Clinical assessment and brain findings in a cohort of mothers, fetuses and infants infected with ZIKA virus

Cortés, Magdalena Sanz; Rivera, Ana María; Yepez, M.; Guimaraes, Carolina V.; Yunes, Israel Diaz; Zarutskie, A.; Davila, I.; Shetty, Anil N.; Mahadev, Arun; Serrano, Saray; Castillo, N. del; Lee, Wesley; Valentine, Gregory C.; Belfort, Michael A.; Parra, Guido; Mohila, Carrie A.; Aagaard, Kjersti M.; Saavedra, Miguel Parra

doi:10.1016/j.ajog.2018.01.012

Cited by 64 publications

(129 citation statements)

References 61 publications

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“…Calcifications caused by focal necrosis are common in CZS. These calcifications are often weakly echogenic without any posterior shadowing on prenatal US and can intensify in echogenicity and size during pregnancy, which may lead to multiple punctiform macro‐calcifications . Prevalence of calcifications in CZS is 71% to 92% …”

Section: Congenital Zikv Syndromementioning

confidence: 88%

“…In our and others experience, microcephaly is always associated with other findings and seems to be the consequence of viral brain injury. Prevalence of microcephaly in CZS is 33.3% to 64 %, but brain volume loss seems to be much more frequent (92% of cases) …”

Section: Congenital Zikv Syndromementioning

confidence: 96%

“…Ventriculomegaly associated with ZIKV is probably related to the atrophic brain, peri‐ventricular, and germinative necrosis, as suggested by the thin cortical mantle frequently observed. Prevalence of ventriculomegaly in CZS is 63.1% to 92% …”

Section: Congenital Zikv Syndromementioning

confidence: 99%

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Zika virus during pregnancy: From maternal exposure to congenital Zika virus syndrome

et al. 2019

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What is already known about the topic? The Zika virus (ZIKV) emergence and its consequences during pregnancy led to an increasing number of data about the maternal and fetal consequences of ZIKV infections. What does this study add? This review evaluates risks of maternal ZIKV infection, maternal‐fetal transmission, congenital Zika syndrome (CZS), other adverse perinatal outcomes, and long‐term sequelae among pregnancies exposed to ZIKV. This review also provides contemporary criteria and guidelines for the follow‐up of exposed fetuses, based on prenatal and postnatal features of CZS.

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Section: Congenital Zikv Syndromementioning

confidence: 88%

Section: Congenital Zikv Syndromementioning

confidence: 96%

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Zika virus during pregnancy: From maternal exposure to congenital Zika virus syndrome

et al. 2019

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“…(20) This definition was consistent with standards for diagnosing microcephaly outside of ZIKV exposure and designed to minimize the chance that a fetus with a constitutionally small head would be labeled as microcephalic. (21) A less conservative definition was adopted by the WHO and the International Society for Ultrasound in Obstetrics and Gynecology, which chose to define ZIKV-associated microcephaly as a HC less than 2 standard deviations (SD) below the mean (Z-score ≤ −2 SD). (22) The Centers for Disease Control and Prevention (CDC, USA) similarly defined ZIKV-associated microcephaly as a fetal or neonatal HC less than 2 SD below the mean or the 3 rd centile for gestational age.…”

Section: Congenital Zika Syndrome and Diagnostic Challengesmentioning

confidence: 99%

“…(25) Others reported a 10% rate of a normal HC in the context of significant brain anomalies. (21, 26) Note that a sex-independent threshold for microcephaly (single cutoff for neonatal HC by the Integrowth-21 st sonographic standard), is more likely to label female infants as microcephalic, because girls tend to have smaller heads than boys. (27)…”

Section: Congenital Zika Syndrome and Diagnostic Challengesmentioning

confidence: 99%

Zika virus and the nonmicrocephalic fetus: why we should still worry

Walker

Little²,

Roby

et al. 2019

American Journal of Obstetrics and Gynecology

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Zika virus (ZIKV) is a mosquito-transmitted flavivirus and was first linked to congenital microcephaly due to a large outbreak in Northeastern Brazil. Although the ZIKV epidemic is now in decline, pregnancies in large parts of the Americas remain at risk due to ongoing transmission and the potential for new outbreaks. This review presents why Zika virus is still a complex and worrisome public health problem with an expanding spectrum of birth defects and why ZIKV and related viruses may evade the immune response to injure the fetus. Recent reports indicate that the spectrum of fetal brain and other anomalies associated with ZIKV exposure is broader and more complex than microcephaly alone and includes subtle fetal brain and ocular injuries; thus, the ability to prenatally diagnose fetal injury associated with ZIKV infection remains limited. New studies indicate that ZIKV imparts disproportionate effects on fetal growth with an unusual femur-sparing profile, potentially providing a new approach to identify viral injury to the fetus. Studies to determine the limitations of prenatal and postnatal testing for detection of ZIKV-associated birth defects and long-term neurocognitive deficits are needed to better guide counseling for women with a possible infectious exposure. It is also imperative that we investigate why ZIKV is so adept at infecting the placenta and the fetal brain to better predict other viruses with similar capabilities that may give rise to new epidemics. The efficiency with which ZIKV evades the early immune response to enable infection of the mother, placenta and fetus is likely critical for understanding why the infection may either be fulminant or limited. Furthermore, studies suggest that several emerging and related viruses may also cause birth defects, including West Nile virus, which is endemic in many parts of the United States. With mosquito-borne diseases increasing worldwide, there remains an urgent need to better understand the pathogenesis of ZIKV and related viruses to protect pregnancies and child health.

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Association of Prenatal Ultrasonographic Findings With Adverse Neonatal Outcomes Among Pregnant Women With Zika Virus Infection in Brazil

et al. 2018

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Key Points Question Are prenatal ultrasonographic findings in maternal Zika virus infection associated with adverse neonatal outcomes? Findings In this cohort study of 92 women with confirmed Zika virus infection in pregnancy, 37 had an abnormal result on prenatal ultrasonography that was associated with adverse composite neonatal outcomes. However, 23 of 55 neonates who had normal results on prenatal ultrasonography still had adverse neonatal outcomes. Meaning Abnormal results on prenatal ultrasonography are associated with adverse neonatal outcomes; however, a comprehensive neonatal evaluation is recommended for all infants with suspected in utero Zika exposure.

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Clinical assessment and brain findings in a cohort of mothers, fetuses and infants infected with ZIKA virus

Cited by 64 publications

References 61 publications

Zika virus during pregnancy: From maternal exposure to congenital Zika virus syndrome

Zika virus during pregnancy: From maternal exposure to congenital Zika virus syndrome

Zika virus and the nonmicrocephalic fetus: why we should still worry

Association of Prenatal Ultrasonographic Findings With Adverse Neonatal Outcomes Among Pregnant Women With Zika Virus Infection in Brazil

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