Pregnancy, Birth, Infant, and Early Childhood Neurodevelopmental Outcomes among a Cohort of Women with Symptoms of Zika Virus Disease during Pregnancy in Three Surveillance Sites, Project Vigilancia de Embarazadas con Zika (VEZ), Colombia, 2016–2018

Abstract

Project Vigilancia de Embarazadas con Zika (VEZ), an intensified surveillance of pregnant women with symptoms of the Zika virus disease (ZVD) in Colombia, aimed to evaluate the relationship between symptoms of ZVD during pregnancy and adverse pregnancy, birth, and infant outcomes and early childhood neurodevelopmental outcomes. During May–November 2016, pregnant women in three Colombian cities who were reported with symptoms of ZVD to the national surveillance system, or with symptoms of ZVD visiting participating clinics, were enrolled in Project VEZ. Data from maternal and pediatric (up to two years of age) medical records were abstracted. Available maternal specimens were tested for the presence of the Zika virus ribonucleic acid and/or anti-Zika virus immunoglobulin antibodies. Of 1213 enrolled pregnant women with symptoms of ZVD, 1180 had a known pregnancy outcome. Results of the Zika virus laboratory testing were available for 569 (48.2%) pregnancies with a known pregnancy outcome though testing timing varied and was often distal to the timing of symptoms; 254 (21.5% of the whole cohort; 44.6% of those with testing results) were confirmed or presumptive positive for the Zika virus infection. Of pregnancies with a known outcome, 50 (4.2%) fetuses/infants had Zika-associated brain or eye defects, which included microcephaly at birth. Early childhood adverse neurodevelopmental outcomes were more common among those with Zika-associated birth defects than among those without and more common among those with laboratory evidence of a Zika virus infection compared with the full cohort. The proportion of fetuses/infants with any Zika-associated brain or eye defect was consistent with the proportion seen in other studies. Enhancements to Colombia’s existing national surveillance enabled the assessment of adverse outcomes associated with ZVD in pregnancy.

Outcomes Up to Age 36 Months after Congenital Zika Virus Infection – U.S. States

“…These ndings are consistent with earlier reports from the USZPIR and existing literature describing other surveillance cohorts. 9,26 Developmental delays were common among children with ZBD in this cohort. Structural brain malformation and injury from CZVE can affect all areas of development.…”

“…29 Similar ndings were described among a large surveillance cohort of children with CZVE in Colombia. 9 However, ZIKV clearly demonstrates neurotropism, and there is concern that CZVE may lead to long term neurodevelopmental abnormalities in children without ZBD. This has been demonstrated in several other published surveillance and research cohorts in the U.S. and internationally.…”

“…[5][6][7] Emerging evidence suggests that children with ZBD can exhibit neurodevelopmental delays not detected until after their rst year of life. 8,9 However, among children without ZBD, information about the longer-term neurodevelopmental effects of CZVE is limited. 1,10 A study in Colombia examined 77 infants with laboratory evidence of maternal ZIKV during pregnancy but no clinical signs of congenital Zika syndrome and normal prenatal neuroimaging.…”

Vertical Zika Virus Transmission at the Maternal-Fetal Interface

“…Unlike most viruses, which cannot cross the placental barrier, Zika virus (ZIKV), varicella zoster virus, rubella, and cytomegalovirus are transmitted from the mother to the fetus by infecting various placental cell types (1)(2)(3). Serving as major antecedents of infection-related global morbidity and mortality during pregnancy, these pathogens cause congenital anomalies and placental dysfunction resulting in adverse pregnancy outcomes such as preterm birth or fetal growth restriction and/or miscarriage (1)(2)(3)(4)(5)(6)(7)(8). Therefore, pregnant women represent a vulnerable population for viral infections since pregnancy confers a unique immune status that facilitates maternal tolerance of the semi-allogenic fetus and enables viral infections (9,10).…”

Zika virus in Pregnancy in a Honduran cohort: neurodevelopmental assessment of normocephalic children born to Zika virus exposed and non-exposed pregnant people

“…There are several studies that have described abnormal neurodevelopmental effects in children prenatally exposed to ZIKV but not including a comparison group. (3,(5)(6)(7)(27)(28)(29)(30)(31)(32) At present, there are fewer studies regarding the effects of congenital ZIKV infection on the neurodevelopmental outcomes of children without apparent defects at birth. These studies implemented a variety of neurodevelopmental assessments or screeners used to evaluate the children and applied at different ages.…”