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Sobhani NC, Avvad-Portari E, Nascimento ACM, Machado HN, Lobato DSS, Pereira JP, Esquivel MS, Vasconcelos ZC, Zin AA, Tsui I, Adachi K, Brickley EB, Fisher SJ, Nielsen-Saines K, Brasil P, Moreira ME, Gaw SL. Discordant Zika Virus Findings in Twin Pregnancies Complicated by Antenatal Zika Virus Exposure: A Prospective Cohort. J Infect Dis 2021; 221:1838-1845. [PMID: 31773163 DOI: 10.1093/infdis/jiz629] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There are limited data on the natural history of antenatal Zika virus (ZIKV) exposure in twin pregnancies, especially regarding intertwin concordance of prenatal, placental, and infant outcomes. METHODS This prospective cohort study included twin pregnancies referred to a single institution from September 2015 to June 2016 with maternal ZIKV. Polymerase chain reaction (PCR) testing of maternal, placental, and neonatal samples was performed. Prenatal ultrasounds were completed for each twin, and histomorphologic analysis was performed for each placenta. Abnormal neonatal outcome was defined as abnormal exam and/or abnormal imaging. Two- to three-year follow-up of infants included physical exams, neuroimaging, and Bayley-III developmental assessment. RESULTS Among 244 pregnancies, 4 twin gestations without coinfection were identified. Zika virus infection occurred at 16-33 weeks gestation. Zika virus PCR testing revealed discordance between dichorionic twins, between placentas in a dichorionic pair, between portions of a monochorionic placenta, and between a neonate and its associated placenta. Of the 8 infants, 3 (38%) had an abnormal neonatal outcome. Of 6 infants with long-term follow-up, 3 (50%) have demonstrated ZIKV-related abnormalities. CONCLUSIONS Neonatal PCR testing, placental findings, and infant outcomes can be discordant between co-twins with antenatal ZIKV exposure. These findings demonstrate that each twin should be evaluated independently for vertical transmission.
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Affiliation(s)
- Nasim C Sobhani
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | | | | | | | | | - Mikaela S Esquivel
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Andrea A Zin
- Fiocruz, Fernandes Figueira Institute, Rio de Janeiro, Brazil
| | - Irena Tsui
- Jules Stein Eye Institute, Retina Division, University of California, Los Angeles, Los Angeles, California, USA
| | - Kristina Adachi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, USA
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Susan J Fisher
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Karin Nielsen-Saines
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, USA
| | - Patricia Brasil
- Fiocruz, Fernandes Figueira Institute, Rio de Janeiro, Brazil
| | - Maria E Moreira
- Fiocruz, Fernandes Figueira Institute, Rio de Janeiro, Brazil
| | - Stephanie L Gaw
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
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