ArticlesSymptomatic dengue infection during pregnancy and livebirth outcomes in Brazil, 2007–13: a retrospective observational cohort study
Introduction
Dengue is the most important arboviral disease in the world because of its morbidity, mortality, and economic burden.1, 2 The virus is transmitted by Aedes spp mosquitoes and all four serotypes of the virus can cause symptomatic infections ranging from dengue fever to severe dengue, which can lead to death.3
In Brazil, the disease has become a major public health challenge, with 9 million probable cases, over 5200 deaths from 2002 to 2015, and an increase in the number of cases in children younger than 2 years, people older than 60 years, and pregnant women.4, 5, 6 Thus, it is important to monitor outbreaks of dengue to understand any new or unexpected outcomes associated with the disease. However, despite the hyperendemic transmission of dengue, only a few studies have investigated the association of symptomatic dengue infection during pregnancy with adverse fetal outcomes. They have shown no association with fetal outcomes or with premature birth and low birthweight. However, these studies had small sample sizes (n=202 for all studies combined).7, 8, 9 To our knowledge, no national or large investigations have been done to date.
The use of infectious disease surveillance data allows for a quick and comprehensive investigation of some uncertainties regarding this disease.10 Dengue fever has been a mandatorily notifiable disease in Brazil since 1986.11 The dengue surveillance system relies on passive reporting of outpatients and those admitted to or treated in hospital with the use of standardised forms. Livebirths are also systematically registered in Brazil, including data on birth outcomes.12 In this study, we used the well established national information systems in Brazil to assess the effect of symptomatic dengue infection during pregnancy on these birth outcomes, before the introduction of chikungunya and Zika viruses to this country.
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Study design
We did a retrospective observational cohort study that was based on probabilistic record linkage between the national reportable disease information system (SINAN) and the livebirth information system (SINASC) databases in Brazil. SINAN collects information on a comprehensive set of communicable diseases, including dengue, whereas SINASC collects information on livebirth characteristics, including prenatal care and neonatal health. We restricted our study to data from 2007 to 2013, when a
Results
Among the 56 817 reported cases of dengue in pregnant women during the study period, 11 382 had laboratory-confirmed dengue (11 190 confirmed by IgM ELISA test, 133 by virus isolation, and 59 by RT-PCR) and 9351 had a negative serological test. The rest of the reported cases were excluded owing to the absence of a laboratory test. 885 records from SINAN and 1559 from SINASC were excluded because of duplication or inconsistencies. 4025 dengue-positive women were linked to livebirths, and 127
Discussion
We did a retrospective cohort study to investigate the association between reported symptomatic dengue infections during pregnancy and subsequent birth outcomes in women in Brazil. The unadjusted risk of premature birth in the dengue-positive group during the second trimester and across all trimesters aggregated was lower than that in the dengue-negative group. However, after adjustment for confounders, the risk of premature birth was higher in the dengue-positive group than in the
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2019, Infectious Disease Clinics of North AmericaDengue vaccination during pregnancy – An overview of clinical trials data
2018, VaccineCitation Excerpt :The largest study included in the analysis was a retrospective cohort study showing increased risk of preterm birth and low birth weight in infants born to women with symptomatic dengue infection during pregnancy in French Guiana [35]. A more recent retrospective cohort study based on two Brazilian national information system databases (2007–2013) found the risk of preterm birth to be higher in women with symptomatic dengue during pregnancy, with no association observed for low birth weight or congenital malformation [36]; while a smaller study based on 2008 data from Rio de Janeiro again supported a potential association between maternal disease specifically in the final period of gestation and adverse pregnancy outcomes (prematurity and low birth weight) [37]. Among the pregnancies (exposed or non-exposed) reported in the current analysis, there were no reported cases of concurrent dengue infection leading to hospitalisation or severe disease, probably due to the generally infrequent occurrence of severe dengue or dengue-related hospitalisation and the limited number of pregnancies reported.
Symptomatic dengue infection during pregnancy and the risk of stillbirth in Brazil, 2006–12: a matched case-control study
2017, The Lancet Infectious DiseasesCitation Excerpt :These studies could be done with a much smaller number of patients than was used here. According to a systematic review11 of studies of small sample size,11 a comment by Carles,30 and a study of similar Brazilian data,31 dengue infection during pregnancy is associated with adverse fetal outcomes, and severe forms of the disease carry a higher risk than less severe forms. This finding was supported by our study, in which the risk of stillbirth among women who had severe forms of dengue was almost three times that of those with mild disease.
Dengue virus infection during pregnancy increased the risk of adverse fetal outcomes? An updated meta-analysis
2017, Journal of Clinical VirologyCitation Excerpt :Table 2). Ten studies [17,23,25–30,33,34], including three prospective cohort studies and seven retrospective cohort studies, with a total of 358443 participants, reported the impact of DENV infection on risk of low birth weight. The pooled result suggested that there was no positive association between DENV infection and low birth weight (RR = 0.99, 95% CI: 0.87–1.12, I2 = 35.1%) (Fig. 3).