Pregnancy Outcomes after ZIKV Infection in French Territories in the Americas
2 CIC - Antilles Guyane - Centre d'investigation clinique Antilles-Guyane
3 UAG - Université des Antilles et de la Guyane
4 MFME [Fort de France] - Maison de la Femme de la Mère et de l'Enfant [CHU de la Martinique]
5 Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology
6 Santé publique France - French National Public Health Agency [Saint-Maurice, France]
7 CHOG - Centre Hospitalier de l'Ouest Guyanais Franck Joly [Saint-Laurent-du-Maroni, Guyane Française]
8 CHU de Martinique - Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique]
9 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
10 UAG UFR SM - Université des Antilles et de la Guyane - UFR des sciences médicales
11 Institut Pasteur de la Guyane
12 MAITC EA 4537 - Maladies infectieuses et tropicales dans la Caraïbe
13 CH Saint-Martin - Centre Hospitalier Louis Constant Fleming [Saint-Martin]
14 Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française]
15 CGH - Center for Global Health Research and Education - Centre pour la Recherche et la Formation en Santé Mondiale
16 Cnam - Conservatoire National des Arts et Métiers [Cnam]
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Résumé
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 .).

