From: Zika virus infection in pregnancy: a systematic review of disease course and complications
Characteristics | Publications | Study designs | Countries | Reported findings | Other information | Knowledge gaps |
---|---|---|---|---|---|---|
Clinical manifestation: maternal, fetal and newborn | McCarthy M., [22] Ventura C.V., et al., [34] Ventura C.V., et al., [38] Villamil-Gómez W.E., et al. [24] Thomas D.L., et al. [25] Shuler-Faccini L., et al., [26] Reyna-Villasmil E., et al. [23] Oliveira Melo A., el atl., [30] Mlakar J., et al., [36] Meaney-Delman D., et al., [37] Kleber de Oliveira W., et al., [29] Calvet G., et al. [32] Brasil Martines R., et al., [27] Brasil P., et al., [33] Besnard M, et al., [31] de Paula Freitas B., et al. [28] | Retrospective cohort Case series Case series Case report Case report Retrospective cohort Case report Case report Case report Case series Retrospective + Prospect cohort Case series Case series Prospective cohort Case series Case series | Brazil Brazil Brazil Colombia Puerto Rico Brazil Venezuela Brazil Brazil USA Brazil Brazil Brazil Brazil Brazil Brazil | Cutaneous rash, maculopapular rash, fever, arthralgia, itch, myalgia, nausea or vomiting, bleeding, respiratory findings, conjunctivitis, malaise, headache, abdominal pain, chills, retroocular pain, edema in lower limbs, hemiparesis, asthenia, jaundice, lumbar pain | Besnard M, et al., reported mild pruritic rash with mild fever (37.5–38 °C) and without fever | - Selection bias based on symptoms suspicious of infection and observed in several studies limits our understanding of ZIKV infection in pregnancy. - Lack of a detailed history of infection to childbirth or related factors confines our of maternal ZIKV infection. |
Clinical manifestations: not reported or vaguely reported | Cauchemez S., et al., [31] Oliveira Melo A., et al., [30] | Retrospective cohort Case report | French Polynesia Brazil | No rash, fever or other infection. Stated as “suffered from symptoms related to Zika virus infection.” | - Generalizations or vague reporting limited our understanding of associated ZIKV symptoms | |
Clinical manifestation: asymptomatic | Sarno M., et al., [35] | Case report | Brazil | No symptoms shown, the first indication of abnormal pregnancy was at ultrasound; intrauterine growth retardation at18 weeks’ gestation | The influence of an asymptomatic presentation on management modalities | |
Trimester infection | Ventura C.V., et al., [34] Ventura C.V., et al., [38] Sarno M., et al., [35] Villamil-Gómez W.E., et al., [24] Thomas D.L., et al., [25] Schuler-Faccini L., et al., [26] Reyna-Villasmil E., et al., [23] Mlakar J., et al., [36] Meaney-Delman D., et al., [37] Calvet G., et al., [32] Brasil Martines R., et al., [27] Besnard M., et al., [21] de Paula Freitas B., et al., [28] | Case series Case series Case report Case report Case report Retrospective cohort Case report Case report Case series Case series Case series Case series Case series | Brazil Brazil Brazil Colombia Puerto Rico Brazil Venezuela Brazil USA Brazil Brazil Brazil Brazil | 50 First trimester 22 s trimester 25 Third Trimester 1 Post-partum | Cauchemez S., et al., [30] did not report trimester infection | - Timing of ZIKV infection is critical to maternal and fetal management, however, most studies made only generalised trimester-specific reports - This restricted our assessment of potential differences in disease susceptibility and progression during pregnancy |
Effects on pregnancy complications (maternal) | Reyna-Villasmil E., et al., [23] Meaney-Delman D., et al., [37] Brasil Martines R., et al., [27] Brasil P., et al., [33] | Case report Case series Case series Prospective cohort | Venezuela USA Brazil Brazil | Guillain-Barré Syndrome; decreased muscle movements and difficulty speaking/swallowing, myalgia, fever, rash, and conjunctivitis for 10 days. Neurological examination showed logical alteration of cranial nerves and speech, decreased muscle strength and respiratory failure. Four miscarriages (first trimester) Two stillbirths (fetal deaths after 30 weeks of gestation) | - The isolated case of Guillain-Barré Syndrome and other neurological manifestations proposes a need for detailed neurological investigations in the context of ZIKV infection which was lacking - Proximal causes of stillbirths were not reported | |
Effects on pregnancy complications (fetus/newborn) | All publications except: Reyna-Villasmil E., et al., [23] Thomas D. L. et al., [25] | Case report Case report | Venezuela Puerto Rico | Microcephaly, hydraencephaly, macular alterations, optic abnormalities, intra-ocular calcification, cataracts, cerebral (intracranial) calcification, ascites and subcutaneous edema, coarse calcification, cerebellar involvement, severe arthrogryposis, severe central nervous system, affection and gross intrauterine growth retardation, ventriculomegaly | Brasil Martines, R., et al., [26] reported two fetal deaths Brasil, P., et al., 2016 reported two fetal deaths All fetal deaths occurred at >30 weeks gestation. | Causes of fetal deaths were unclear |
Fetus alterations: frequencies/rates and absolute risk | Kleber de Oliveira W., et al., [29] Cauchemez S., et al., [31] Ventura C.V., et al., [34] | Retrospective + Prospective. cohort Retrospective cohort Case report | Brazil French Polynesia Brazil | Microcephaly had the highest prevalence in the Brazilian states of Pernambuco. Risk of microcephaly (estimated 1%) 95 cases (34–191) per 1000 women (first trimester) corresponding to a risk ratio of 53.4 (95% CI 6.5–1061–2) Severe ocular abnormalities when the infection occurs in the first or second trimester of pregnancy | #NR | Lack of clear estimates on the risk of fetal alterations in ZIKV infected pregnant women were observed |
Postpartum clinical presentations (maternal) | Besnard M., et al., [21] | Case report | French Polynesia | Post-delivery mild pruritic rash, mild fever (37.5 – 38 °C) and myalgia | #NR | Limited information on maternal progression after childbirth for ZIKV-infected pregnant women |
Postpartum clinical presentations (childbirth) | Brasil Martines, R., et al., [27] Besnard M., et al., [21] | Case report Case report | Brazil French Polynesia | Two newborns at 36 and 38 weeks’ gestation with microcephaly who died within 20 h of birth; 1 displayed a maculopapular rash on the 4th day after delivery and thrombocytopenia had severe hypotrophy. | aNR | Limited information on presentations at birth |
Other tests | McCarthy M., [21] Ventura C.V., et al., [22] Ventura C.V., et al., [38] Sarno M., et al., [35] Villamil-Gómez W.E., et al., [24] Reyna-Villasmil E., et al., [23] Mlakar J., et al., [36] Calvet G., et al., [32] Brasil Martines R., et al., [27] Brazil P., et al., 2016 [33] de Paulas Freitas B., et al., 2016 [28] | Retrospective cohort Case series Case series Case report Case report Case report Case report Case series Case series Prospective cohort Case series | Brazil Brazil Brazil Brazil Colombia Venezuela Brazil Brazil Brazil Brazil Brazil | Negative serology for toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, or HIV, HTLV, HSV 1 &2, Rheumatoid fever, HBV, VDRL, EBV. Tests for dengue virus, chikungunya virus, toxoplasmosis, rubella virus, cytomegalovirus, Treponema pallidum and parvovirus B19, syphilis. | Ventura, C.V., et al., [33] had positive IgG and negative IgM ELISA results for toxoplasmosis, rubella virus and cytomegalovirus Villamil-Gómez, W.E., et al., [23] reported one positive (isolating Escherichia coli) trichomonas trophozoites and three positives for Toxoplasma IgG and one for rubella. Brazil, P., et al., 2016 reported immunity to rubella and cytomegalovirus Besnard, M., et al., [20] reported dengue negative test results. | - For studies which reported on the presence of coinfections, potential synergy due to the presence of immunity and/or seropositivity to other viruses could not be ascertained - The effect of coinfections on disease course, consequent maternal, fetal and neonatal outcomes is unknown |