To estimate the rates of maternal-fetal transmission of Zika virus, adverse fetal/neonatal outcomes, and subsequent rates of asymptomatic/symptomatic congenital Zika virus infections up to the first ...week of life.
Cohort study with prospective data collection and subsequent review of fetal/neonatal outcomes.
Referral centre for prenatal diagnosis of the French Guiana Western Hospital.
Pregnant women at any stage of pregnancy with a laboratory confirmed symptomatic or asymptomatic Zika virus infection during the epidemic period in western French Guiana. The cohort enrolled 300 participants and prospectively followed their 305 fetuses/newborns.
Rate of maternal-fetal transmission of Zika virus (amniotic fluid, fetal and neonatal blood, urine, cerebrospinal fluid, and placentas); clinical, biological, and radiological outcomes (blindly reviewed); and adverse outcomes defined as moderate signs potentially related to congenital Zika syndrome (CZS), severe complications compatible with CZS, or fetal loss. Associations between a laboratory confirmed congenital Zika virus infection and adverse fetal/neonatal outcomes were evaluated.
Maternal-fetal transmission was documented in 26% (76/291) of fetuses/newborns with complete data. Among the Zika virus positive fetuses/newborns, 45% (34/76) presented with no signs/complications at birth, 20% (15/76) with moderate signs potentially related to CZS, 21% (16/76) with severe complications compatible with CZS, and 14% (11/76) with fetal loss. Compared with the Zika virus positive fetuses/neonates, those that were identified as negative for Zika virus (215/291) were less likely to present with severe complications (5%; 10/215) or fetal loss (0.5%; 1/215; relative risk 6.9, 95% confidence interval 3.6 to 13.3). Association between a positive Zika virus test and any adverse fetal/neonatal outcome was also significant (relative risk 4.4, 2.9 to 6.6). The population attributable fraction estimates that a confirmed congenital Zika virus infection contributes to 47% of adverse outcomes and 61% of severe adverse outcomes observed.
In cases of a known maternal Zika virus infection, approximately a quarter of fetuses will become congenitally infected, of which a third will have severe complications at birth or fetal loss. The burden of CZS might be lower than initially described in South America and may not differ from other congenital infections.
Whether prolonged maternal viremia after Zika virus infection represents a risk factor for maternal-fetal transmission and subsequent adverse outcomes remains unclear. In this prospective cohort ...study in French Guiana, we enrolled Zika virus-infected pregnant women with a positive PCR result at inclusion and noninfected pregnant women; both groups underwent serologic testing in each trimester and at delivery during January-July 2016. Prolonged viremia was defined as ongoing virus detection >30 days postinfection. Adverse outcomes (fetal loss or neurologic anomalies) were more common in fetuses and neonates from mothers with prolonged viremia (40.0%) compared with those from infected mothers without prolonged viremia (5.3%, adjusted relative risk aRR 7.2 95% CI 0.9-57.6) or those from noninfected mothers (6.6%, aRR 6.7 95% CI 3.0-15.1). Congenital infections were confirmed more often in fetuses and neonates from mothers with prolonged viremia compared with the other 2 groups (60.0% vs. 26.3% vs. 0.0%, aRR 2.3 95% CI 0.9-5.5).
Objectives: To correlate placental thickness during pregnancy and histopathological results with placental Zika virus (ZIKV) infection.Methods: During the ZIKV epidemic in French Guiana, ...trans-placental contamination was defined either by a positive RT-PCR or identification of specific IgM in at least one placental, fetal or neonatal sample. Placentas were classified as non-exposed (from non-infected pregnant woman), exposed (from ZIKV-infected pregnant women without trans-placental contamination) or infected (from ZIKV-infected pregnant women with proven trans-placental contamination). Placentas were assessed by monthly prenatal ultrasound, measuring placental thickness and umbilical artery Doppler, and anatomopathologic examination after birth or IUFD. Placental thickness during pregnancy and anatomopathologic findings were correlated to the ZIKV-status of the placenta.Results: Among 291 fetuses/placentas from proven infected mothers, trans-placental infection was confirmed in 76 cases, of which 16 resulted in Congenital Zika Syndrome (CZS) and 11 in fetal loss. The 215 remaining placentas without evidence of ZIKV infection represented the exposed group. A total of 334 placentas from ZIKV-negative pregnant women represented the non-exposed group. Placentomegaly (thickness>40 mm) was observed more frequently in infected placentas (39.5%) compared to exposed placentas (17.2%) or controls (7.2%), even when considering gestational age at diagnosis and co-morbidities (adjusted Hazard Ratio aHR 2.02 95%CI 1.22-3.36 and aHR 3.23 95%CI 1.86-5.61, respectively), and appeared earlier in infected placentas. Placentomegaly was observed even more frequently in case of CZS (62.5%) or fetal loss (45.5%) compared to asymptomatic congenital infection (30.6%) (aHR 5.43 95%CI 2.17-13.56 and aHR 4.95 95%CI 1.65-14.83, respectively). Umbilical artery Doppler anomaly was observed more frequently in case of trans-placental infection resulting in fetal loss (30.0% vs 6.1%; adjusted Relative Risk aRR 4.83 95%CI 1.09-20.64). Infected placentas also exhibited a higher risk of any pathological anomalies than exposed placentas (aRR 2.60 1.40-4.83).Conclusions: Early placentomegaly may represent the first sign of trans-placental contamination and should lead to an enhanced follow-up of these pregnancies.
Conformations of Cα backbones in X-ray structures of most organophosphate (OP)-inhibited human acetylcholinesterases (hAChEs) have been previously shown to be similar to that of the native hAChE. One ...of the exceptions is the structure of the diethylphosphoryl-hAChE conjugate, where stabilization of a large ethoxy group into the acyl pocket (AP) of hAChE-triggered notable loop distortions and consequential dissociation of the hAChE homodimer. Recently, six X-ray structures of hAChE conjugated with large OP nerve agents of the A-type, Novichoks, have been deposited to PDB. In this study we analyzed backbone conformation shifts in those structures, as well as in OP-hAChE conjugates formed by Paraoxon, Soman, Tabun, and VX. A Java-based pairwise alpha carbon comparison tool (PACCT 3) was used for analysis. Surprisingly, despite the snug fit of large substituents on phosphorus, inside Novichok-conjugated hAChEs only minor conformational changes were detected in their backbones. Small magnitudes of observed changes were due to a 1.2–2.4 Å shift of the entire conjugated OP away from the AP. It thus appears that the small AP of AChEs can accommodate, without distortion, substituents of the size of ethoxy or butyryl groups, provided that conjugated OP is “pulled” away from the AP. This observation has practical consequences in the structure-based design of nucleophilic reactivation antidotes as well as in the definition of the AChE specificity that relies on the size of its AP.
Background:
Pregnancy mobile applications (apps) have grown in popularity over the past decade, with some being used to promote study recruitment or health behaviors. However, no app serves as an ...all-in-one solution for collecting general data for research purposes and providing women with useful and desirable features.
Aim:
To create and develop a Swiss pregnancy mobile app as an innovative means to collect research data and provide users with reliable information.
Methods:
Determining the key features of the app involved a review of the literature and assessment of popular apps in the Swiss AppStore. A team of engineers developed the app, which includes a pregnancy timeline, questionnaires for data collection, medical and psychological articles and a checklist with appointment reminders. The content was written and reviewed by healthcare providers considered experts in the topics adressed. The questionnaires are distributed based on the user’s gestational age, by a chatbot. The project was authorized by the ethics commission in the canton of Vaud. An online survey of ten questions, advertised on Datamama’s home screen, was conducted to assess the users’ use of the app (27.11- 19.12.2022).
Results:
A review of 84 articles and 25 popular apps showed the need for a comprehensive pregnancy app. The development of Datamama took 2 years and included the creation of 70 medical and psychological articles and 29 questionnaires covering 300 unique variables. Six months after the launch, there were 800 users with a 73% average participation rate in the questionnaires. Sixty-five women completed the survey, with 70.8% using the app once to multiple times per week. The primary reason for using the app was to help research by answering the questionnaires, followed by access to reliable medical information. The reason most frequently ranked first for using the app was to help research by answering the questionnaires (42/65, 67% of women rated it first), followed by access to reliable medical information (34/65, 54% women rated it second). Women rated the information as clear, understandable, and interesting with a trust rating in data handling at 98.5%. The average grade for recommending the app was 8/10, with suggestions for increasing the amount of medical content and tailoring it based on gestational age.
Conclusion:
Datamama is the first pregnancy app to address the needs of both patients and researchers. Initial feedback from users was positive, highlighting future challenges for success. Future work will consist in improving the app, validating the data and use it to answer specific pregnancy-related research questions.
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