经逆转录聚合酶链反应（RT-PCR）确认产前暴露于寨卡病毒的后代出现不良结局的风险：寨卡巴西队列联盟中13个队列的个体参与者数据荟萃分析。
Risk of adverse outcomes in offspring with RT-PCR confirmed prenatal Zika virus exposure: An individual participant data meta-analysis of 13 cohorts in the Zika Brazilian Cohorts Consortium.
作者信息
de Alencar Ximenes Ricardo Arraes, Miranda-Filho Demócrito de Barros, Brickley Elizabeth B, Barreto de Araújo Thalia Velho, Montarroyos Ulisses Ramos, Abtibol-Bernardino Marília Rosa, Mussi-Pinhata Marisa M, Duarte Geraldo, Coutinho Conrado Milani, Biason de Moura Negrini Silvia Fabiana, Costa Alecrim Maria das Graças, Albuquerque de Almeida Peixoto Lucíola de Fátima, Lopes Moreira Maria Elisabeth, Zin Andrea, Pereira Júnior José Paulo, Nielsen-Saines Karin, Turchi Martelli Celina Maria, Rodrigues Laura Cunha, de Souza Wayner Vieira, Ventura Liana O, de Oliveira Consuelo Silva, de Matos Haroldo, Furtado Serra Emilene Monteiro, Souza Gomes Luna Thais, Nogueira Maurício L, Estofolete Cassia, Vaz-Oliani Denise Cristina, Passos Saulo Duarte, Moron Antonio, Duarte Rodrigues Maria Manoela, Pereira Sarmento Stéphanno Gomes, Turchi Marília Dalva, Pela Rosado Luiza Emylce, de Sene Amâncio Zara Ana Laura, Franco Gomes Maria Bárbara, Schuler-Faccini Lavínia, Herrero-Silva Juliana, Amorim Melania M, Melo Adriana Oliveira, Ledo Alves da Cunha Antônio José, Prata-Barbosa Arnaldo, Amim Joffre, Rezende-Filho Jorge, Calcagno Juan Ignacio, Júnior Alcântara Luiz Carlos, de Almeida Breno Lima, Hofer Cristina Barroso, Machado Elizabeth S, de Siqueira Isadora Cristina, Martinez-Espinoza Flor Ernestina, Brasil Patrícia
机构信息
Postgraduate Program in Tropical Medicine, Federal University of Pernambuco, Recife, PE, Brazil.
Post-Graduation in Health Sciences, University of Pernambuco, Recife, PE, Brazil.
出版信息
Lancet Reg Health Am. 2023 Jan;17. doi: 10.1016/j.lana.2022.100395. Epub 2022 Nov 28.
BACKGROUND
Knowledge regarding the risks associated with Zika virus (ZIKV) infections in pregnancy has relied on individual studies with relatively small sample sizes and variable risk estimates of adverse outcomes, or on surveillance or routinely collected data. Using data from the Zika Brazilian Cohorts Consortium, this study aims, to estimate the risk of adverse outcomes among offspring of women with RT-PCR-confirmed ZIKV infection during pregnancy and to explore heterogeneity between studies.
METHODS
We performed an individual participant data meta-analysis of the offspring of 1548 pregnant women from 13 studies, using one and two-stage meta-analyses to estimate the absolute risks.
FINDINGS
Of the 1548 ZIKV-exposed pregnancies, the risk of miscarriage was 0.9%, while the risk of stillbirth was 0.3%. Among the pregnancies with liveborn children, the risk of prematurity was 10,5%, the risk of low birth weight was 7.7, and the risk of small for gestational age (SGA) was 16.2%. For other abnormalities, the absolute risks were: 2.6% for microcephaly at birth or first evaluation, 4.0% for microcephaly at any time during follow-up, 7.9% for neuroimaging abnormalities, 18.7% for functional neurological abnormalities, 4.0% for ophthalmic abnormalities, 6.4% for auditory abnormalities, 0.6% for arthrogryposis, and 1.5% for dysphagia. This risk was similar in all sites studied and in different socioeconomic conditions, indicating that there are not likely to be other factors modifying this association.
INTERPRETATION
This study based on prospectively collected data generates the most robust evidence to date on the risks of congenital ZIKV infections over the early life course. Overall, approximately one-third of liveborn children with prenatal ZIKV exposure presented with at least one abnormality compatible with congenital infection, while the risk to present with at least two abnormalities in combination was less than 1.0%.
背景
关于孕期感染寨卡病毒（ZIKV）相关风险的知识，以往依赖样本量相对较小且不良结局风险估计各异的个别研究，或监测数据及常规收集的数据。本研究利用巴西寨卡病毒队列联盟的数据，旨在估计孕期经逆转录聚合酶链反应（RT-PCR）确诊感染ZIKV的女性所生后代出现不良结局的风险，并探讨不同研究之间的异质性。
方法
我们对来自13项研究的1548名孕妇的后代进行了个体参与者数据荟萃分析，采用单阶段和两阶段荟萃分析来估计绝对风险。
研究结果
在1548例暴露于ZIKV的妊娠中，流产风险为0.9%，死产风险为0.3%。在有活产儿的妊娠中，早产风险为10.5%，低出生体重风险为7.7%，小于胎龄儿（SGA）风险为16.2%。对于其他异常情况，绝对风险分别为：出生时或首次评估时小头畸形为2.6%，随访期间任何时间小头畸形为4.0%，神经影像学异常为7.9%，功能性神经异常为18.7%，眼科异常为4.0%，听觉异常为6.4%，关节挛缩为0.6%，吞咽困难为1.5%。在所有研究地点和不同社会经济条件下，这一风险相似，表明不太可能存在其他因素改变这种关联。
解读
这项基于前瞻性收集数据的研究，产生了迄今为止关于先天性ZIKV感染在生命早期阶段风险的最有力证据。总体而言，产前暴露于ZIKV的活产儿中，约三分之一出现至少一种与先天性感染相符的异常情况，而同时出现至少两种异常情况的风险小于1.0%。
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