A novel population-based cohort study, published in Nature Communications, found that Brazilian mothers who were symptomatic with either chikungunya, dengue or Zika during pregnancy experienced some form of adverse perinatal health outcome.
Arthropod-born viral diseases, such as chikungunya, dengue and Zika infection, are all endemic to Brazil, and typically have a presence in other tropical and subtropical climates with a high mosquito count. GlobalData epidemiologists estimate that by the end of 2025 in Brazil, there will be just over 96,000 diagnosed incident cases of Chikungunya fever in men and women of all ages. That number is estimated to remain relatively unchanged by the end of 2034.
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Researchers Cerqueira-Silva and colleagues wanted to understand the individual associations between chikungunya, dengue and Zika infection, and adverse birth and neonatal outcomes. The measured outcomes included status on preterm birth, low birth weight, babies being small or large for gestational age, the occurrence of any congenital anomaly, a low score in a newborn health assessment test called the 5-minute Apgar score (Apgar 5), and neonatal death. Data on 6,993,396 live births between 2015 and 2020 was taken from a population-based registry: among this cohort of women, fewer than 0.1% were positive for symptomatic chikungunya, 0.3% for dengue and 0.1% for Zika.
Infections with any of the three viral diseases were associated with a low Apgar 5 score. Chikungunya increased the risk of a low Apgar score the most – by 44% compared to the uninfected controls. Symptomatic Zika infection during pregnancy was associated with all the measured adverse health outcomes: infection increased the risk of congenital abnormalities by more than twice compared to those unexposed to any infection. The risk of neonatal death was also 50% higher in chikungunya-exposed mothers compared to the controls.
Symptomatic maternal dengue infection was associated with preterm birth, low birth weight and congenital anomalies. Risk of adverse birth and neonatal health outcomes varied depending on the infection and by trimester: Zika infection mainly acted in the first trimester, while chikungunya acted mainly in the second trimester and dengue in the third.
A large proportion of the global population resides in countries with tropical and subtropical climates. Thus, vector control and infection prevention, especially during pregnancy, are important priorities. The result of this study shows that the risk of adverse neonatal health outcomes fluctuates depending on the type of arbovirus infection and the trimester in which the mother acquires the infection. These are important factors to note, especially regarding formulating prevention and control interventions.
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By GlobalData