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#Grand Rounds

Update on Zika Virus Infection and Adverse Pregnancy Outcome

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BACKGROUND AND PURPOSE:

  • Cooper et al. (Obstetrics & Gynecology, 2019) provides an update on Zika virus infection, specifically addressing the extent of risk for small-for-gestational-age (SGA), preterm birth, and lower birth weight of term neonates

METHODS:

  • Retrospective observational study (2016)
    • New York City Health Department Bureau of Vital Statistics birth record data
    • Surveillance data for cases of Zika virus infection diagnosed in New York City residents
  • Participants
    • Database includes all liveborn singleton neonates
  • Primary exposure
    • Laboratory evidence of confirmed or probable Zika virus infection during pregnancy or peri-conception (6 weeks before LMP) or
    • Delivery of a neonate with congenital Zika virus infection
  • Study design and data analysis
    • Zika virus infection determination based on reports to the New York City Health Department
    • Analysis was adjusted for maternal characteristics
    • Regression analyses were used to assess the risks of having an SGA neonate and delivering preterm
    • Association of infection with mean birth weight of term neonates was also assessed

RESULTS:

  • 116,034 deliveries | Antenatal Zika virus infection identified in 251 (0.2%) | 20 neonates were diagnosed with congenital Zika virus (based on laboratory evidence)
  • Women with antenatal Zika virus infection were more likely to be
    • Primiparous | < 20 years | Non-Hispanic black | Born outside of the US
  • A higher percentage of women with Zika virus infection delivered an SGA neonate (11.2%) compared with those who were not infected (5.8%)
    • Adjusted relative risk (RR) 1.8 (95% CI, 1.3 to 2.6)
  • There was no difference in preterm birth frequency for women with (8.8%) and without (7.8%) Zika virus infection
    • Adjusted RR 1.0 (95% CI, 0.69 to 1.6)
  • Mean birth weight of term neonates was not significantly different for women with (3,256 g) and without (3,303 g) Zika virus infection
    • Adjusted mean difference: -41 g (95% CI, -94 to 12)
  • Percent of neonates born SGA and preterm were similar for neonates with positive and negative Zika virus test results

CONCLUSION:

  • Authors note limitations including
    • Study only included live births and Zika virus infection may cause fetal loss
  • Women with antenatal Zika virus infection were
    • More likely to give birth to an SGA neonate
    • No significant differences in preterm birth rate or mean term birth weight were noted (although confidence intervals were wide)
  • Zika virus may impact placental function and result in SGA even if there is no vertical transmission

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Learn More – Primary Sources:

Maternal Zika Virus Infection – Association With Small-for-Gestational-Age Neonates and Preterm Birth

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Related ObG Topics:

CDC Guidance on Zika and Pregnancy
Zika Virus and Birth Defects: How Strong is the Correlation?
Is Prenatal Ultrasound Sufficient to Identify Zika Virus Brain Defects?
A Better Test for Zika?

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