CLÍNICA E EPIDEMIOLOGIA DE GESTANTES E NASCIDOS VIVOS EXPOSTOS E POTENCIALMENTE EXPOSTOS AO ZIKA VÍRUS DURANTE A GESTAÇÃO, MATO GROSSO DO SUL, 2015- 2018.

Abstract

ZIKV infection during pregnancy had unexpected consequences for fetuses and live births. Congenital ZIKV syndrome (SCZ) is a consequence of direct neurological damage caused by the replication of ZIKV in neuronal progenitor cells. This study aimed to describe the clinical and epidemiological profile of pregnant women and live births infected with ZIKV, during pregnancy, in Mato Grosso do Sul, from 2015 to 2018. This is an observational study that had the public- target pregnant women with confirmed ZIKV infection and children exposed and potentially exposed to ZIKV during pregnancy. To meet the specific objectives, three methodological approaches were developed: (1) a cross-sectional descriptive study to describe the congenital anomalies diagnosed at birth; (2) longitudinal descriptive study, to describe confirmed and potential cases of SCZ; and (3) a retrospective cohort study, which evaluated ZIKV infection during pregnancy, as an exposure and, consequently, a risk factor for the occurrence of immediate and late adverse outcomes. Results from the three studies show that, in the state of Mato Grosso do Sul, during the period of the ZIKV epidemic, 1,473 children were born with congenital anomalies, classified into 74 types. An increase in the incidence of central nervous system anomalies was observed, which accompanied the increase in the incidence of ZIKV fever cases. 11 children were diagnosed with SCZ, among these, 64% were diagnosed with epilepsy and in 57% there was no adequate pharmacological control of seizures. In the cohort study, 155 pregnancies were evaluated (mother-child binomial), 78 in the exposed group and 77 in the control group. 45 children (33 exposed and 12 control) had some type of adverse birth outcome. The risk for adverse outcomes in children in the exposed group was almost three times (RR 2.7, 95% CI 1.5–4.9; p-value <0.001) when compared to the control group. The risk for motor delay was 6.9 times that observed in the control group (RR 6.9; 95% CI 1.6–29.3; p-value=0.01). The risk for cognitive delay was four times (RR 4.1; 95% CI 1.6–10.4; p-value < 0.001) that observed in the control group. In 67% of pregnancies in which the infection occurred in the first trimester, at least one type of adverse finding was identified in the child, with an 8-fold chance (OR 8.0; 95% CI 1.6–37.9) when compared to children born to women who had the infection in the third trimester. The study allowed estimating the incidence of congenital anomalies during the ZIKV epidemic; describe the follow-up of children with SCZ through clinical assessments; estimating the risk for immediate and late outcomes, as well as estimating the risk for each trimester of pregnancy according to maternal infection. It is hoped that the results of this study may contribute to the elucidation of the consequences of Zika infection during pregnancy and that it will draw attention to the follow-up of children exposed or potentially exposed to ZIKV during pregnancy, even if they do not present structural defects at birth.