Consequences of In Utero Zika Virus Exposure and Adverse Pregnancy and Early Childhood Outcomes: A Prospective Cohort Study

Abstract

We aimed to describe adverse pregnancy outcomes among women who had symptomatic, RT-PCR-confirmed ZIKV infection and early childhood outcomes among their infants. We enrolled pregnant women with symptomatic, RT-PCR-confirmed ZIKV infection in a prospective cohort study, and their infants in a prospective pediatric cohort study. We defined adverse pregnancy and early childhood outcomes based on selected neurologic, ophthalmologic, auditory, musculoskeletal, and anthropometric abnormalities. We used RT-PCR and serologic tests to determine the ZIKV infection status of the child. Between 10 March and 24 November 2016, we enrolled 546 pregnant women with RT-PCR-confirmed ZIKV infection. The overall risk of adverse pregnancy and early childhood outcomes possibly related to in utero ZIKV exposure was 15.7% (95% CI: 12.8–19.0), distributed as follows: 3.6% (95% CI: 2.3–5.6) severe sequelae or fatality; 2.7% (95% CI: 1.6–4.5) major abnormalities; 9.4% (95% CI:7.1–12.2) mild abnormalities. The risk of severe sequelae or fatality was higher when ZIKV infection occurred during the first trimester (7.0%), compared to the second (2.7%) or third trimester (1.4%) (p = 0.02). Among the infants for whom ZIKV infection status could be determined, the vertical transmission rate was 3.0% (5/167) (95% CI: 1.1–7.2). Among pregnant women with symptomatic, RT-PCR-confirmed ZIKV infection, severe or major pregnancy or early childhood outcomes were present in 6.3% of fetuses and infants. Severe outcomes occurred more frequently in fetuses and infants whose mothers had been infected in the first trimester.

Review on Main Arboviruses Circulating on French Guiana, An Ultra-Peripheric European Region in South America

“…The Saint Laurent du Maroni hospital, in western FG, has been actively sharing their experience on the maternal–infant impact of ZIKV infection [ 25 ]. A recently published study, in which 24 of the 546 investigated pregnant women lived in FG, assessed the risk of adverse pregnancy and early childhood likely related to in utero ZIKV exposure and found that among the 555 fetuses and infants, the overall risk was 15.7% (9.4% for mild abnormalities and 3.6% for severe sequelae or fatal outcomes) [ 26 ]. In another study assessing the long-term neurological development of children diagnosed with congenital ZIKV infection at birth in FG, 129 children exposed to ZIKV in utero, born and managed in western FG were followed for up to 3 years of life.…”

Molecular and Cellular Mechanisms Underlying Neurologic Manifestations of Mosquito-Borne Flavivirus Infections

“…ZIKV is a mosquito-borne flavivirus that was first isolated in 1947 and became of broad interest to the medical community in 2013-2017, when the virus emerged in the Americas [101]. This ZIKV outbreak was of particular concern to pregnant women due to the increased risk of fetal demise and microcephaly [102], but has also been associated with Guillain-Barré syndrome [103] and ocular complications [104]. Unlike WNV and JEV, ZIKV can infect a broad range of cell types in the brain including neurons [105], astrocytes [105,106], oligodendrocytes [106], Schwann cells [107], neural progenitor cells [108], glial progenitor cells [109], and pericytes in the choroid plexus [110].…”

Editorial: Cellular and molecular mechanisms of neurotropic viral infection

“…Zika virus (ZIKV) is a mosquito-borne flavivirus that became of broad interest to the medical community in 2013, when the virus emerged in the Americas causing increased risk of fetal demise and microcephaly in infected pregnant women (Grant et al, 2022 ). Early gestational age at the time of ZIKV infection correlates with more severe neurodevelopmental effects (Nielsen-Saines et al, 2019 ).…”