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Zika Infection Late in Pregnancy May Impact Fetal Neurologic Development

MAR 03, 2017 | KRISTI ROSA
For their study, Dr. Zorilla and her team selected, “fetuses whose mothers contracted Zika virus infection during pregnancy and showed no prenatal intracranial abnormalities [and] evaluated them prospectively.” Dr. Zorilla stated, “We selected women who had Zika diagnosed during pregnancy because they had symptoms and they had a positive PCR.”

The patients were grouped based on when they got infected in pregnancy. “We chose to include one study [for the prospective research] performed more than 6 weeks after the documented Zika to allow time to identify any impact on growth,” Dr. Zorilla said. The fetuses’ biometric data was then compared to a reference population consisting of “normal fetuses [studied between] 2014 and 2015, prior to the onset of the Zika epidemic in Puerto Rico.”

For the reference population as well as the Zika-affected population, the exclusion criteria included any condition that would cause abnormal fetal growth, including: maternal drug use, uncertain gestational age, multiple gestation, fetal structural abnormalities, documented fetal genetic abnormalities, abnormal placentation, abnormal amniotic fluid volume at the time of examination, and single umbilical artery. In addition, the researchers eliminated any pregnancy that “was affected with Zika where we did not know when it happened. So, women who had Zika but were asymptomatic were not included in analysis.”

A graph depicting the reference population, which included over 2,000 fetuses “that had absolutely normal conditions during pregnancy,” was shown to attendees during the presentation. It also illustrated the “mean for fetal growth” for Puerto Rico (in red) and United States (in blue) fetuses. Dr. Zorilla explained, “As you can see, the Puerto Rico fetuses behave the same as the United States fetuses in terms of Zika [impacted] growth [pertaining to] head circumference.”

A total of 620 fetuses had been referred to their unit for evaluation, and of those, 14 had brain damage (2.3%), 298 (48%) met the exclusion criteria (due to the fact that the researchers were unsure of exactly when the infection happened), and 322 (52%) met the inclusion criteria, meaning that they did not have any brain abnormalities, they knew when infection occurred, and they had Zika-positive PCRs for the women.

The researchers then divided the women into four groups:
Group 1: Women who acquired Zika prior to 7 weeks of gestation: 33 patients
Group 2: Women who acquired Zika between 7 and 14 weeks of gestational age: 85 patients
Group 3: Women who acquired Zika between 14 and 26 gestational age: 170 patients
Group 4: Women who acquired Zika after 26 weeks: 34 patients

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