Dengue em gestantes e a associação entre a infecção sintomática e desfechos desfavoráveis em nascidos vivos: um relacionamento entre os dados dos sistemas de informação em saúde no Brasil
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2016-12-01
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Universidade Federal de Goiás
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Introduction: dengue is the most important arboviral disease in the world and a major
health challenge in Brazil. The hyperendemic scenario with large epidemics led to an
increase in severe forms of the disease, including special groups such as pregnant
women. Dengue infection during pregnancy has been associated with the development
of unfavorable maternal and infant outcomes, however, few studies have addressed this
association and usually with a small sample size. Objective: to evaluate the
epidemiological profile of pregnant women reported with dengue and the symptomatic
infection caused by dengue virus during pregnancy as a factor associated with
premature birth, low birth weight and congenital malformations in live births in Brazil.
Methods: a descriptive study of dengue probable cases reported in pregnant women in
Brazil with onset of symptoms between 2007 and 2015 was conducted from data of
National Reportable Disease Information System (SINAN). We then carried one
retrospective cohort study based on a probabilistic linkage between databases from
SINAN and Live Birth Information System (SINASC) from 2007 to 2013. The linkage
was performed for pregnant women with a positive or negative laboratory specific test
for dengue and all live births using the the Fine-Grained Record Integration and
Linkage (FRIL) software. Additionally, an external reference group was randomly
selected for each dengue positive case among newborns from the same municipality of
residence and year of the onset of symptoms of the case. Multivariate logistic regression
was performed to assess the relationship between symptomatic dengue during
pregnancy and adverse outcomes in live births, adjusted for relevant covariates.
Results: 43,772 probable dengue cases in pregnant women were reported during the
study period. The proportion of cases per trimester of gestation presented a similar
distribution, with a slightly higher frequency in the second trimester of pregnancy
(32.6%). The risk of death due to dengue was higher in pregnant women when
compared to women childbearing age not pregnant (RR: 3.95; 95% CI 3.07 to 5.08, p
<0.001), reaching a risk of 8.55 (95% CI: 6.08 to 12.02, p <0.001) in the third trimester
of pregnancy. 3,898 live births in the group of positive pregnant women from 1,283
municipalities were included in the retrospective cohort study. The distribution of birth
weight was similar among all study groups, ranging from 2.8 to 3.5 kg in 50% of
newborns. The adjusted odds ratio for preterm birth was higher in the group of pregnant
women positive for dengue than negative group compared in all trimesters (OR 1.26,
95% CI 1.06 to 1.49; p = 0.006). The incidence of congenital malformations was <1%
in all groups. Conclusions: this is the first study based on national data and establishes
the baseline of the evaluated outcomes in live births before the introduction of
Chikungunya and Zika virus in the country. Our findings reinforce the dengue as a
major problem for pregnant women, indicating increased risk for death from the disease
and preterm birth in live births, but not to congenital malformations or low birth weight.
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NASCIMENTO, L. B. Dengue em gestantes e a associação entre a infecção sintomática e desfechos desfavoráveis em nascidos vivos: um relacionamento entre os dados dos sistemas de informação em saúde no Brasil. 2016. 108 f. Tese (Doutorado em Medicina Tropical e Saúde Publica) - Universidade Federal de Goiás, Goiânia, 2016.