Symptomatic dengue and adverse pregnancy outcomes: a population-based record linkage study

Dengue stands out from other viral mosquito borne diseases because it is the most common; its incidence is growing and it is reaching new geographical areas and spreading worldwide. Indeed, reported cases of negative pregnancy outcomes after dengue infection is not new, however, the evidence of the association between maternal dengue and adverse pregnancy outcomes is limited, controversial and mostly supported by cases reports. The aim of this thesis is to explore the relationship between pregnancy outcome and symptomatic maternal dengue. I conducted a population-based study using routinely-collected Brazilian data from 2006-2012. These data have the information required to expand the existing knowledge on birth outcomes from women with dengue acquired during pregnancy. The linkage process imposed complex challenges, and the final linked data showed a low sensitivity. However, it is unlikely that the linkage error introduced bias on the final analysis since it occurred randomly between cases and the comparison group. Our main findings showed that dengue during pregnancy is associated with adverse maternal and birth outcomes. The effect was higher in the acute disease period (first 10/20 days) and severe disease increased the magnitude of the association. Therefore in areas where dengue virus is circulating, the health of pregnant women should be not only a public health priority, but health professionals attending pregnant women with dengue should more closely observe these patients to be able to intervene in a timely way and avoid adverse outcomes.