Zika virus infection in pregnancy: a systematic review of disease course and complications

OBJECTIVES: To characterize maternal Zika virus (ZIKV) infection\n and complement the evidence base for the WHO interim guidance on\n pregnancy management in the context of ZIKV infection. METHODS:\n We searched the relevant database from inception until March\n 2016. Two review authors independently screened and assessed\n full texts of eligible reports and extracted data from relevant\n studies. The quality of studies was assessed using the\n Newcastle-Ottawa Scale (NOS) and the National Institute of\n Health (NIH) tool for observational studies and case\n series/reports, respectively. RESULTS: Among 142 eligible\n full-text articles, 18 met the inclusion criteria (13 case\n series/reports and five cohort studies). Common symptoms among\n pregnant women with suspected/confirmed ZIKV infection were\n fever, rash, and arthralgia. One case of Guillain-Barre syndrome\n was reported among ZIKV-infected mothers, no other case of\n severe maternal morbidity or mortality reported. Complications\n reported in association with maternal ZIKV infection included a\n broad range of fetal and newborn neurological and ocular\n abnormalities; fetal growth restriction, stillbirth, and\n perinatal death. Microcephaly was the primary neurological\n complication reported in eight studies, with an incidence of\n about 1% among newborns of ZIKV infected women in one study.\n CONCLUSION: Given the extensive and variable fetal and newborn\n presentations/complications associated with prenatal ZIKV\n infection, and the dearth of information provided, knowledge\n gaps are evident. Further research and comprehensive reporting\n may provide a better understanding of ZIKV infection in\n pregnancy and attendant maternal/fetal complications. This\n knowledge could inform the creation of effective and\n evidence-based strategies, guidelines and recommendations aimed\n at the management of maternal ZIKV infection. Adherence to\n current best practice guidelines for prenatal care among health\n providers is encouraged, in the context of maternal ZIKV\n infection.