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Pregnancy Outcomes after ZIKV Infection in French Territories in the Americas

Bruno Hoen 1, 2, 3 Bruno Schaub 4 Anna L Funk 5 Vanessa Ardillon 6 Manon Boullard 2 André Cabié 2 Caroline Callier 2 Gabriel Carles 7 Sylvie Cassadou 6 Raymond Césaire 8 Maylis Douine 2 Cécile Herrmann-Storck 1 Philippe Kadhel 1 Cédric Laouénan 9 Yoann Madec 5 Alice Monthieux 10 Mathieu Nacher 2 Fatiha Najioullah 8 Dominique Rousset 11 Catherine Ryan 1 Kinda Schepers 12 Sofia Stegmann-Planchard 13 Benoît Tressières 2 Jean-Luc Voluménie 4 Samson Yassinguezo 14 Eustase Janky 1 Arnaud Fontanet 5, 15, 16
Abstract : BACKGROUND: The risk of congenital neurologic defects related to Zika virus (ZIKV) infection has ranged from 6 to 42% in various reports. The aim of this study was to estimate this risk among pregnant women with symptomatic ZIKV infection in French territories in the Americas. METHODS: From March 2016 through November 2016, we enrolled in this prospective cohort study pregnant women with symptomatic ZIKV infection that was confirmed by polymerase-chain-reaction (PCR) assay. The analysis included all data collected up to April 27, 2017, the date of the last delivery in the cohort. RESULTS: Among the 555 fetuses and infants in the 546 pregnancies included in the analysis, 28 (5.0%) were not carried to term or were stillborn, and 527 were born alive. Neurologic and ocular defects possibly associated with ZIKV infection were seen in 39 fetuses and infants (7.0%; 95% confidence interval, 5.0 to 9.5); of these, 10 were not carried to term because of termination of pregnancy for medical reasons, 1 was stillborn, and 28 were live-born. Microcephaly (defined as head circumference more than 2 SD below the mean for sex and gestational age) was detected in 32 fetuses and infants (5.8%), of whom 9 (1.6%) had severe microcephaly (more than 3 SD below the mean). Neurologic and ocular defects were more common when ZIKV infection occurred during the first trimester (24 of 189 fetuses and infants [12.7%]) than when it occurred during the second trimester (9 of 252 [3.6%]) or third trimester (6 of 114 [5.3%]) (P=0.001). CONCLUSIONS: Among pregnant women with symptomatic, PCR-confirmed ZIKV infection, birth defects possibly associated with ZIKV infection were present in 7% of fetuses and infants. Defects occurred more frequently in fetuses and infants whose mothers had been infected early in pregnancy. Longer-term follow-up of infants is required to assess any manifestations not detected at birth. (Funded by the French Ministry of Health and others; ClinicalTrials.gov number, NCT02916732 .).
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Submitted on : Monday, April 16, 2018 - 2:33:21 PM
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Bruno Hoen, Bruno Schaub, Anna L Funk, Vanessa Ardillon, Manon Boullard, et al.. Pregnancy Outcomes after ZIKV Infection in French Territories in the Americas. New England Journal of Medicine, Massachusetts Medical Society, 2018, 378 (11), pp.985-994. ⟨10.1056/NEJMoa1709481⟩. ⟨hal-01744446⟩

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