IDE, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK.
Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
BMJ Open. 2019 Jul 24;9(7):e023529. doi: 10.1136/bmjopen-2018-023529.
Dengue is the most common viral mosquito-borne disease, and women of reproductive age who live in or travel to endemic areas are at risk. Little is known about the effects of dengue during pregnancy on birth outcomes. The objective of this study is to examine the effect of maternal dengue severity on live birth outcomes.
We conducted a population-based cohort study using routinely collected Brazilian data from 2006 to 2012.
We linked birth registration records and dengue registration records to identify women with and without dengue during pregnancy. Using multinomial logistic regression and Firth method, we estimated risk and ORs for preterm birth (<37 weeks' gestation), low birth weight (<2500 g) and small for gestational age (<10thcentile). We also investigated the effect of time between the onset of the disease and each outcome.
We included 16 738 000 live births. Dengue haemorrhagic fever was associated with preterm birth (OR=2.4; 95% CI 1.3 to 4.4) and low birth weight (OR=2.1; 95% CI 1.1 to 4.0), but there was no evidence of effect for small for gestational age (OR=2.1; 95% CI 0.4 to 12.2). The magnitude of the effects was higher in the acute disease period.
This study showed an increased risk of adverse birth outcomes in women with severe dengue during pregnancy. Medical intervention to mitigate maternal risk during severe acute dengue episodes may improve outcomes for infants born to exposed mothers.
登革热是最常见的病毒性蚊媒疾病，处于生育年龄且居住或前往流行地区的女性存在患病风险。人们对妊娠期间登革热对分娩结局的影响知之甚少。本研究旨在探讨母亲登革热严重程度对活产结局的影响。
我们进行了一项基于人群的队列研究，使用了 2006 年至 2012 年巴西常规收集的数据。
我们将出生登记记录和登革热登记记录联系起来，以确定妊娠期间患有和未患有登革热的女性。我们使用多项逻辑回归和 Firth 方法，估计早产（<37 周妊娠）、低出生体重（<2500 克）和小于胎龄儿（<第 10 百分位数）的风险和比值比。我们还研究了疾病发作与每个结局之间的时间间隔的影响。
我们纳入了 16738000 例活产儿。登革出血热与早产（比值比[OR]=2.4；95%可信区间[CI]：1.3 至 4.4）和低出生体重（OR=2.1；95%CI：1.1 至 4.0）相关，但与小于胎龄儿无关联（OR=2.1；95%CI：0.4 至 12.2）。疾病急性期的效应幅度更高。
本研究显示，妊娠期间患有严重登革热的女性不良分娩结局的风险增加。在严重急性登革热发作期间进行医疗干预以降低母亲的风险，可能会改善暴露于登革热的母亲所生婴儿的结局。
