Am J Perinatol
DOI: 10.1055/s-0041-1740057
SMFM Fellows Research Series

Middle Cerebral Artery Dopplers and Abnormal Neonatal Outcomes among Pregnant Women with Zika Virus Infection

1  Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of California, Los Angeles, School of Medicine, Los Angeles, California
,
Jose Paulo Pereira Jr
2  Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
,
3  Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, San Francisco, California
,
Renan Fonseca Cardozo
2  Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
,
Helena Abreu Valle
2  Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
,
Beatriz Ribeiro Torres Dutra
2  Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
,
Helder Dotta Gama
2  Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
,
Maria Elisabeth Moreira
2  Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
,
Zilton Vasconcelos
2  Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
,
Marcos Pone
2  Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
,
Stephanie L. Gaw
3  Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, San Francisco, California
› Author Affiliations
Funding SLG was supported by National Institutes of Health (NIAID K08AI141728, NICHD K12HD000849), the Burroughs Wellcome Fund for the Reproductive Scientist Development Program, the Queenan Fellowship from the Foundation for the Society of Maternal-Fetal Medicine, and the UCSF National Center of Excellence in Women's Health. Additional support was received from Departamento de Ciência e Tecnologia (DECIT) do Ministério da Saúde do Brasil (CNPq 441098/2016–9), the Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (Faperj E_18/2015TXB), the Wellcome Trust (205377/Z/16/Z), the United Kingdom's Department for International Development, and the European Union's Horizon 2020 Research and Innovation Program under Zika-PLAN grant agreement no. 734584.

Abstract

Objective The aim of this study was to investigate the role of middle cerebral artery (MCA) Doppler measurements for the prediction of abnormal neonatal outcomes in pregnancies affected by Zika virus (ZIKV).

Methods Secondary analysis of a prospective cohort of pregnant women diagnosed with ZIKV infection from September 2015 to December 2016 at a single regional referral center. Ultrasonography with measurements of MCA peak systolic velocity (PSV), PSV multiples of the median (MoM) for gestational age, and pulsatility index (PI) were collected. The primary outcome was a composite abnormal neonatal outcome. MCA Doppler values of normal and abnormal neonatal outcomes were compared with Wilcoxon rank sum test. The predictive value of MCA Dopplers for development of abnormal neonatal outcome was calculated by logistic regression.

Results One-hundred twenty-seven ZIKV-positive pregnancies with MCA Doppler measurements and known neonatal outcomes were included. Of the 132 neonates, 66 (50%) had an abnormal neonatal outcome. Lower MCA PSV (p = 0.027) and PSV MoM (p = 0.008) were associated with abnormal neonatal outcomes. There was no significant difference in MCA PI. Abnormal neonatal outcomes had lower MCA PSV by 5.36 cm/s (95% confidence interval [CI]: 0.95–9.77, p = 0.018) and lower MCA PSV MoM by 0.13 (95% CI: 0.05–0.22, p = 0.002). MCA PSV of 30 cm/s had a 65% predicted probability of an abnormal neonatal outcome (95% CI: 51–79%).

Conclusion In ZIKV-infected pregnancies, lower MCA PSV and PSV MoM measurements were seen with abnormal neonatal outcomes. This may represent a physiologic response to fetal ZIKV infection. Evaluation of MCA Dopplers may be of clinical utility in the surveillance of ZIKV-affected pregnancies.

Key Points

  • Significantly lower MCA PSV is associated with abnormal neonatal outcomes in ZIKV pregnancies.

  • Lower MCA PSV may reflect the underlying neuropathology of ZIKV exposure on the fetus.

  • There is potential utility for MCA Doppler evaluation in antepartum surveillance of ZIKV pregnancies.



Publication History

Received: 31 May 2021

Accepted: 03 October 2021

Publication Date:
28 November 2021 (online)

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