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Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy.
JAMA. 2017 01 03; 317(1):59-68.JAMA

Abstract

Importance

Understanding the risk of birth defects associated with Zika virus infection during pregnancy may help guide communication, prevention, and planning efforts. In the absence of Zika virus, microcephaly occurs in approximately 7 per 10 000 live births.

Objective

To estimate the preliminary proportion of fetuses or infants with birth defects after maternal Zika virus infection by trimester of infection and maternal symptoms.

Design, Setting, and Participants

Completed pregnancies with maternal, fetal, or infant laboratory evidence of possible recent Zika virus infection and outcomes reported in the continental United States and Hawaii from January 15 to September 22, 2016, in the US Zika Pregnancy Registry, a collaboration between the CDC and state and local health departments.

Exposures

Laboratory evidence of possible recent Zika virus infection in a maternal, placental, fetal, or infant sample.

Main Outcomes and Measures

Birth defects potentially Zika associated: brain abnormalities with or without microcephaly, neural tube defects and other early brain malformations, eye abnormalities, and other central nervous system consequences.

Results

Among 442 completed pregnancies in women (median age, 28 years; range, 15-50 years) with laboratory evidence of possible recent Zika virus infection, birth defects potentially related to Zika virus were identified in 26 (6%; 95% CI, 4%-8%) fetuses or infants. There were 21 infants with birth defects among 395 live births and 5 fetuses with birth defects among 47 pregnancy losses. Birth defects were reported for 16 of 271 (6%; 95% CI, 4%-9%) pregnant asymptomatic women and 10 of 167 (6%; 95% CI, 3%-11%) symptomatic pregnant women. Of the 26 affected fetuses or infants, 4 had microcephaly and no reported neuroimaging, 14 had microcephaly and brain abnormalities, and 4 had brain abnormalities without microcephaly; reported brain abnormalities included intracranial calcifications, corpus callosum abnormalities, abnormal cortical formation, cerebral atrophy, ventriculomegaly, hydrocephaly, and cerebellar abnormalities. Infants with microcephaly (18/442) represent 4% of completed pregnancies. Birth defects were reported in 9 of 85 (11%; 95% CI, 6%-19%) completed pregnancies with maternal symptoms or exposure exclusively in the first trimester (or first trimester and periconceptional period), with no reports of birth defects among fetuses or infants with prenatal exposure to Zika virus infection only in the second or third trimesters.

Conclusions and Relevance

Among pregnant women in the United States with completed pregnancies and laboratory evidence of possible recent Zika infection, 6% of fetuses or infants had evidence of Zika-associated birth defects, primarily brain abnormalities and microcephaly, whereas among women with first-trimester Zika infection, 11% of fetuses or infants had evidence of Zika-associated birth defects. These findings support the importance of screening pregnant women for Zika virus exposure.

Authors+Show Affiliations

Centers for Disease Control and Prevention, Atlanta, Georgia.Centers for Disease Control and Prevention, Atlanta, Georgia.Centers for Disease Control and Prevention, Atlanta, Georgia.Centers for Disease Control and Prevention, Atlanta, Georgia.New York City Department of Health and Mental Hygiene, Queens, New York.Massachusetts Department of Public Health, Boston.New York State Department of Health, Albany.Virginia Department of Health, Richmond.Texas Department of State Health Services, Austin.Florida Department of Health, Tallahassee.Centers for Disease Control and Prevention, Atlanta, Georgia.Centers for Disease Control and Prevention, Atlanta, Georgia.Centers for Disease Control and Prevention, Atlanta, Georgia.New York City Department of Health and Mental Hygiene, Queens, New York.Massachusetts Department of Public Health, Boston.New York State Department of Health, Albany.Virginia Department of Health, Richmond.Florida Department of Health, Tallahassee.New York City Department of Health and Mental Hygiene, Queens, New York.New York State Department of Health, Albany.Centers for Disease Control and Prevention, Atlanta, Georgia.Centers for Disease Control and Prevention, Atlanta, Georgia.Centers for Disease Control and Prevention, Atlanta, Georgia.Centers for Disease Control and Prevention, Atlanta, Georgia.Centers for Disease Control and Prevention, Atlanta, Georgia.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27960197

Citation

Honein, Margaret A., et al. "Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy." JAMA, vol. 317, no. 1, 2017, pp. 59-68.
Honein MA, Dawson AL, Petersen EE, et al. Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy. JAMA. 2017;317(1):59-68.
Honein, M. A., Dawson, A. L., Petersen, E. E., Jones, A. M., Lee, E. H., Yazdy, M. M., Ahmad, N., Macdonald, J., Evert, N., Bingham, A., Ellington, S. R., Shapiro-Mendoza, C. K., Oduyebo, T., Fine, A. D., Brown, C. M., Sommer, J. N., Gupta, J., Cavicchia, P., Slavinski, S., ... Jamieson, D. J. (2017). Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy. JAMA, 317(1), 59-68. https://doi.org/10.1001/jama.2016.19006
Honein MA, et al. Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy. JAMA. 2017 01 3;317(1):59-68. PubMed PMID: 27960197.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy. AU - Honein,Margaret A, AU - Dawson,April L, AU - Petersen,Emily E, AU - Jones,Abbey M, AU - Lee,Ellen H, AU - Yazdy,Mahsa M, AU - Ahmad,Nina, AU - Macdonald,Jennifer, AU - Evert,Nicole, AU - Bingham,Andrea, AU - Ellington,Sascha R, AU - Shapiro-Mendoza,Carrie K, AU - Oduyebo,Titilope, AU - Fine,Anne D, AU - Brown,Catherine M, AU - Sommer,Jamie N, AU - Gupta,Jyoti, AU - Cavicchia,Philip, AU - Slavinski,Sally, AU - White,Jennifer L, AU - Owen,S Michele, AU - Petersen,Lyle R, AU - Boyle,Coleen, AU - Meaney-Delman,Dana, AU - Jamieson,Denise J, AU - ,, PY - 2016/12/14/pubmed PY - 2017/2/10/medline PY - 2016/12/14/entrez SP - 59 EP - 68 JF - JAMA JO - JAMA VL - 317 IS - 1 N2 - Importance: Understanding the risk of birth defects associated with Zika virus infection during pregnancy may help guide communication, prevention, and planning efforts. In the absence of Zika virus, microcephaly occurs in approximately 7 per 10 000 live births. Objective: To estimate the preliminary proportion of fetuses or infants with birth defects after maternal Zika virus infection by trimester of infection and maternal symptoms. Design, Setting, and Participants: Completed pregnancies with maternal, fetal, or infant laboratory evidence of possible recent Zika virus infection and outcomes reported in the continental United States and Hawaii from January 15 to September 22, 2016, in the US Zika Pregnancy Registry, a collaboration between the CDC and state and local health departments. Exposures: Laboratory evidence of possible recent Zika virus infection in a maternal, placental, fetal, or infant sample. Main Outcomes and Measures: Birth defects potentially Zika associated: brain abnormalities with or without microcephaly, neural tube defects and other early brain malformations, eye abnormalities, and other central nervous system consequences. Results: Among 442 completed pregnancies in women (median age, 28 years; range, 15-50 years) with laboratory evidence of possible recent Zika virus infection, birth defects potentially related to Zika virus were identified in 26 (6%; 95% CI, 4%-8%) fetuses or infants. There were 21 infants with birth defects among 395 live births and 5 fetuses with birth defects among 47 pregnancy losses. Birth defects were reported for 16 of 271 (6%; 95% CI, 4%-9%) pregnant asymptomatic women and 10 of 167 (6%; 95% CI, 3%-11%) symptomatic pregnant women. Of the 26 affected fetuses or infants, 4 had microcephaly and no reported neuroimaging, 14 had microcephaly and brain abnormalities, and 4 had brain abnormalities without microcephaly; reported brain abnormalities included intracranial calcifications, corpus callosum abnormalities, abnormal cortical formation, cerebral atrophy, ventriculomegaly, hydrocephaly, and cerebellar abnormalities. Infants with microcephaly (18/442) represent 4% of completed pregnancies. Birth defects were reported in 9 of 85 (11%; 95% CI, 6%-19%) completed pregnancies with maternal symptoms or exposure exclusively in the first trimester (or first trimester and periconceptional period), with no reports of birth defects among fetuses or infants with prenatal exposure to Zika virus infection only in the second or third trimesters. Conclusions and Relevance: Among pregnant women in the United States with completed pregnancies and laboratory evidence of possible recent Zika infection, 6% of fetuses or infants had evidence of Zika-associated birth defects, primarily brain abnormalities and microcephaly, whereas among women with first-trimester Zika infection, 11% of fetuses or infants had evidence of Zika-associated birth defects. These findings support the importance of screening pregnant women for Zika virus exposure. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/27960197/Birth_Defects_Among_Fetuses_and_Infants_of_US_Women_With_Evidence_of_Possible_Zika_Virus_Infection_During_Pregnancy_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.19006 DB - PRIME DP - Unbound Medicine ER -