Neuropsychomotor development of children born to infected-HIV women in the city of Ribeirão Preto, SP.

O panorama epidemiológico da AIDS indica a expansão da epidemia entre mulheres e conseqüentemente a infecção de crianças através da transmissão vertical. As crianças acometidas pela AIDS podem apresentar diversos sintomas e sinais próprios da doença, entre eles, atraso no desenvolvimento neuropsicomotor. No entanto, crianças filhas de mães soropositivas mesmo quando não infectadas, podem sofrer as conseqüências da doença em sua família. Os objetivos deste estudo foram: comparar o desenvolvimento neuropsicomotor de crianças não infectadas filhas de mães soropositivas para o HIV com crianças não expostas ao vírus; identificar fatores para atraso no desenvolvimento destas crianças e refletir sobre a necessidade de intervenção pela terapia ocupacional. Foram comparados dois grupos, com 45 crianças em cada um deles, nas idades de 3, 8 e 18 meses. Em relação ao desenvolvimento neuropsicomotor não foram encontradas diferenças entre o grupo de crianças filhas de mães soropositivas para o HIV e crianças não expostas ao vírus nas idades em conjunto, porém foi encontrada diferença significativa entre eles na idade de 3 meses. Também foram encontradas diferenças significativas entre os grupos quando comparados quanto à renda familiar, ao peso da criança ao nascimento e ao hábito materno da utilização de drogas ilícitas. Contudo, aos 3 meses de idade, apenas o hábito materno da utilização de drogas ilícitas influenciou negativamente o desenvolvimento neuropsicomotor das crianças. Os resultados permitiram discutir o papel do terapeuta ocupacional junto a esta população e sugere-se que novos estudos envolvendo o tema poderão colaborar com a confirmação dos dados obtidos, bem como dar continuidade às reflexões sobre a atuação deste profissional.The Aids epidemiological background indicates the spread of epidemic among women and consequentially the infection of children through vertical transmission. The HIV infected children can show several peculiar symptoms and signs of the disease, such as the delay in the neuropsychomotor development. Nevertheless, children born to HIV-infected women even when uninfected, might suffer the disease consequences in their family. The objectives of this study are: to compare neuropsychomotor development of uninfected children born to HIV-infected women to children not exposed to the virus; to identify factors that influence the delay of children development and discuss the need for intervention by Occupational Therapy. Comparing the group of children born to HIV-infected women to children not exposed (in each group were included 45 children), in the three studied ages (3, 8 e 18 months), no differences were found related to the neuropsychomotor development, but in the age of 3 months a significant difference was observed. Significant differences were also found among the groups when familiar income, at birth weight of children and maternal habits of illicit drug use were analyzed. However, in the age of 3 months, only the maternal habit of illicit drug use had negative effects in the neuropsychomotor development. According to the results, its possible to discuss the occupational therapist practice with this population and to suggest the need of new studies related to this subject that can contribute to the confirmation of the data and also continue the discussing about this professional actuation

Neuropsychomotor development of children born to infected-HIV women in the city of Ribeirão Preto, SP.

O panorama epidemiológico da AIDS indica a expansão da epidemia entre mulheres e conseqüentemente a infecção de crianças através da transmissão vertical. As crianças acometidas pela AIDS podem apresentar diversos sintomas e sinais próprios da doença, entre eles, atraso no desenvolvimento neuropsicomotor. No entanto, crianças filhas de mães soropositivas mesmo quando não infectadas, podem sofrer as conseqüências da doença em sua família. Os objetivos deste estudo foram: comparar o desenvolvimento neuropsicomotor de crianças não infectadas filhas de mães soropositivas para o HIV com crianças não expostas ao vírus; identificar fatores para atraso no desenvolvimento destas crianças e refletir sobre a necessidade de intervenção pela terapia ocupacional. Foram comparados dois grupos, com 45 crianças em cada um deles, nas idades de 3, 8 e 18 meses. Em relação ao desenvolvimento neuropsicomotor não foram encontradas diferenças entre o grupo de crianças filhas de mães soropositivas para o HIV e crianças não expostas ao vírus nas idades em conjunto, porém foi encontrada diferença significativa entre eles na idade de 3 meses. Também foram encontradas diferenças significativas entre os grupos quando comparados quanto à renda familiar, ao peso da criança ao nascimento e ao hábito materno da utilização de drogas ilícitas. Contudo, aos 3 meses de idade, apenas o hábito materno da utilização de drogas ilícitas influenciou negativamente o desenvolvimento neuropsicomotor das crianças. Os resultados permitiram discutir o papel do terapeuta ocupacional junto a esta população e sugere-se que novos estudos envolvendo o tema poderão colaborar com a confirmação dos dados obtidos, bem como dar continuidade às reflexões sobre a atuação deste profissional.The Aids epidemiological background indicates the spread of epidemic among women and consequentially the infection of children through vertical transmission. The HIV infected children can show several peculiar symptoms and signs of the disease, such as the delay in the neuropsychomotor development. Nevertheless, children born to HIV-infected women even when uninfected, might suffer the disease consequences in their family. The objectives of this study are: to compare neuropsychomotor development of uninfected children born to HIV-infected women to children not exposed to the virus; to identify factors that influence the delay of children development and discuss the need for intervention by Occupational Therapy. Comparing the group of children born to HIV-infected women to children not exposed (in each group were included 45 children), in the three studied ages (3, 8 e 18 months), no differences were found related to the neuropsychomotor development, but in the age of 3 months a significant difference was observed. Significant differences were also found among the groups when familiar income, at birth weight of children and maternal habits of illicit drug use were analyzed. However, in the age of 3 months, only the maternal habit of illicit drug use had negative effects in the neuropsychomotor development. According to the results, its possible to discuss the occupational therapist practice with this population and to suggest the need of new studies related to this subject that can contribute to the confirmation of the data and also continue the discussing about this professional actuation

Revelação do diagnóstico de HIV/AIDS na infância : impactos, cotidiano e perspectivas de jovens infectados verticalmente

Children living with HIV / AIDS are growing and demanding new interventions and health care strategies, such as the need to know their clinical status. Recent national and international studies have sought a better understanding of the issue of disclosure of HIV / AIDS diagnosis to vertically infected children and adolescents and their consequences. The objective of this research was to understand about the contributions and limits of a diagnostic disclosure process to children infected vertically by HIV / AIDS, developed by a multidisciplinary team of a tertiary hospital and approach, from the perspective of these current young people Social relations, daily challenges and future expectations. To do so, two studies were carried out: Study 1 aimed to identify the variations in CD4 and Viral Load rates of children infected vertically by HIV / AIDS, after participating in the process of diagnosis, developed by a multidisciplinary team of a hospital Ternary school in the interior of São Paulo - Brazil, as well as if this variation is associated with variables such as: gender, age, family composition and frequency in the groups, both of the children and the parents, and Study 2 aimed to investigate the impacts in daily life, the Challenges and future expectations, after the moment of revelation and in the present, from the perspective of young people, children at the time of revelation. The research was approved by the Research Ethics Committee of the Hospital das Clínicas of the Medical School of Ribeirão Preto - USP and both studies were carried out in this place. For Study 1, data were collected in 65 charts of young people, children at the time of diagnosis. The information was recorded in a specific form and stored in a database. The results are presented in a descriptive and analytical way and, to verify the association between the variables, the "Fisher's exact test" was used. In Study 2, 17 young people, aged between 16 and 24 years participated, being 10 females and 7 males. All participants were infected with HIV by vertical transmission, they were part of the diagnostic disclosure process focused on this study, and they continue to be followed at the same health service. The instruments used were an identification form and a semi-structured interview script. For the data analysis, the Collective Subject Discourse (DSC) technique was used. The results of Study 1 show that there was an association between the participation of the caregivers in the group of the diagnostic process and the improvement in the CD4 rates of the children, besides the stabilization in the levels of viral load and CD4, after the diagnosis was revealed. The results of Study 2 point to the benefits reported by the participants regarding disclosure by the family associated with the UETDI disclosure process. Nevertheless, it was verified that it is during adolescence that the concreteness of the diagnosis is placed in their lives and, as a daily challenge, reveal the common presence of social prejudice imposed on young people with HIV. It discusses the relevance of diagnostic disclosure processes and highlights the relevance of the disclosure proposal evaluated in this study. Suggestions are suggested for the improvement of the process, especially regarding the resumption of the diagnosis and its implications in adolescence. Furthermore, the challenge of coping with prejudice as collective responsibility and with the concrete involvement of public policies is discussed.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Crianças que vivem com HIV/Aids estão crescendo e demandando novas intervenções e estratégias de cuidado em saúde, tal como a necessidade do conhecimento do seu status clínico. Estudos nacionais e internacionais recentes, têm buscado uma melhor compreensão acerca da temática da revelação de diagnóstico de HIV/Aids a crianças e adolescentes infectados verticalmente e suas decorrências. O objetivo desta pesquisa foi o de compreender acerca das contribuições e limites de um processo de revelação de diagnóstico a crianças infectadas verticalmente pelo HIV/AIDS, desenvolvido por uma equipe multidisciplinar de um hospital terciário e abordar, sob a perspectiva destes atuais jovens como se dão as relações sociais, desafios cotidianos e expectativas futuras. Para tanto, realizou-se 2 Estudos: o Estudo 1 objetivou identificar as variações nas taxas de CD4 e Carga Viral de crianças infectadas verticalmente pelo HIV/AIDS, após a participação no processo de revelação de diagnóstico, desenvolvido por uma equipe multidisciplinar de um hospital terciário no interior de São Paulo – Brasil, bem como se essa variação se associa com variáveis como: sexo, idade, composição familiar e frequência nos grupos, tanto das crianças quanto dos pais e, o Estudo 2 objetivou investigar os impactos no cotidiano, os desafios e as expectativas futuras, após o momento da revelação e no presente, sob a ótica dos jovens, crianças à época da revelação. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – USP e ambos os estudos foram realizados neste local. Para o Estudo 1 foi realizada a coleta de dados em 65 prontuários de jovens, crianças à época da revelação do diagnóstico. As informações foram registradas em formulário específico e armazenadas em banco de dados. Os resultados são apresentados de maneira descritiva e analítica e, para verificar-se a associação entre as variáveis foi utilizado o “Teste Exato de Fisher”. No Estudo 2, participaram 17 jovens, com idades entre 16 e 24 anos, sendo 10 do sexo feminino e 7 do sexo masculino. Todos os participantes foram contaminados pelo HIV por transmissão vertical, fizeram parte do processo de revelação de diagnóstico focalizado neste estudo, e, continuam sendo acompanhados no mesmo serviço de saúde. Os instrumentos utilizados foram a uma ficha de identificação e um roteiro de entrevista semiestruturado. Para a análise dos dados utilizou-se a técnica do Discurso do Sujeito Coletivo (DSC). Os resultados do Estudo 1 revelam que houve associação entre a participação dos cuidadores no grupo do processo de revelação diagnóstico e a melhora nas taxas de CD4 das crianças, além da estabilização nos níveis de carga viral e CD4, após a revelação do diagnóstico. Os resultados do Estudo 2 apontam para os benefícios relatados pelos participantes quanto à revelação ter sido feita pela família, associada ao processo de revelação da UETDI. Não obstante, verificou-se que é no período da adolescência que a concretude do diagnóstico se coloca em suas vidas e, revelam como maior desafio cotidiano, a presença comum do preconceito social imposto aos jovens soropositivos. Discute-se sobre a relevância de processos de revelação de diagnóstico e destaca-se a pertinência da proposta de revelação avaliada neste estudo. Indicam-se sugestões para o aprimoramento do processo, especialmente ao que se refere à retomada sobre o diagnóstico e suas implicações no período da adolescência. Ainda, discute-se sobre o desafio de enfrentamento relativo ao preconceito como responsabilidade coletiva e com o envolvimento concreto de políticas públicas

Language aspects of children infected with hiv Aspectos da linguagem em crianças infectadas pelo HIV

PURPOSE: to assess the lexical proficiency and the incidence of phonologic disorders in the language of children infected with HIV. METHOD: the study population consisted of 31 children between three and seven year-old. For evaluation purposes the Test of Infantile Language - ABFW was applied in the areas of phonology and vocabulary. RESULTS: the results obtained were analyzed according to the clinical criteria for the classification of the disease proposed by the CDC and regarding the immunological profile and the viral burden using the Mann-Whitney test for statistical analysis. In the vocabulary evaluation, 100% of the children presented an inappropriate response for their age in at least two distinct conceptual fields. In the phonologic evaluation, 67.7% of the assessed children were considered to be affected by some phonologic disorder. When we compared adequate and inadequate results of phonologic evaluation to the clinical and immunological parameters of AIDS such as clinical classification (p=0,16), CD4 count (p=0,37) and viral burden (p=0,82), we did not detect a statistically significant relation between language alterations and disease severity. CONCLUSION: this research has shown that the studied group presents a high risk for language disorders and that constant phonoaudiological follow-up is essential to identify the alterations in early stage.<br>OBJETIVO: avaliar a proficiência lexical e a incidência de distúrbios fonológicos na linguagem de crianças infectadas com HIV. MÉTODO: a população do estudo consistiu de 31 crianças com idades entre três e sete anos. Para avaliação foi utilizado o Teste de Linguagem Infantil - ABFW foi nas áreas de fonologia e vocabulário. RESULTADOS: os resultados obtidos foram analisados de acordo com os critérios clínicos para a classificação da doença, proposta pelo CDC e sobre o perfil imunológico e a carga viral através do teste de Mann-Whitney para análise estatística. Na avaliação de vocabulário, 100% das crianças apresentaram uma resposta inadequada para a sua idade em pelo menos dois campos distintos conceptuais. Na avaliação fonológica, 67,7% das crianças avaliadas foram consideradas afetadas por algum distúrbio fonológico. Quando comparamos os resultados adequados e inadequados da avaliação fonológica para os parâmetros clínicos e immunovirological de AIDS, tais como classificação clínica (p = 0,16), contagem de CD4 (p = 0,37) e carga viral (p =0,82), não se detectou uma relação estatisticamente significativa entre alterações de linguagem e severidade da doença. CONCLUSÃO: a pesquisa mostrou que o grupo estudado apresenta um alto risco de distúrbios de linguagem e que acompanhamento fonoaudiológico constante é essencial para identificar as alterações precocemente

Relationship between viral load and behavioral measures of adherence to antiretroviral therapy in children living with human immunodeficiency virus in Latin America

Few studies have examined antiretroviral therapy adherence in Latin American children. Standardized behavioral measures were applied to a large cohort of human immunodeficiency virus-infected children in Brazil, Mexico, and Peru to assess adherence to prescribed antiretroviral therapy doses during the three days prior to study visits, assess timing of last missed dose, and evaluate the ability of the adherence measures to predict viral suppression. Time trends in adherence were modeled using a generalized estimating equations approach to account for possible correlations in outcomes measured repeatedly in the same participants. Associations of adherence with human immunodeficiency virus viral load were examined using linear regression. Mean enrollment age of the 380 participants was 5 years; 57.6% had undetectable’ viral load ( 0.3). Last time missed any antiretroviral therapy dose was reported as “never” for 52.0% at enrollment, increasing to 60.7% and 65.9% at the 6- and 12-month visits, respectively (p < 0.001 for test of trend). The proportion with undetectable viral load was higher among those who never missed a dose at enrollment and the 12-month visit (p ≤ 0.005), but not at the 6-month visit (p = 0.2). While antiretroviral therapy adherence measures utilized in this study showed some association with viral load for these Latin American children, they may not be adequate for reliably identifying non-adherence and consequently children at risk for viral resistance. Other strategies are needed to improve the evaluation of adherence in this population. Keywords: Pediatric, ART, Adherence, Latin Americ

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

The Zika Brazilian Cohorts Consortium was supported by the National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq) (grant number 404861/2018-0). The individual studies participating in the ZBC-Consortium were funded by: Wellcome Trust and the United Kingdom’s Department for International Development (grant numbers: 205377/Z/16/Z; 201870/Z/16/Z). European Union’s Horizon 2020 research and innovation programme under ZikaPLAN (grant number 734584). Wellcome Trust - Research Enrichment in Epidemic Situation (grant number 107779/Z/15/Z; with ER1505 & ER1601). Medical Research Council on behalf of the Newton Fund and Wellcome Trust (grant number MC_PC_15088). National Institutes of Health/National Institute of Allergy and Infectious Diseases (grant number RO1/ AI140718). Fondation Christophe et Rodolphe Mérieux. National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq) (grant numbers 443875/2018-9; 440573/2016-5; 441098/2016-9; 305090/2016-0; 307282/2017-1; 304476/2018-8; 465549/2014-4; 440763/2016-9; 309722/2017-9; 306708/2014-0; 440577/2016-0). Coordination for the improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Capes) (grant numbers 88881.130813/2016-01; 88887.116627/2016-01; 88887.136366/2017-00). Ministry of Health of Brazil - Emergency Response in Public Health - Zika virus and Microcephaly (Ministério da Saúde de Brasil - Resposta à Emergência em Saúde Pública – Zika vírus e Microcefalia) (grant number 837058/2016). Department of Science and Technology (Departamento de Ciência e Tecnologia - DECIT) (grant numbers 25000.072811/2016-19; 440839/2016-5). Foundation of Research Support of the State of São Paulo (Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP) (grant numbers 2016/08578-0; 2017/21688-1; 2013/21719-3; 2016/ 15021-1; 2015/12295-0; 2016/05115-9). Foundation of Research Support of the State of Rio de Janeiro (Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ) (grant numbers E-26/201.351/2016; E-18/ 2015TXB; E-26/202.862/2018; E 26/010.002477/2016). Foundation of Support for Research and Scientific and Technological Development of Maranhão (Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão – FAPEMA) (grant number 008/2016). Brazilian Ministry of Health (Ministério da Saúde – MS) (grant number 929698560001160-02). Evandro Chagas Institute/Brazilian Ministry of Health (Instituto Evandro Chagas/Ministério da Saúde). Foundation of Research Support of the State of Goiás (Fundação de Amparo à Pesquisa do Estado de Goiás – FAPEG) (number grant 2017/10267000531). Foundation of Research Support of the State of Rio Grande do Sul (Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul – FAPERGS) (grant number 17/2551-0000521-0). Foundation to Support Teaching, Research and Assistance at Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto (Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto) and São Paulo State Department of Health (Secretaria de Saúde do Estado de São Paulo). Support Foundation of Pernambuco Science and Technology (Fundação de Amparo à Ciência e Tecnologia de Pernambuco – FACEPE) (grant numbers APQ-0172-4.01/16; APQ-0192-4.01/17; APQ0793-4.01/17).Federal University of Pernambuco. Postgraduate Program in Tropical Medicine. Recife, PE, Brazil / University of Pernambuco. Post-Graduation in Health Sciences. Recife, PE, Brazil.University of Pernambuco. Post-Graduation in Health Sciences. Recife, PE, Brazil.London School of Hygiene & Tropical Medicine. Department of Infectious Disease Epidemiology. London, UK.Federal University of Pernambuco. Postgraduate Program in Collective Health. Recife, PE, Brazil.University of Pernambuco. Post-Graduation in Health Sciences. Recife, PE, Brazil.University of Amazonas State. Postgraduate Program in Tropical Medicine. Manaus, AM, Brazil / Doctor Heitor Vieira Dourado Tropical Medicine Foundation. Postgraduate Program in Tropical Medicine. Manaus, AM, Brazil.Ribeirão Preto Medical School. Department of Pediatrics. Ribeirão Preto, SP, Brazil.Ribeirão Preto Medical School. Department of Gynecology and Obstetrics. Ribeirão Preto, SP, Brazil.Ribeirão Preto Medical School. Department of Gynecology and Obstetrics. Ribeirão Preto, SP, Brazil.Ribeirão Preto Medical School. Department of Pediatrics. Ribeirão Preto, SP, Brazil.University of Amazonas State. Postgraduate Program in Tropical Medicine. Manaus, AM, Brazil / Doctor Heitor Vieira Dourado Tropical Medicine Foundation. Postgraduate Program in Tropical Medicine. Manaus, AM, Brazil.University of Amazonas State. Postgraduate Program in Tropical Medicine. Manaus, AM, Brazil / Doctor Heitor Vieira Dourado Tropical Medicine Foundation. Postgraduate Program in Tropical Medicine. Manaus, AM, Brazil.Instituto Fernandes Figueira. Clinical Research Unit. Rio de Janeiro, RJ, Brazil.Oswaldo Cruz Foundation. Instituto Fernandes Figueira. Clinical Research Unit. Rio de Janeiro, RJ, Brazil.Oswaldo Cruz Foundation. Instituto Fernandes Figueira. Obstretics. Rio de Janeiro, RJ, Brazil.University of California. David Geffen School of Medicine. Department of Pediatrics. Los Angeles, CA, Estados Unidos.Oswaldo Cruz Foundation. Research Center Aggeu Magalhães. Recife, PE, Brazil.London School of Hygiene & Tropical Medicine. Department of Infectious Disease Epidemiology. London, UK.Oswaldo Cruz Foundation. Research Center Aggeu Magalhães. Recife, PE, Brazil.Altino Ventura Foundation. Department of Ophthalmology. Recife, PE, Brazil / Pernambuco Eyes Hospital. Recife, PE, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Medicine School of São José do Rio Preto. Department of Infectious Disease. São José do Rio Preto, SP, Brazil.Medicine School of São José do Rio Preto. Department of Infectious Disease. São José do Rio Preto, SP, Brazil.Medicine School of São José do Rio Preto. Department of Gynecology and Obstetrics. São José do Rio Preto, SP, Brazil.Medicine School of Jundiaí. Infectious Pediatric Laboratory. Jundiaí, SP, Brazil.Federal University of São Paulo. Department of Fetal Medicine. São Paulo, SP, Brazil.Father Anchieta University Center. Nursing School. Jundiaí, SP, Brazil.Federal University of São Paulo. Paulista School of Medicine. Departament of Obstetrics. São Paulo, SP, Brazil.Federal University of Goiás. Institute of Tropical Pathology and Public Health. Goiânia, GO, Brazil.Health Secretariat of Goiás State. Maternal and Child Hospital. Goiânia, GO, Brazil.Federal University of São Paulo. Paulista School of Medicine. Departament of Obstetrics. São Paulo, SP, Brazil.Health Secretariat of Goiás State. Maternal and Child Hospital. Goiânia, GO, Brazil.Universidade Federal do Rio Grande do Sul. Hospital das Clinicas de Porto Alegre. Departamento de Genética. Porto Alegre, RS, Brazil.City Hall of Tangará da Serra, Municipal Health Department, Tangará da Serra, MT, Brazil.Federal University of Campina Grande. Medical Academic Unit. Campina Grande, PB, Brazil.Federal University of Campina Grande. Medical Academic Unit. Campina Grande, PB, Brazil.Federal University of Rio de Janeiro. Department of Pediatrics. Rio de Janeiro, RJ, Brazil.D’Or Institute for Research & Education. Department of Pediatrics. Rio de Janeiro, RJ, Brazil.Departmentiversity of Rio de Janeiro Maternity School. Department of Obstectrics. Rio de Janeiro, RJ, Brazil.Departmentiversity of Rio de Janeiro Maternity School. Department of Obstectrics. Rio de Janeiro, RJ, Brazil.Reference Maternity Prof. José Maria de Magalhães Netto. Bahia Health Department, Salvador, BA, Brazil.Oswaldo Cruz Foundation. Gonçalo Moniz Institute. Salvador, BA, Brazil.Oswaldo Cruz Foundation. Gonçalo Moniz Institute. Salvador, BA, Brazil.Federal University of Rio de Janeiro. Department of Infecitous Diseases. Rio de Janeiro, RJ, Brazil.Federal University of Rio de Janeiro. Department of Infecitous Diseases. Rio de Janeiro, RJ, Brazil.Oswaldo Cruz Foundation. Gonçalo Moniz Institute. Salvador, BA, Brazil.Oswaldo Cruz Foundation. Leonidas and Maria Deane Institute. Manaus, AM, Brazil.University of Amazonas State. Postgraduate Program in Tropical Medicine. Manaus, AM, Brazil / Doctor Heitor Vieira Dourado Tropical Medicine Foundation. Postgraduate Program in Tropical Medicine. Manaus, AM, Brazil / Oswaldo Cruz Foundation. Leonidas and Maria Deane Institute. Manaus, AM, Brazil.Oswaldo Cruz Foundation. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brazil.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%

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 ConsortiumResearch in context

Summary: 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%. Funding: National Council for Scientific and Technological Development - Brazil (Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq); Wellcome Trust and the United Kingdom's Department for International Development; European Union's Horizon 2020 research and innovation program; Medical Research Council on behalf of the Newton Fund and Wellcome Trust; National Institutes of Health/National Institute of Allergy and Infectious Diseases; Foundation Christophe et Rodolphe Mérieux; Coordination for the improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Capes); Ministry of Health of Brazil; Brazilian Department of Science and Technology; Foundation of Research Support of the State of São Paulo (Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP); Foundation of Research Support of the State of Rio de Janeiro (Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ); Foundation of Support for Research and Scientific and Technological Development of Maranhão; Evandro Chagas Institute/Brazilian Ministry of Health (Instituto Evandro Chagas/Ministério da Saúde); Foundation of Research Support of the State of Goiás (Fundação de Amparo à Pesquisa do Estado de Goiás – FAPEG); Foundation of Research Support of the State of Rio Grande do Sul (Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul – FAPERGS); Foundation to Support Teaching, Research and Assistance at Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto (Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto); São Paulo State Department of Health (Secretaria de Saúde do Estado de São Paulo); Support Foundation of Pernambuco Science and Technology (Fundação de Amparo à Ciência e Tecnologia de Pernambuco – FACEPE)