Melo Natália de L, Sousa Danilo F de, Laporta Gabriel Z
Graduate Research and Innovation Program, Centro Universitario FMABC, Santo André 09060-870, Brazil.
College of Medicine, Estacio University, Juazeiro 48924-999, Brazil.
Trop Med Infect Dis. 2022 Sep 24;7(10):261. doi: 10.3390/tropicalmed7100261.
Congenital microcephaly is caused by a multitude of drivers affecting maternal−fetal health during pregnancy. It is a rare outcome in high-income industrial countries where microcephaly rates are in the range of 0.3−0.9 per 1000 newborns. Prevalence of microcephaly varies considerably across developing countries and can go as high as 58 cases per 1000 live births in pregnancies exposed to infection by Zika virus (ZIKV). Not only ZIKV-infected pregnancies, but other drivers can modulate the occurrence and severity of this outcome. Here, we sought to test the ZIKV−microcephaly association vs. competing hypotheses using a meta-analysis with 8341 microcephaly cases pooled from 10,250,994 newborns in the Americas, Africa, and Asia. Analysis of risk ratios (RR) showed teratogens the most likely microcephaly-associated risk factor (RR = 3.43; 95%-CI 2.69−4.38; p-value < 0.0001), while the statistical significance of the ZIKV−microcephaly association was marginal (RR = 2.12; 95%-CI 1.01−4.48; p-value = 0.048). Other congenital infections showed strong but variable associations with microcephaly (RR = 15.24; 95%-CI 1.74−133.70; p-value = 0.014). Microcephaly cases were associated with impoverished socioeconomic settings, but this association was statistically non-significant (RR = 2.75; 95%-CI 0.55−13.78; p-value = 0.22). The marginal ZIKV−microcephaly association and statistical significance of the competing hypotheses suggest maternal ZIKV infection might not be a cause of microcephaly alone.
先天性小头畸形是由孕期影响母婴健康的多种因素导致的。在高收入工业化国家，小头畸形是一种罕见的情况，小头畸形发生率在每1000例新生儿中为0.3 - 0.9例。小头畸形的患病率在发展中国家差异很大，在感染寨卡病毒（ZIKV）的孕妇中，每1000例活产儿中可能高达58例。不仅感染ZIKV的孕妇会出现这种情况，其他因素也会影响小头畸形的发生及严重程度。在此，我们试图通过荟萃分析来检验ZIKV与小头畸形之间的关联以及与其他竞争性假说，该荟萃分析纳入了来自美洲、非洲和亚洲的10250994例新生儿中的8341例小头畸形病例。风险比（RR）分析显示，致畸物是最可能与小头畸形相关的风险因素（RR = 3.43；95%置信区间2.69 - 4.38；p值<0.0001），而ZIKV与小头畸形关联的统计学显著性较弱（RR = 2.12；95%置信区间1.01 - 4.48；p值 = 0.048）。其他先天性感染与小头畸形呈现出强但多变的关联（RR = 15.24；95%置信区间1.74 - 133.70；p值 = 0.014）。小头畸形病例与社会经济贫困环境相关，但这种关联在统计学上不显著（RR = 2.75；95%置信区间0.55 - 13.78；p值 = 0.22）。ZIKV与小头畸形之间较弱的关联以及竞争性假说的统计学显著性表明，孕妇感染ZIKV可能并非小头畸形的唯一病因。
