Zika virus infection in pregnancy: a systematic review of disease course and complications

Abstract

ObjectivesTo characterize maternal Zika virus (ZIKV) infection and complement the evidence base for the WHO interim guidance on pregnancy management in the context of ZIKV infection.MethodsWe searched the relevant database from inception until March 2016. Two review authors independently screened and assessed full texts of eligible reports and extracted data from relevant studies. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS) and the National Institute of Health (NIH) tool for observational studies and case series/reports, respectively.ResultsAmong 142 eligible full-text articles, 18 met the inclusion criteria (13 case series/reports and five cohort studies). Common symptoms among pregnant women with suspected/confirmed ZIKV infection were fever, rash, and arthralgia. One case of Guillain-Barré syndrome was reported among ZIKV-infected mothers, no other case of severe maternal morbidity or mortality reported. Complications reported in association with maternal ZIKV infection included a broad range of fetal and newborn neurological and ocular abnormalities; fetal growth restriction, stillbirth, and perinatal death. Microcephaly was the primary neurological complication reported in eight studies, with an incidence of about 1% among newborns of ZIKV infected women in one study.ConclusionGiven the extensive and variable fetal and newborn presentations/complications associated with prenatal ZIKV infection, and the dearth of information provided, knowledge gaps are evident. Further research and comprehensive reporting may provide a better understanding of ZIKV infection in pregnancy and attendant maternal/fetal complications. This knowledge could inform the creation of effective and evidence-based strategies, guidelines and recommendations aimed at the management of maternal ZIKV infection. Adherence to current best practice guidelines for prenatal care among health providers is encouraged, in the context of maternal ZIKV infection.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-017-0285-6) contains supplementary material, which is available to authorized users.

Zika virus infection and microcephaly: Evidence regarding geospatial associations

“…Best practices for pregnancy management during the ZIKV epidemic detail clinical manifestations of infection, endorse serological testing [ 38 ] depending on symptom presentation and timing of acute infection, and recommend routine ultrasounds before 24 weeks gestation [ 35 ]. Laboratory confirmation of ZIKV facilitates systematic efforts to estimate its prevalence and risk [ 39 ]. These practices need to be considered in the Midwest region for pregnancy management, as our findings suggest that this region will face an increase in microcephaly cases.…”

Variable Sensitivity in Molecular Detection of Zika Virus in European Expert Laboratories: External Quality Assessment, November 2016

“…In May 2016, ZIKV serology was available in 24 European Union/European Economic Area (EEA) countries (45). Nonetheless, the potential negative consequences of false-negative results for ZIKV infection are considerable, especially for pregnant women, the partners of pregnant women, or women who wish to become pregnant, due to the teratogenic nature of ZIKV (5,38). No differences in the detection of Asian-lineage ZIKV versus African-lineage ZIKV were observed in this EQA.…”

“…ZIKV infections have been linked to congenital malformations in neonates from mothers that were infected with ZIKV during pregnancy and to neurological disorders, like Guillain-Barré syndrome (GBS), in adults (5,6). ZIKV is a positive-sense RNA virus that belongs to the genus Flavivirus, family Flaviviridae.…”

Inhibition of autophagy limits vertical transmission of Zika virus in pregnant mice

“…Hitherto, ZIKV was known to cause a self-limiting febrile illness characterized by rash, myalgia, conjunctivitis, and headache. However, recent epidemics have linked ZIKV infection to Guillain-Barré syndrome in adults ( Cao-Lormeau et al, 2016 ) and placental insufficiency, fetal demise, microcephaly, and other congenital malformations in fetuses and newborn infants in the setting of maternal infection during pregnancy ( Chibueze et al, 2017 ). In the human placenta, ZIKV has a broad cell tropism, including villous placental trophoblasts, endothelial cells, fibroblasts, and fetal Hofbauer macrophages in the intervillous space ( El Costa et al, 2016 ; Jurado et al, 2016 ; Miner et al, 2016 ; Quicke et al, 2016 ; Tabata et al, 2016 ; Aagaard et al, 2017 ).…”