Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy
Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy
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DOI：
10.1001/jama.2016.19006
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发表时间：
2017-01-03
影响因子：
120.7
通讯作者：
Jamieson, Denise J.
中科院分区：
文献类型：
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作者：
Honein, Margaret A.;Dawson, April L.;Jamieson, Denise J.
了解妊娠期间寨卡病毒感染相关的出生缺陷风险可能有助于指导沟通、预防和规划工作。在没有寨卡病毒的情况下，每10000名活产婴儿中约有7名发生小头畸形。目的通过感染的三个月和母体症状估计母体寨卡病毒感染后胎儿或婴儿出生缺陷的初步比例。设计，设置和参与者2016年1月15日至9月22日在美国大陆和夏威夷报告的可能近期寨卡病毒感染和结局的婴儿实验室证据，在美国寨卡妊娠登记处，这是CDC与州和地方卫生部门之间的合作。暴露在母体、胎盘、胎儿或婴儿样本中可能最近感染寨卡病毒的实验室证据。主要结果和指标可能与寨卡相关的出生缺陷：有或没有小头畸形的脑异常，神经管缺陷和其他早期脑畸形，眼异常，结果在442例已完成妊娠的妇女中，（中位年龄，28岁;范围，15-50岁），有实验室证据表明可能最近感染寨卡病毒，26例中发现了可能与寨卡病毒相关的出生缺陷。（6%; 95% CI，4%-8%）胎儿或婴儿。395例活产儿中有21例出生缺陷儿，47例妊娠丢失儿中有5例出生缺陷儿。271例无症状孕妇中有16例（6%; 95% CI，4%-9%）报告了出生缺陷，167例有症状孕妇中有10例（6%; 95% CI，3%-11%）报告了出生缺陷。在26只受影响的胎仔或婴儿中，4只患有小头畸形，未报告神经影像学检查，14只患有小头畸形和脑异常，4只患有脑异常，但无小头畸形;报告的脑异常包括颅内钙化、胼胝体异常、皮质形成异常、脑萎缩、脑室扩大、脑积水和小脑异常。患有小头畸形的婴儿（18/442）占完成妊娠的4%。85例中有9例报告有出生缺陷（11%; 95% CI，6%-19%）仅在妊娠早期出现母体症状或暴露的已完成妊娠（或孕早期和妊娠期），没有关于产前暴露于寨卡病毒感染的胎儿或婴儿仅在妊娠中期或晚期出现出生缺陷的报告。在完成妊娠和实验室证据表明可能最近感染寨卡病毒的情况下，6%的胎儿或婴儿有寨卡相关出生缺陷的证据，主要是大脑异常和小头畸形，而在妊娠早期感染寨卡病毒的妇女中，11%的胎儿或婴儿有寨卡相关出生缺陷的证据。这些发现支持了筛查孕妇暴露于寨卡病毒的重要性。
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.