# Dengue infection during pregnancy and the occurrence of pathological neonatal outcome: a systematic review and meta-analysis

## TL;DR

This study finds that dengue during pregnancy increases risks of complications like preterm birth and low birth weight, but not all neonatal outcomes are clearly linked.

## Contribution

A systematic review and meta-analysis of dengue's impact on maternal and neonatal outcomes during pregnancy, identifying specific clinical risks.

## Key findings

- Dengue during pregnancy increases risks of postpartum hemorrhage, premature rupture of membranes, and cesarean section.
- Neonatal outcomes like preterm delivery and low birth weight are common but not definitively linked to dengue.
- Common symptoms in infected pregnant women include fever, abdominal pain, vomiting, and anemia.

## Abstract

Dengue infection during pregnancy increases the risk of maternal and neonatal complications; therefore, the objective of this research is to determine these outcomes and describe the clinical manifestations of the infection.

A systematic review of studies published in PubMed, MEDLINE, LILACS, Web of Science, Scopus and thesis repositories published between 2013 and October 2023 was performed. DeCS and MeSH dengue and maternal-neonatal outcome were used. Thirteen studies were selected and the New Castle-Ottawa scale was used to assess their quality. Mantel-Haenszel hazard ratios were calculated to report the overall effect size using random-effects models. All analyses were performed in Rev Man 5.4.1

The 13 studies involved a population of 18,724 pregnant women, with cohorts ranging from 25 to 17,673 pregnant women. The most frequent outcomes in the pregnant women were cesarean section and postpartum hemorrhage, and in the newborns, preterm delivery and low birth weight. According to the New Castle-Ottawa scale, six studies were considered low risk and seven studies moderate risk. Dengue is a risk factor for postpartum hemorrhage (OR: 2.24), premature rupture of membranes (OR: 1.04) and cesarean section (OR: 1.13). It could not be concluded that dengue is a risk factor for the neonatal outcomes studied. The clinical picture of pregnant women with dengue was predominantly fever, abdominal pain, vomiting and nausea, anemia, dyspnea and myalgia.

Pregnancy-related changes in the immune, cardiovascular and coagulation systems, among others, increase the probability of adverse maternal and neonatal outcomes in case of DENV infection, such as postpartum hemorrhage, premature rupture of membranes, cesarean section, low birth weight and preterm delivery. Pregnant women should be considered a population at risk and should be included in dengue control, diagnosis and treatment policies.