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Prolonged Maternal Zika Viremia as a Marker of Adverse Perinatal Outcomes.

ABSTRACT: Whether prolonged maternal viremia after Zika virus infection represents a risk factor for maternal-fetal transmission and subsequent adverse outcomes remains unclear. In this prospective cohort study in French Guiana, we enrolled Zika virus-infected pregnant women with a positive PCR result at inclusion and noninfected pregnant women; both groups underwent serologic testing in each trimester and at delivery during January-July 2016. Prolonged viremia was defined as ongoing virus detection >30 days postinfection. Adverse outcomes (fetal loss or neurologic anomalies) were more common in fetuses and neonates from mothers with prolonged viremia (40.0%) compared with those from infected mothers without prolonged viremia (5.3%, adjusted relative risk [aRR] 7.2 [95% CI 0.9-57.6]) or those from noninfected mothers (6.6%, aRR 6.7 [95% CI 3.0-15.1]). Congenital infections were confirmed more often in fetuses and neonates from mothers with prolonged viremia compared with the other 2 groups (60.0% vs. 26.3% vs. 0.0%, aRR 2.3 [95% CI 0.9-5.5]).

SUBMITTER: Pomar L

PROVIDER: S-EPMC7853546 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Prolonged Maternal Zika Viremia as a Marker of Adverse Perinatal Outcomes.

Pomar Léo L Lambert Véronique V Matheus Séverine S Pomar Céline C Hcini Najeh N Carles Gabriel G Rousset Dominique D Vouga Manon M Panchaud Alice A Baud David D

Emerging infectious diseases 20210201 2

Whether prolonged maternal viremia after Zika virus infection represents a risk factor for maternal-fetal transmission and subsequent adverse outcomes remains unclear. In this prospective cohort study in French Guiana, we enrolled Zika virus-infected pregnant women with a positive PCR result at inclusion and noninfected pregnant women; both groups underwent serologic testing in each trimester and at delivery during January-July 2016. Prolonged viremia was defined as ongoing virus detection >30 d ...[more]

PMID: 33496246

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Project description:ObjectivesTo estimate the rates of maternal-fetal transmission of Zika virus, adverse fetal/neonatal outcomes, and subsequent rates of asymptomatic/symptomatic congenital Zika virus infections up to the first week of life.DesignCohort study with prospective data collection and subsequent review of fetal/neonatal outcomes.SettingsReferral centre for prenatal diagnosis of the French Guiana Western Hospital.ParticipantsPregnant women at any stage of pregnancy with a laboratory confirmed symptomatic or asymptomatic Zika virus infection during the epidemic period in western French Guiana. The cohort enrolled 300 participants and prospectively followed their 305 fetuses/newborns.Main outcome measuresRate of maternal-fetal transmission of Zika virus (amniotic fluid, fetal and neonatal blood, urine, cerebrospinal fluid, and placentas); clinical, biological, and radiological outcomes (blindly reviewed); and adverse outcomes defined as moderate signs potentially related to congenital Zika syndrome (CZS), severe complications compatible with CZS, or fetal loss. Associations between a laboratory confirmed congenital Zika virus infection and adverse fetal/neonatal outcomes were evaluated.ResultsMaternal-fetal transmission was documented in 26% (76/291) of fetuses/newborns with complete data. Among the Zika virus positive fetuses/newborns, 45% (34/76) presented with no signs/complications at birth, 20% (15/76) with moderate signs potentially related to CZS, 21% (16/76) with severe complications compatible with CZS, and 14% (11/76) with fetal loss. Compared with the Zika virus positive fetuses/neonates, those that were identified as negative for Zika virus (215/291) were less likely to present with severe complications (5%; 10/215) or fetal loss (0.5%; 1/215; relative risk 6.9, 95% confidence interval 3.6 to 13.3). Association between a positive Zika virus test and any adverse fetal/neonatal outcome was also significant (relative risk 4.4, 2.9 to 6.6). The population attributable fraction estimates that a confirmed congenital Zika virus infection contributes to 47% of adverse outcomes and 61% of severe adverse outcomes observed.ConclusionIn cases of a known maternal Zika virus infection, approximately a quarter of fetuses will become congenitally infected, of which a third will have severe complications at birth or fetal loss. The burden of CZS might be lower than initially described in South America and may not differ from other congenital infections.

Project description:BackgroundAdolescent girls between 15 and 19 years give birth to around 16 million babies each year, around 11% of births worldwide. We sought to determine whether adolescent mothers are at higher risk of maternal and perinatal adverse outcomes compared with mothers aged 20-24 years in a prospective, population-based observational study of newborn outcomes in low resource settings.MethodsWe undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in six low-middle income countries (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). The study population for this analysis was restricted to women aged 24 years or less, who gave birth to infants of at least 20 weeks' gestation and 500g or more. We compared adverse pregnancy maternal and perinatal outcomes among pregnant adolescents 15-19 years, <15 years, and adults 20-24 years.ResultsA total of 269,273 women were enrolled from January 2010 to December 2013. Of all pregnancies 11.9% (32,097/269,273) were in adolescents 15-19 years, while 0.14% (370/269,273) occurred among girls <15 years. Pregnancy among adolescents 15-19 years ranged from 2% in Pakistan to 26% in Argentina, and adolescent pregnancies <15 year were only observed in sub-Saharan Africa and Latin America. Compared to adults, adolescents did not show increased risk of maternal adverse outcomes. Risks of preterm birth and LBW were significantly higher among both early and older adolescents, with the highest risks observed in the <15 years group. Neonatal and perinatal mortality followed a similar trend in sub-Saharan Africa and Latin America, with the highest risk in early adolescents, although the differences in this age group were not significant. However, in South Asia the risks of neonatal and perinatal death were not different among adolescents 15-19 years compared to adults.ConclusionsThis study suggests that pregnancy among adolescents is not associated with worse maternal outcomes, but is associated with worse perinatal outcomes, particularly in younger adolescents. However, this may not be the case in regions like South Asia where there are decreasing rates of adolescent pregnancies, concentrated among older adolescents. The increased risks observed among adolescents seems more likely to be associated with biological immaturity, than with socio-economic factors, inadequate antenatal or delivery care.Trial registration numberNCT01073475.

Project description:Adverse perinatal outcomes (APO) are unfavourable incidents of at least one of the following: low birth weight, preterm delivery, stillbirths, neonatal deaths, and perinatal deaths. They contribute significantly to neonatal and infant morbidity and mortality, developmental abnormalities, and long-term impairments. Studies are lacking on the influence of maternal lifestyle on APO in Nigeria. Hence, we investigated the determinants of APO using the Ibadan Pregnancy Cohort Study (IbPCS) data and examined 1,339 mothers who had hospital delivery. The outcome variable was APO (low birth weight, birth asphyxia and preterm delivery). Explanatory variables comprised Antepartum Depression (Edinburgh Depression Scale ≥ 12), Physical activity (Pregnancy Physical Activity Questionnaire (PPAQ), Dietary pattern (Qualitative Food Frequency Questionnaire (FFQ), Maternal Stress (Perceived Stress Scale), Alcohol consumption, and Tobacco exposure. We used binary and multiple logistic regression to assess the associations between the risk factors and adverse perinatal outcomes at a significant P-value <0.05. Prevalence of APO was 26.7%, 95%CI (24.4-29.1); low birth weight - 8.5%, 95%CI (7.0-10.1) preterm delivery 14.8%, 95% CI (12.9-16.7); birth asphyxia 16.3%, 95%CI (14.0-18.9). The factors associated with LBW were being a female infant AOR: 2.00, 95%CI (1.13 -3.52); emergency caesarean section AOR: 2.40, 95%CI (1.06-5.42); a history of hypertension in pregnancy AOR: 3.34, 95%CI (1.45 -7.52). Preterm birth was associated with being poor AOR: 2.00, 95%CI (1.13 -3.52); history of stillbirth AOR: 2.05, 95%CI (1.14-3.68); antepartum depression AOR: 1.87, 95%CI (1.08-3.25). Of the lifestyle factors examined, only a high protein diet with a non-alcoholic beverage dietary pattern had a statistically significant association with preterm birth [AOR: 0.50, 95%CI (1.08-3.52)]. However, lifestyle factors had no significant association with LBW and birth asphyxia in our study. Understanding these risk factors can help policymakers and healthcare professionals create cost-effective interventions to curtail the burden of APO in Nigeria.

Dataset Information

Prolonged Maternal Zika Viremia as a Marker of Adverse Perinatal Outcomes.

Publications

Prolonged Maternal Zika Viremia as a Marker of Adverse Perinatal Outcomes.

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