15 Mar Zika Birth Defects More Severe When Mothers Infected During First Trimester
MedicalResearch.com Interview with:
Professor Bruno Hoen, M.D., Ph.D
Dept of Infectious Diseases, Dermatology, and Internal Medicine
University Medical Center of Guadeloupe
MedicalResearch.com: What is the background for this study?
Response: Zika virus (ZIKV) infection during pregnancy has been identified only recently to cause severe birth defects, including microcephaly, other brain defects, and the congenital Zika syndrome. However, the magnitude of this risk was not clearly defined, with discrepancies between observational data from Brazil and the U.S. Zika Pregnancy Registry. We implemented a cohort study of pregnant women who have been exposed to ZIKV throughout the outbreak that hit the Caribbean in 2016.
MedicalResearch.com: What are the main findings?
Response: Using a sensitive case definition, neurologic and ocular defects possibly associated with ZIKV infection were seen in 7% of fetuses and infants (95% confidence interval, 5.0 to 9.5). Using more specific definitions, microcephaly (defined as head circumference more than 2 SD below the mean for sex and gestational age) was detected in 5.8% of fetuses and infants and severe microcephaly (defined as head circumference more than 3 SD below the mean for sex and gestational age) in 1.6% of fetuses and infants. Whichever endpoint was considered (neurologic and ocular defects, microcephaly,
Zika congenital syndrome abnormalities were more common when ZIKV infection occurred during the first trimester than when it occurred during the second or third trimester of pregnancy.
MedicalResearch.com: What should readers take away from your report?
Response: ZIKV should definitely be added to the list of infectious agents that can cause severe birth defects, as are rubella virus, cytomegalovirus, and others. Although defects, and especially the most severe ones, occurred more frequently in fetuses and infants whose mothers had been infected early in pregnancy, some abnormalities were observed in neonates whose mothers had been infected with ZIKV during the third trimeester.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Some brain abnormalities may have been missed among babies whose mothers had confirmed infection, because not all fetuses or infants underwent the recommended brain imaging. Continued efforts are needed to increase the proportion of infants who receive thorough evaluation, which is currently ongoing within infant cohorts in the French Territories in America.
Pregnancy Outcomes after ZIKV Infection in French Territories in the Americas
Bruno Hoen, M.D., Ph.D., Bruno Schaub, M.D., Anna L. Funk, M.Sc., Vanessa Ardillon, M.D., Manon Boullard, M.Sc., André Cabié, M.D., Ph.D., Caroline Callier, M.Sc., Gabriel Carles, M.D., Sylvie Cassadou, M.D., Raymond Césaire, M.D., Ph.D., Maylis Douine, M.D., Ph.D., Cécile Herrmann-Storck, M.D., et al
N Engl J Med 2018; 378:985-994
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