Early maternal Zika infection predicts severe neonatal neurological damage: results from the prospective Natural History of Zika Virus Infection in Gestation cohort study

Objective To define the prevalence of adverse outcomes of maternal infection in a large cohort of ZIKV‐infected Brazilian women and their infants. Design Prospective population‐based cohort study. Setting Ribeirão Preto's region's private and public health facilities. Population Symptomati...

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Published in:	BJOG : an international journal of obstetrics and gynaecology Vol. 128; no. 2; pp. 317 - 326
Main Authors:	Coutinho, CM, Negrini, SFBM, Araujo, DCA, Teixeira, SR, Amaral, FR, Moro, MCR, Fernandes, JDCP, Motta, MSF, Negrini, BVM, Caldas, CACT, Anastasio, ART, Furtado, JM, Bárbaro, AAT, Yamamoto, AY, Duarte, G, Mussi‐Pinhata, MM
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-01-2021
Subjects:	Adult Adverse outcomes Age Asymptomatic Brazil Cohort analysis Cohort Studies Congenital defects congenital Zika syndrome Female Fetuses Gestational Age Humans infant Infant, Newborn Infants Infections Male Microencephaly Neonates Nervous System Malformations - epidemiology Newborn babies Population studies Pregnancy Pregnancy Complications, Infectious - diagnosis Pregnancy Complications, Infectious - virology Pregnancy Outcome Prevalence Public health Risk Factors Stillbirth Zika virus Zika Virus Infection - complications Zika Virus Infection - diagnosis Brazil Adverse outcomes Zika virus congenital Zika syndrome infant pregnancy
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Summary:	Objective To define the prevalence of adverse outcomes of maternal infection in a large cohort of ZIKV‐infected Brazilian women and their infants. Design Prospective population‐based cohort study. Setting Ribeirão Preto's region's private and public health facilities. Population Symptomatic ZIKV‐infected mothers and their infants. Methods Prenatal/early neonatal data were obtained for all mother–child pairs. A subgroup of infants had cranial ultrasonography, eye fundoscopy, hearing and neurological examinations and Bayley III screening tests within 3 months of age. Main outcome measures Prevalence of pregnancy losses and anomalies detected at birth or within 3 months according to the gestational age of infection. Results Overall, 511 ZIKV‐infected women were identified from a total of 1116 symptomatic women; as there were two twins, there were a total of 513 fetuses included. Of these, 13 (2.5%; 95% CI 1.5–4.3) presented with major signs of congenital Zika syndrome (CZS). Of the 511 women, there were 489 livebirths and 24 (4.7%) pregnancy losses (20 miscarriages and four stillbirths). ZIKV‐related anomalies occurred in the offspring of 42/511 (8.2%) mothers. Microcephaly or other CNS malformations were diagnosed in 1/4 (25.0%) stillbirths and in 19/489 (3.9%; 95% CI 2.5–5.9) of the liveborn infants. Fetal abnormalities were 14.0 (95% CI 7.6–26.0) times more likely with gestational infection occurring in ≤11 weeks. On follow up of 280 asymptomatic infants, 2/155 (1.3%) had eye abnormalities, 1/207 (0.5%) had CNS imaging findings and 16/199 (8%) presented neurological alert signs. Conclusions This prospective population‐based study represents the largest Brazilian cohort study of ZIKV in pregnancy. Congenital anomalies potentially associated with CZS are less frequent than previously thought. There is a strong association between the gestational age of infection (≤11 weeks) and a poorer early infant prognosis. A notable proportion of apparently asymptomatic newborns can present with subclinical findings within 3 months of age. Tweetable ZIKV and pregnancy: adverse outcomes are less common, more prevalent for first‐trimester infections, and potentially subclinical. Tweetable ZIKV and pregnancy: adverse outcomes are less common, more prevalent for first‐trimester infections, and potentially subclinical.
Bibliography:	The list of NATZIG cohort study members can be found in Appendix 1. This article is commented on by M Prabhu, LE Riley, p. 327 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16549 Linked article . ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1470-0328 1471-0528
DOI:	10.1111/1471-0528.16490