Ebola Virus Disease and Pregnancy: A Retrospective Cohort Study of Patients Managed at 5 Ebola Treatment Units in West Africa

• Published in: Clinical infectious diseases Vol. 65; no. 2; pp. 292 - 299
• Main Authors: Henwood, Patricia C., Bebell, Lisa M., Roshania, Reshma, Wolfman, Vanessa, Mallow, Michaela, Kalyanpur, Anushka, Levine, Adam C.
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 15-07-2017
• Subjects: Adult; Anorexia; ARTICLES AND COMMENTARIES; Asthenia; Cohort analysis; Cohort Studies; Diarrhea; Disease control; Disease Outbreaks; Ebola virus; Ebolavirus - drug effects; Ebolavirus - isolation & purification; Epidemics; Female; Fetuses; Fever; Fever - epidemiology; Hemorrhagic Fever, Ebola - mortality; Hemorrhagic Fever, Ebola - therapy; Hemorrhagic Fever, Ebola - virology; Hospitalization; Humans; Infant; Infant, Newborn; Liberia - epidemiology; Major; Management methods; Maternal Mortality; Mortality; Nausea; Neonates; Patients; Pregnancy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - mortality; Pregnancy Complications, Infectious - therapy; Pregnancy Complications, Infectious - virology; Pregnancy Outcome; Retrospective Studies; Risk; Sierra Leone - epidemiology; Viral diseases; Viral Load; Viruses; Vomiting; Women; Young Adult; West Africa; Liberia; Sierra Leone; maternal mortality; Ebola virus disease; pregnant
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cix290

Background. Reliable data are lacking on pregnancy outcomes during Ebola virus disease (EVD) epidemics. We aimed to characterize symptoms and outcomes among pregnant women admitted to Ebola treatment units (ETUs) with suspected and confirmed EVD to better inform obstetric management. Methods. We analyzed a retrospective cohort of reproductive-aged women presenting to 5 West African ETUs from September 2014 to September 2015. We compared clinical symptoms, risk of EVD diagnosis, and mortality between pregnant and nonpregnant women. Results. Of 729 reproductive-aged women admitted to study ETUs, 44 (6%) reported pregnancy. Thirteen of 44 pregnant women (30%) tested EVD positive; 6 of 13 (46%) died. Pregnant women were less likely than nonpregnant women to report anorexia, asthenia, diarrhea, fever, myalgias/arthralgias, nausea, or vomiting (P < .05) at admission. Pregnant women with suspected EVD had the same risk, however, of laboratory-confirmed EVD (30% vs 24%, P = .38). While pregnant women with confirmed EVD had similar Ebola viral loads on presentation to nonpregnant women, as measured by initial cycle threshold (26.4 vs 23.2, P = .16), they were less likely to have myalgias/arthralgias (P < .001) and vomiting (P = .02). Both all cause mortality (14% vs 19%, P= .39) and EVDspecific mortality (46% vs 54%, P = .60) were not significantly different between pregnant and nonpregnant women. Two neonates born live in the ETU died within 8 days. Conclusions. We find no evidence to support a difference in the risk of death between pregnant women with suspected or confirmed EVD compared to nonpregnant women. Limited data suggest poor fetal and neonatal outcomes in EVD-affected pregnancies.