Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil.
Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil.
Lancet Infect Dis. 2017 Sep;17(9):949-956. doi: 10.1016/S1473-3099(17)30169-X. Epub 2017 May 18.
Dengue is a major public health challenge in Brazil. We assessed the relationship between symptomatic dengue infection during pregnancy and adverse birth outcomes in the country between 2007 and 2013.
We did a retrospective observational cohort study using information reported in the Brazilian national reportable disease information system (SINAN) and the livebirth information system (SINASC) databases. We probabilistically linked confirmed dengue-positive and dengue-negative pregnancies with live childbirths using Fine-Grained Record Integration and Linkage (FRIL) software. We also included an external reference population of randomly selected newborn babies. Pregnancy was adopted as the unit of analysis. We assessed the relationship between symptomatic dengue infection during pregnancy and adverse birth outcomes, using multivariable logistic regression adjusted for relevant covariates.
3898 dengue-positive pregnant women, 3165 dengue-negative women, and 3898 newborn babies from the reference population were included in the analysis. Preterm birth occurred in 322 (8·4%) of 3821 cases in the dengue-positive group versus 324 (10·4%) of 3101 in the dengue-negative group (unadjusted analysis: relative risk [RR] 0·81, 95% CI 0·70-0·93; adjusted analysis: odds ratio [OR] 1·26, 95% CI 1·06-1·49, p=0·006) and 349 (9·1%) of 3818 in the reference population (RR 0·92, 0·80-1·07; OR 0·98, 0·83-1·16, p=0·84). The prevalence of low birthweight (<2500 g) was similar for dengue-positive women and dengue-negative women (8·3% [322 of 3897] vs 9·8% [310 of 3163]; OR 1·17, 95% CI 0·99-1·39, p=0·07), and in the reference population (8·3% vs 9·0% [350 of 3895]; OR 1·00, 0·85-1·17, p=0·97). The prevalence of malformations did not differ significantly for the dengue-positive group (27 [0·7%] of 3789) versus the dengue-negative group (27 [0·9%] of 3059, p=0·51) or versus the reference population (32 [0·9%] of 3738, p=0·56).
In the adjusted analysis, the risk of preterm birth seems to be increased in women with symptomatic dengue infection during pregnancy. However, symptomatic dengue infection during pregnancy does not appear to be associated with congenital malformations or low birthweight.
Sanofi Pasteur.
登革热是巴西的一个主要公共卫生挑战。我们评估了 2007 年至 2013 年期间该国孕妇出现有症状的登革热感染与不良出生结局之间的关系。
我们使用巴西国家报告疾病信息系统（SINAN）和活产信息系统（SINASC）数据库中的信息进行了回顾性观察性队列研究。我们使用 Fine-Grained Record Integration and Linkage（FRIL）软件对确诊的登革热阳性和登革热阴性妊娠与活产儿进行了概率性链接。我们还纳入了随机选择的新生儿外部参考人群。将妊娠作为分析单位。我们使用多变量逻辑回归调整了相关协变量，评估了孕妇出现有症状的登革热感染与不良出生结局之间的关系。
在分析中纳入了 3898 名登革热阳性孕妇、3165 名登革热阴性孕妇和 3898 名来自参考人群的新生儿。在登革热阳性组的 3821 例中，早产发生 322 例（8.4%），而在登革热阴性组的 3101 例中，早产发生 324 例（10.4%）（未调整分析：相对风险[RR]0.81，95%CI0.70-0.93；调整分析：比值比[OR]1.26，95%CI1.06-1.49，p=0.006），而在参考人群的 3818 例中，早产发生 349 例（9.1%）（RR0.92，0.80-1.07；OR0.98，0.83-1.16，p=0.84）。登革热阳性孕妇和登革热阴性孕妇的低出生体重（<2500g）发生率相似（8.3%[322 例/3897 例]vs 9.8%[310 例/3163 例]；OR1.17，95%CI0.99-1.39，p=0.07），而在参考人群中（8.3%vs 9.0%[350 例/3895 例]；OR1.00，0.85-1.17，p=0.97）。登革热阳性组（3789 例中有 27 例[0.7%]）和登革热阴性组（3059 例中有 27 例[0.9%]）或与参考人群（3738 例中有 32 例[0.9%]）的先天畸形发生率无显著差异（p=0.51）。
在调整分析中，有症状的登革热感染似乎会增加孕妇发生早产的风险。然而，孕妇出现有症状的登革热感染似乎与先天性畸形或低出生体重无关。
赛诺菲巴斯德。
