Is Pregnancy Associated with Severe Dengue? A Review of Data from the Rio de Janeiro Surveillance Information System

Abstract

BackgroundDengue is a reportable disease in Brazil; however, pregnancy has been included in the application form of the Brazilian notification information system only after 2006. To estimate the severity of maternal dengue infection, the available data that were compiled from January 2007 to December 2008 by the official surveillance information system of the city of Rio de Janeiro were reviewed.Methods and Principal FindingsDuring the study period, 151,604 cases of suspected dengue infection were reported. Five hundred sixty-one women in their reproductive age (15–49 years) presented with dengue infection; 99 (18.1%) pregnant and 447 (81.9%) non-pregnant women were analyzed. Dengue cases were categorized using the 1997 WHO classification system, and DHF/DSS were considered severe disease. The Mann-Whitney test was used to compare maternal age, according to gestational period, and severity of disease. A chi-square test was utilized to evaluate the differences in the proportion of dengue severity between pregnant and non-pregnant women. Univariate analysis was performed to compare outcome variables (severe dengue and non-severe dengue) and explanatory variables (pregnancy, gestational age and trimester) using the Wald test. A multivariate analysis was performed to assess the independence of statistically significant variables in the univariate analysis. A p-value<0.05 was considered statistically significant.A higher percentage of severe dengue infection among pregnant women was found, p = 0.0001. Final analysis demonstrated that pregnant women are 3.4 times more prone to developing severe dengue (OR: 3.38; CI: 2.10–5.42). Mortality among pregnant women was superior to non-pregnant women.ConclusionPregnant women have an increased risk of developing severe dengue infection and dying of dengue.

Dengue Virus Infection Triggering Thrombotic Thrombocytopenic Purpura in Pregnancy

“…Recent reports indicate that dengue in pregnancy is associated with poor fetal and maternal outcomes such as miscarriage, low birth weight, preterm birth, and maternal death. [20][21][22][23] One should be cautious while generalizing the findings from individual case reports, but they are useful for generating hypotheses. This case report exemplifies the fact that dengue in pregnancy is a ripe setting for the development of TTP.…”

Os efeitos maternos, fetais e infantis decorrentes da infecção por dengue durante a gestação em Rio Branco, Acre, Brasil, 2007-2012

“…According to a study in Rio de Janeiro by Machado et al 26 , pregnant women were 3.4 times more likely to develop severe dengue (OR = 3.38; 95%CI: 2.10-5.42), and mortality was higher in pregnant than in non-pregnant women. Therefore, any pregnant woman with an acute febrile illness, especially in endemic areas, should be investigated for dengue virus infection, since the increased probability of evolution to the severe form during pregnancy requires closer surveillance of pregnant women infected with the virus 27 .…”

Molecular and clinical epidemiological surveillance of dengue virus in Paraíba, Northeast Brazil

“…Despite pregnancy being associated with higher disease severity 38 , only a small number of pregnant women in our study were referred to hospital. This may explain why only one case was fatal.…”