Perdas fetais, mortalidade infantil e achados clínicos relacionados à síndrome da Zika congênita: resultados de uma coorte de mulheres do Nordeste brasileiro

Abstract

The Zika virus (ZIKV) epidemic interfered with obstetric outcomes worsening infant morbidity and mortality indicators. The number of ZIKV infections caused in pregnant women that had unfavorable birth outcomes (miscarriages or stillbirths) or resulted in Congenital Alterations or Congenital Zika Syndrome (CZS) was expressive. We aim to characterize the magnitude of spontaneous fetal loss (SFL), clinical findings related to CZS, and infant mortality reported by women in a cohort from Northeast Brazil. The cohort had a study population of 1496 women aged between 15 and 39. The interviews were carried out from February to October 2018 in four Health Units located in areas of socioeconomic vulnerability at Fortaleza. The cutoff points between the Pre-epidemic Period (PEP) and the Epidemic Period (EP) were: January 2013 for SFP and January 2014 for live births (LB). We compared between the PEP and EP periods the variables signs and symptoms related to CSZ (SSr-CZS), SFL, Probable CZS (Pr-CZS), and Mortality Rates (MR). We calculated MR from the death dates of NV children. We performed descriptive and analytical statistics. We used Pearson or Fisher chi-square, odds ratio (OR), hierarchical logistic regression, and 95% confidence intervals (95%CI). We followed ethical standards and procedures for research involving human beings (Protocol number: 2,497,069). The prevalence of SFL was 13.6%. We compared SFL between the periods, and it showed 1.7 times (OR=1.7; 95%CI: 1.3-2.2) more likely to occur in the EP. When testing SFL with independent variables, they showed an association with received funds from Bolsa Família (OR=0.7; 95%CI:0.5-0.9), belonging to the AB economic class (OR=1.6; 95%CI:1.1-2, 5), not performing early capture (OR=3,2; 95%CI: 1.4-7.4) and not performing prenatal care (OR=55.4; 95%CI: 37.5-82.0). SSr-SCZ were reported in 345 children, and the most prevalent were Hyperirritability (OR=5.2; 95%CI: 1.4-18.8) and Urinary Disorders (OR=2.8; 95%CI: 1.1- 7.2). Among the LB, we classified 7.7% as Pr-CZS. Pr-CZS was compared between periods and presented 1.6 times (OR=1.7; 95%CI: 1.1-2.3) more likely to occur in the EP. When testing Pr-CZS with independent variables, it showed association: belonging to the CDE economic class (OR 2.2; 95% CI: 0.9-5.5), having a diagnosis of Zika (OR 1.6; 95% CI: 1, 1-2.3), having prenatal consultations (OR=2.6; 95%CI: 1.1-6.5) and having a partner concerned about the risk of infection with Zika (OR=0.4; 95%CI: 0.3-0.6). When comparing the MR between the PEP and EP, we noticed that: the Infantile MR was 4.8 times higher (95%CI 1.8-13.2); Neonatal MR was 18.4 times higher (95%CI 2.4 - 141.0); Early neonatal MR was 15.5 times higher (95%CI 2.0 - 120.5), and the MR in children under five years was 3.0 times higher (95%CI 1.3 - 6.6). The present study shows a high prevalence of PEF (13.6%). SFL, Pr-CZS, and MR increased in EP and were statistically associated when compared between periods. It evidenced high infant, neonatal and under-five MR. It is recommended to improve prenatal care, the living conditions of women, and the guarantee of health rights.