Adverse fetal and neonatal outcomes in pregnancies with confirmed Zika Virus infection in Rio de Janeiro, Brazil: A cohort study

Abstract

Objective To analyze adverse fetal and neonatal outcomes of Zika virus infection by the timing of infection during pregnancy. Method: Cohort study of 190 pregnancies with 193 offspring with a positive RT-PCR test for Zika virus (March/2016 to April/2017). Results Death or defects related to congenital Zika virus infection were identified in 37.3% of fetuses and newborns, and microcephaly in 21.4% of the newborns. The proportion of small for gestational age newborns was 21.9%. Maternal symptoms in the first trimester were significantly associated with the birth of newborns with microcephaly/cerebral atrophy, small for gestational age and with the deaths (one abortion, one stillbirth and the two neonatal deaths). Maternal infection during the second trimester was further associated with asymptomatic newborns at birth. The study showed that 58.5% of the offspring with microcephaly and / or cortical atrophy were small for gestational age, with an evident decrease in symptomatic offspring without microcephaly, 24.1%, and with only 9.1% in the asymptomatic group. Conclusion This study showed that the earlier the symptoms appear during gestation, the more severe the endpoints. We found a higher percentage of small for gestational age newborns exposed to Zika virus early in gestation. We also found a group of apparently asymptomatic newborns with proven Zika infection, which highlights the importance of follow up studies in this population.

Growth Velocity and Nutritional Status in Children Exposed to Zika Virus during Pregnancy from Amazonas Cohort, Brazil

“…High frequencies of neonatal adverse outcomes (low birth weight, microcephaly, stillbirth, and premature birth) were especially associated with ZIKV infection during early pregnancy in a cohort of pregnant women exposed to ZIKV in the Brazilian Amazon (Manaus, Amazonas) during the peak period of ZIKV transmission (47th epidemiological week of 2015 to last epidemiological week of 2016) [ 21 ]. Similar outcomes associated with the presence of maternal symptoms of ZIKV infection in the first trimester of pregnancy were also evidenced by Souza et al [ 22 ], which highlights the high frequency of intrauterine growth restriction and babies being born small.…”

“…Low birth weight was found in 2.8% of the children in the study, but 5.9% of those with low birth weight showed inadequate growth velocity. Such percentages are lower than those described in the national and international literature for children exposed to ZIKV [ 9 , 22 , 69 , 70 , 71 , 72 ].…”

“…Neurological impairment seems to be greater in children whose mothers had an infection in the first trimester of pregnancy [ 30 ], and the probable risk of growth deficit seems to be associated with the presence of some degree of neurological impairment, even in children born without microcephaly [ 9 ]; nonetheless, nutritional and non-nutritional factors should be better evaluated, aiming to potentially understand the multifactorial etiology of impaired GV in children exposed to ZIKV. Small-for-gestational-age newborns following exposure to ZIKV during the first trimester of pregnancy were evidenced in another study [ 22 ]. Low birth weight was found in 2.8% of the children in the study, but 5.9% of those with low birth weight showed inadequate growth velocity.…”

Neonatal outcomes and indirect consequences following maternal SARS-CoV-2 infection in pregnancy: A systematic review

“…We were unable to examine the impact by trimester of maternal SARS-CoV-2 infection due to a paucity of studies examining offspring of first or second trimester infection. Other viruses such as Zika virus are known to be harmful to the developing foetus when contracted in the first or second trimester[33], so there is a reasonable suspicion that this could be true for SARS-CoV-2. Future studies should focus on examining this critical question, particularly as the virus becomes endemic.…”

The legacy of ZikaPLAN: a transnational research consortium addressing Zika

“…A similar temporal pattern was apparent in the frequency of children born small for gestational age and/or with symptoms consistent with CZS, with the highest rates of adverse outcomes in children born to women reporting rash (i.e. a common sign of acute ZIKV infection) in the first trimester [ 20 ]. Relative to ZIKV-negative neonates, ZIKV-positive neonates have a 5-times higher risk of presenting with microcephaly [ 21 ].…”