What's Already Known about this Topic? Intrauterine Zika virus infection has been associated with several malformations of the central nervous system, mainly microcephaly. What does this Study Add? We present a case of congenital Zika virus infection in which perinatal brain pathology was investigated using multiple diagnostic procedures. Maternal serology for Zika virus was positive when performed at 31 weeks, but the onset of clinical symptoms was at 10 weeks, indicating that early pregnancy infection may result in a long viral shedding and result in severe brain malformations that become detectable only later in pregnancy.

Objective: It was the aim of this study to investigate the pregnancy characteristics that influence the measured concentrations of maternal serum-free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 9⁺⁰–13⁺⁶ weeks’ gestation. Methods: In singleton pregnancies attending for routine care, serum-free β-hCG and PAPP-A were measured at 9⁺⁰–13⁺⁶ weeks’ gestation and fetal nuchal translucency was measured at 11⁺⁰–13⁺⁶ weeks. The population included 27,908 chromosomally normal and 104 trisomy 21 pregnancies. Multiple regression analysis was used to examine the pregnancy characteristics that have a significant effect on the measured concentrations of free β-hCG and PAPP-A. We also examined the impact of incorporating temporal effects on performance of screening for trisomy 21. Results: Serum-free β-hCG and PAPP-A concentrations were significantly affected by gestational age, maternal weight, racial origin, parity, preexisting diabetes mellitus type 2, smoking and conception by in vitro fertilization. There was a significant gestational age-dependent effect of Afro-Caribbean race on PAPP-A levels (p = 0.0005), with a weekly increase of 4.9% (95% CI 2.1–7.8). Conclusions: Serum-free β-hCG and PAPP-A concentrations at 9⁺⁰–13⁺⁶ weeks’ gestation are affected by several pregnancy characteristics and the effect of Afro-Caribbean race on PAPP-A increases with gestational age.

Objective: To examine aortic systolic blood pressure (SBP_Ao), pulse wave velocity (PWV) and augmentation index (adjusted to a heart rate of 75 beats per minute, AIx-75) at 11–13 weeks’ gestation in pregnancies delivering small for gestational age (SGA) neonates with and without preeclampsia (PE). Methods: At 11+0 to 13+6 weeks’ gestation, maternal history was recorded and PWV, AIx-75, SBP_Ao, uterine artery pulsatility index (PI) and maternal serum pregnancy-associated plasma protein-A (PAPP-A) were measured. We compared women with (n = 337) and without (n = 48) PE that delivered SGA neonates with unaffected controls (n = 6,429). Results: In the SGA group without PE, compared to unaffected controls, there was no significant difference in AIx-75 (1.03 vs. 1.00 multiple of the median, MoM), PWV (0.98 vs. 1.00 MoM) or SBP_Ao (1.01 vs. 1.00 MoM), but uterine artery PI was increased (1.10 vs. 1.00 MoM) and PAPP-A decreased (0.85 vs. 1.00 MoM). In SGA with PE, compared to unaffected controls, there was increased AIx-75 (1.13 vs. 1.00 MoM), SBP_Ao (1.09 vs. 1.00 MoM), uterine artery PI (1.40 vs. 1.00 MoM) and decreased PAPP-A (0.72 vs. 1.00 MoM), but no significant difference in PWV (1.05 vs. 1.00 MoM). Conclusion: In pregnancies with SGA neonates, impaired placentation is reflected in low PAPP-A and high uterine artery PI at 11–13 weeks’ gestation. In the SGA group with PE, but not in those without PE, there is increased SBP_Ao and AIx-75.