Relative and attributable risks of neurological and perinatal adverse outcomes among children with and without prenatal Zika virus exposure in Northeast Brazil: A prospective cohort study (2015-2018).

Relative and attributable risks of neurological and perinatal adverse outcomes among children with and without prenatal Zika virus exposure in Northeast Brazil: A prospective cohort study (2015-2018).

<h4>Background</h4>Although there has been substantial progress in the characterization of Congenital Zika Syndrome, the lack of a control group in the majority of published studies on Zika virus (ZIKV) infections during pregnancy limits our understanding of, first, the magnitude by whic...

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Main Authors: Juliana Menezes Soares de Souza Azevedo Fontes, Demócrito de Barros Miranda-Filho, Ulisses Ramos Montarroyos, Thalia Velho Barreto de Araújo, Celina Maria Turchi Martelli, Laura Cunha Rodrigues, Elizabeth Brickley, Maria de Fátima Pessoa Militão de Albuquerque, Wayner Vieira Souza, Liana Maria Vieira de Oliveira Ventura, Camila Vieira de Oliveira Ventura, Adriana Lima Gois, Mariana de Carvalho Leal Gouveia, Danielle Maria da Silva Oliveira, Sophie Helena Eickmann, Maria Durce Costa Gomes Carvalho, Paula Fabiana Sobral da Silva, Maria Ângela Wanderley Rocha, Regina Coeli Ferreira Ramos, Sinval Pinto Brandão-Filho, Marli Tenorio Cordeiro, Luciana Caroline Albuquerque Bezerra, George Santiago Dimech, Sandra Valongueiro Alves, Pedro Pires Ferreira Neto, Priscila Mayrelle da Silva Castanha, Rafael Dhalia, Ernesto Torres de Azevedo Marques, Gabriela Renata Neves Fulco, Maria Valquíria de Medeiros Silva, Ricardo Arraes de Alencar Ximenes, Microcephaly Epidemic Research Group (MERG)
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2025-08-01
Series:PLoS Neglected Tropical Diseases
Online Access:https://doi.org/10.1371/journal.pntd.0013344
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Summary:<h4>Background</h4>Although there has been substantial progress in the characterization of Congenital Zika Syndrome, the lack of a control group in the majority of published studies on Zika virus (ZIKV) infections during pregnancy limits our understanding of, first, the magnitude by which prenatal ZIKV exposure may increase risks of adverse outcomes for offspring and, second, the fraction of abnormalities that are attributable to this exposure.<h4>Methods</h4>To overcome this limitation, this study harmonized and integrated data collected prospectively in Recife, Pernambuco, Brazil, from offspring of ZIKV-exposed women in the Microcephaly Epidemic Research Group (MERG) Pregnant Women Cohort and from offspring of ZIKV-unexposed women in the Zika in Infants and Pregnancy (ZIP) Study. We compared the data to estimate the relative risk (RR) and attributable risk percent (AR%) of: (i) adverse birth outcomes including low birth weight (LBW), prematurity and small for gestational age (SGA) and (ii) developmental abnormalities including microcephaly and neurological, ophthalmological, audiological, and neuroimaging alterations.<h4>Findings</h4>We observed similar odds of adverse birth outcomes and ophthalmological deficits in ZIKV-exposed and unexposed children. However, as compared to ZIKV-unexposed children, ZIKV-exposed children presented with markedly increased risks of microcephaly (RR, 95%-CI: 3.61, 1.70 to 7.63 AR 72%), neurological abnormalities (RR, 95%-CI: 5.64, 3.04 to 10.47.79AR 82%), audiological screening failures (RR, 95%-CI: 9.20, 2.59 to 32.69 AR 89%), and neuroimaging abnormalities (RR, 95%-CI: 22.06, 2.90 to 167.5; AR 95%). The risk of having concurrent abnormalities was lower than the risk of having just one abnormality. Our results provide new insights into the relative and attributable risks related to prenatal ZIKV exposure and demonstrate that, overall, the risks of congenital abnormalities are elevated among children exposed to ZIKV during pregnancy compared to their ZIKV-unexposed peers.
ISSN:1935-2727
1935-2735

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