Pregnancy, Birth, Infant, and Early Childhood Neurodevelopmental Outcomes among a Cohort of Women with Symptoms of Zika Virus Disease during Pregnancy in Three Surveillance Sites, Project Vigilancia de Embarazadas con Zika (VEZ), Colombia, 2016–2018
Abstract
:1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria and Medical Records Abstraction
2.2. Specimen Collection and Testing
2.3. Laboratory Evidence of Zika Virus Infection during Pregnancy
2.4. Zika-Associated Birth Defects and Other Pregnancy Outcomes
2.5. Early Childhood Neurodevelopmental Outcomes
2.6. Data Entry and Analysis
3. Results
3.1. Characteristics of the Study Population
3.2. Pregnancy and Infant Outcomes including Zika-Associated Birth Defects
3.3. Zika Virus Testing Results
3.4. Early Childhood Neurodevelopmental Outcomes
4. Discussion
4.1. Limitations
4.2. Strengths
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Disclaimer
References
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Total (N = 1180) n (%) | Laboratory Evidence of Zika Virus Infection (N = 254) n (%) | |
---|---|---|
Maternal age at conception (years) | ||
<17 | 106 (9.0) | 28 (11.0) |
17–19 | 208 (17.6) | 41 (16.1) |
20–24 | 374 (31.7) | 76 (29.9) |
25–29 | 249 (21.1) | 55 (21.7) |
30–34 | 149 (12.6) | 34 (13.4) |
≥35 | 78 (6.6) | 17 (6.7) |
Not reported | 16 (1.4) | 3 (1.2) |
Maternal education | ||
<Secondary | 120 (10.2) | 30 (11.8) |
Secondary | 595 (50.4) | 114 (44.9) |
Technical | 130 (11.0) | 27 (10.6) |
Professional | 70 (5.9) | 14 (5.5) |
Not reported | 265 (22.5) | 69 (27.2) |
Gravidity | ||
Primigravid | 323 (27.4) | 92 (36.2) |
Multigravid | 668 (56.6) | 131 (51.6) |
Not reported | 189 (16.0) | 31 (12.2) |
Delivery method | ||
Vaginal | 541 (45.9) | 136 (53.5) |
Cesarean section | 622 (52.7) | 115 (45.3) |
Not reported | 17 (1.4) | 3 (1.2) |
Infant sex † | ||
Male | 575 (48.2) | 124 (48.4) |
Female | 602 (50.5) | 127 (49.6) |
Not reported | 15 (1.3) | 5 (2.0) |
Plurality | ||
Singleton | 1150 (97.5) | 246 (96.9) |
Twins | 12 (1.0) | 2 (0.8) |
Not reported | 18 (1.5) | 6 (2.4) |
Symptoms reported ‡ | ||
Rash | 983 (83.3) | 211 (83.1) |
Fever | 787 (66.7) | 149 (58.7) |
Joint pain | 691 (58.6) | 148 (58.3) |
Headache | 612 (51.9) | 110 (43.3) |
Conjunctivitis | 267 (22.6) | 54 (21.3) |
Eye pain | 116 (9.8) | 26 (10.2) |
Diarrhea | 99 (8.4) | 21 (8.3) |
Swollen lymph nodes | 22 (1.9) | 5 (2.0) |
Not reported | 72 (6.1) | 20 (7.9) |
Trimester of symptom onset | ||
Periconception (up to 8 weeks before the estimated date of conception) | 84 (7.1) | 8 (3.2) |
First trimester | 616 (52.2) | 124 (48.8) |
Second trimester | 397 (33.6) | 104 (40.9) |
Third trimester | 63 (5.3) | 13 (5.1) |
Not reported | 20 (1.7) | 5 (2.0) |
Total (N = 1180) n (%) | Laboratory Evidence of Zika Virus Infection (N = 254) n (%) | |
---|---|---|
Pregnancy outcome | ||
Live birth | 1166/1180 (98.8) | 250/254 (98.4) |
Pregnancy loss <20 weeks’ gestation | 6/1180 (0.5) | 1/254 (0.4) |
Pregnancy loss ≥20 weeks’ gestation | 8/1180 (0.7) | 3/254 (1.2) |
Zika-associated birth defects | ||
Total with any Zika-associated birth defect | 50/1180 (4.2) | 22/254 (8.7) |
Selected brain abnormalities with or without microcephaly | 29/1180 (2.5) | 14/254 (5.5) |
Selected eye anomalies | 14/1180 (1.2) | 6/254 (2.4) |
Microcephaly only at birth | 19/1180 (1.6) | 7/254 (2.8) |
Postnatal-onset microcephaly | 17/1180 (1.4) | 4/254 (1.6) |
Other adverse outcomes † | ||
Preterm delivery ‡ | 106/1099 (9.7) | 21/226 (9.3) |
Low birth weight ‡ | 76/1099 (6.9) | 19/226 (8.4) |
Small for gestational age ‡ | 50/1099 (4.6) | 8/226 (3.5) |
Death in the first year of life (among live-born infants) | 16/1178 (1.4) | 9/252 (3.6) |
Total (N = 1160) * | Periconception (N = 84) | 1st Trimester (N = 616) | 2nd Trimester (N = 397) | 3rd Trimester (N = 63) | |
---|---|---|---|---|---|
n (%) | n (%) | n (%) | n (%) | n (%) | |
Pregnancy outcome | |||||
Live birth | 1149/1160 (99.1) | 81/84 (96.4) | 610/616 (99.0) | 395/397 (99.5) | 63/63 (100.0) |
Pregnancy loss <20 weeks’ gestation | 4/1160 (0.3) | 1/84 (1.2) | 3/616 (0.5) | 0/397 (0) | 0/63 (0) |
Pregnancy loss ≥20 weeks’ gestation | 7/1160 (0.6) | 2/84 (2.4) | 3/616 (0.5) | 2/397 (0.5) | 0/63 (0) |
Zika-associated birth defects | |||||
Total with any Zika-associated birth defect | 49/1160 (4.2) | 4/84 (4.8) | 29/616 (4.7) | 13/397 (3.3) | 3/63 (4.8) |
Selected brain abnormalities with or without microcephaly | 28/1160 (2.4) | 2/84 (2.4) | 19/616 (3.1)† | 4/397 (1.0)† | 3/63 (4.8) |
Selected eye anomalies | 14/1160 (1.2) | 0/84 (0) | 11/616 (1.8) | 2/397 (0.5) | 1/63 (1.6) |
Microcephaly only at birth | 19/1160 (1.6) | 2/84 (2.4) | 9/616 (1.5) | 8/397 (2.0) | 0/63 (0) |
Postnatal-onset microcephaly | 17/1160 (1.5) | 3/84 (3.6) | 7/616 (1.1) | 6/397 (1.5) | 1/63 (1.6) |
Other adverse outcomes ‡ | |||||
Preterm delivery § | 105/1082 (9.7) | 10/75 (13.3) | 65/573 (11.3) | 26/375 (6.9) | 4/59 (6.8) |
Low birth weight § | 75/1082 (6.9) | 10/75 (13.3) | 41/573 (7.2) | 21/375 (5.6) | 3/59 (5.1) |
Small for gestational age § | 50/1082 (4.6) | 3/75 (4.0) | 23/573 (4.0) | 20/375 (5.3) | 4/59 (6.8) |
Death in the first year of life (among live births) | 14/1149 (1.2) | 0/81 (0) | 10/614 (1.6) | 3/395 (0.8) | 1/63 (1.6) |
Total (N = 990) | Laboratory Evidence of Zika Virus Infection (N = 223) | |||
---|---|---|---|---|
Neurodevelopmental Sequelae | Zika-Associated Birth Defects ‡ or Postnatal onset Microcephaly (N = 58) n (%) | No Zika-Associated Birth Defects (N = 932) n (%) | Zika-Associated Birth Defects or Postnatal onset Microcephaly (N = 20) n (%) | No Zika-Associated Birth Defects (N = 203) n (%) |
Seizures | 12 (20.7) | 5 (0.5) | 4 (20.0) | 2 (1.0) |
Tone abnormality | 19 (32.8) | 71 (7.6) | 8 (40.0) | 44 (21.7) |
Movement abnormality | 13 (22.4) | 6 (0.6) | 4 (20.0) | 2 (1.0) |
Swallowing abnormality | 11 (19.0) | 7 (0.8) | 3 (15.0) | 4 (2.0) |
Arthrogryposis | 1 (1.7) | 0 (0) | 1 (5.0) | 0 (0) |
Visual impairment | 12 (20.7) | 12 (1.3) | 6 (30.0) | 3 (1.5) |
Hearing abnormality | 3 (5.2) | 22 (2.4) | 2 (10.0) | 3 (1.5) |
Any neurodevelopmental sequela | 26 (44.8) | 100 (10.7) | 11 (55.0) | 51 (25.1) |
Escala Abreviada de Desarrollo(EAD-1) § alert scores | ||||
Gross motor domain | 18 (31.0) | 159 (17.1) | 4 (20.0) | 21 (10.3) |
Fine motor domain | 16 (27.6) | 142 (15.2) | 4 (20.0) | 19 (9.4) |
Personal and social domain | 14 (24.1) | 152 (16.3) | 4 (20.0) | 17 (8.4) |
Hearing and language domain | 16 (27.6) | 151 (16.2) | 4 (20.0) | 16 (7.9) |
Any EAD-1 alert | 20 (34.5) | 202 (21.7) | 4 (20.0) | 30 (14.8) |
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Mercado-Reyes, M.; Gilboa, S.M.; Valencia, D.; Daza, M.; Tong, V.T.; Galang, R.R.; Winfield, C.M.; Godfred-Cato, S.; Benavides, M.; Villanueva, J.M.; et al. Pregnancy, Birth, Infant, and Early Childhood Neurodevelopmental Outcomes among a Cohort of Women with Symptoms of Zika Virus Disease during Pregnancy in Three Surveillance Sites, Project Vigilancia de Embarazadas con Zika (VEZ), Colombia, 2016–2018. Trop. Med. Infect. Dis. 2021, 6, 183. https://doi.org/10.3390/tropicalmed6040183
Mercado-Reyes M, Gilboa SM, Valencia D, Daza M, Tong VT, Galang RR, Winfield CM, Godfred-Cato S, Benavides M, Villanueva JM, et al. Pregnancy, Birth, Infant, and Early Childhood Neurodevelopmental Outcomes among a Cohort of Women with Symptoms of Zika Virus Disease during Pregnancy in Three Surveillance Sites, Project Vigilancia de Embarazadas con Zika (VEZ), Colombia, 2016–2018. Tropical Medicine and Infectious Disease. 2021; 6(4):183. https://doi.org/10.3390/tropicalmed6040183
Chicago/Turabian StyleMercado-Reyes, Marcela, Suzanne M. Gilboa, Diana Valencia, Marcela Daza, Van T. Tong, Romeo R. Galang, Christina M. Winfield, Shana Godfred-Cato, Mónica Benavides, Julie M. Villanueva, and et al. 2021. "Pregnancy, Birth, Infant, and Early Childhood Neurodevelopmental Outcomes among a Cohort of Women with Symptoms of Zika Virus Disease during Pregnancy in Three Surveillance Sites, Project Vigilancia de Embarazadas con Zika (VEZ), Colombia, 2016–2018" Tropical Medicine and Infectious Disease 6, no. 4: 183. https://doi.org/10.3390/tropicalmed6040183