1.5-4.3) presented with major signs of congenital Zika syndrome (CZS). Of the 511 women, there were 489 livebirths and 24 (4.7%) pregnancy losses (20 miscarriages and four stillbirths). ZIKV-related anomalies occurred in the offspring of 42/511 (8.2%) mothers. Microcephaly or other CNS malformations were diagnosed in 1/4 (25.0%) stillbirths and in 19/489 (3.9%; 95% CI 2.5-5.9) of the liveborn infants. Fetal abnormalities were 14.0 (95% CI 7.6-26.0) times more likely with gestational infection occurring in ≤11 weeks. On follow up of 280 asymptomatic infants, 2/155 (1.3%) had eye abnormalities, 1/207 (0.5%) had CNS imaging findings and 16/199 (8%) presented neurological alert signs. CONCLUSIONS: This prospective population-based study represents the largest Brazilian cohort study of ZIKV in pregnancy. Congenital anomalies potentially associated with CZS are less frequent than previously thought. There is a strong association between the gestational age of infection (≤11 weeks) and a poorer early infant prognosis. A notable proportion of apparently asymptomatic newborns can present with subclinical findings within 3 months of age. TWEETABLE ABSTRACT: ZIKV and pregnancy: adverse outcomes are less common, more prevalent for first-trimester infections, and potentially subclinical.
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: Alexandra P Key; Silvia F B de Moura Negrini; Carla A C Tanuri Caldas; Sara Reis Teixeira; Adriana R T Anastasio; Juliana Cavalcante; Marisa M Mussi-Pinhata; Linda J Hood Journal: Early Hum Dev Date: 2021-09-15 Impact factor: 2.079
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Authors: Kathia Guardado; Miguel Varela-Cardoso; Verónica Ofelia Pérez-Roa; Jaime Morales-Romero; Roberto Zenteno-Cuevas; Ángel Ramos-Ligonio; Oscar Guzmán-Martínez; Clara L Sampieri; Christian S Ortiz-Chacha; Rosybet Pérez-Varela; Cristina Fernanda Mora-Turrubiate; Hilda Montero Journal: Children (Basel) Date: 2022-08-12