Neonatal outcomes associated with maternal arbovirus infection (dengue, Zika, and chikungunya) among pregnant women with obstetric complications in Brazil: a cross-sectional study

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BACKGROUND: Arboviruses, including dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV), pose serious threats to neonatal health; however, the consequences of maternal peripartum infections, particularly those that are asymptomatic, remain poorly characterized. METHODS: This hospital-based cross-sectional study investigated the adverse neonatal outcomes associated with maternal arbovirus infection among pregnant women hospitalized for obstetric complications in Northeast Brazil (October 2018 to May 2019). Maternal and neonatal data were collected through interviews and reviewing medical records. Acute/recent maternal infections were confirmed by molecular or serological assays. Associations between maternal infection (categorized as any arbovirus, ZIKV-only, or CHIKV-only) and neonatal outcomes were assessed using Poisson's regression with robust variance, yielding adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs), controlled for maternal covariates. RESULTS: Among 806 neonates, 131 (16.3%) were born to arbovirus-infected mothers and had a higher prevalence of prematurity (aPR=1.25, 95% CI: 1.00-1.56) and sepsis (aPR=1.74, 95% CI: 1.07-2.83) compared with those born to non-infected mothers. Neonates of ZIKV-infected mothers had a two-fold higher prevalence of sepsis (aPR=2.02, 95% CI: 1.00-4.11) than neonates of non-infected mothers, and a trend was observed for CHIKV (aPR=1.76, 95% CI: 0.97-3.20). CONCLUSIONS: In this hyperendemic region, a high frequency of newborns were exposed to maternal arbovirus infection during the inter-epidemic period, which was associated with increased premature births and neonatal sepsis. These findings underscore the need for increased clinical vigilance and routine screening in endemic areas, necessitating further longitudinal studies to confirm causality and guide management.

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