Robust epidemiological and biological evidence supports a causal link between prenatal Zika Virus (ZIKV) infection and congenital brain abnormalities including microcephaly. However, it remains uncertain if ZIKV infection in pregnancy also increases the risk for other adverse fetal and birth outcomes. In a prospective cohort study we investigated the influence of ZIKV on the prevalence of prematurity, low birth weight, small-for-gestational-age, and fetal death as well as microcephaly (i.e., overall and disproportionate) in the offspring of women attending a high-risk pregnancy clinic during the recent ZIKV outbreak in Brazil. During the recruitment period (01 March 2016–23 August 2017), urine samples were tested for ZIKV by RT-PCR from all women attending the high-risk pregnancy clinic at Jundiaí University Hospital and from the neonates after delivery. Of the 574 women evaluated, 44 (7.7%) were ZIKV RT-PCR positive during pregnancy. Of the 409 neonates tested, 19 (4.6%) were ZIKV RT-PCR positive in the first 10 days of life. In this cohort, maternal ZIKV exposure was not associated with increased risks of prematurity, low birth weight, small-for-gestational-age, or fetal death. However, relative to ZIKV-negative neonates, ZIKV-positive infants had a five-fold increased risk of microcephaly overall (RR 5.1, 95% CI 1.2–22.5) and a ten-fold increased risk of disproportionate microcephaly (RR 10.3, 95% CI 2.0–52.6). Our findings provide new evidence that, in a high-risk pregnancy cohort, ZIKV RT-PCR positivity in the neonate at birth is strongly associated with microcephaly. However, ZIKV infection during pregnancy does not appear to influence the risks of prematurity, low birth weight, small-for-gestational-age or fetal death in women who already have gestational comorbidities. The results suggest disproportion between neonatal head circumference and weight may be a useful screening indicator for the detection of congenital microcephaly associated with ZIKV infection.

Migrant women who are pregnant or postpartum and their infants are often at increased risk of poorer perinatal outcomes compared to host country populations. This review aimed to identify public health, policy, and clinical interventions to improve maternity care for migrant women and their infants in high-income countries (HICs). In this systematic review we searched EMBASE, EMCARE, MEDLINE and PsycINFO, CENTRAL, Scopus, CINAHL Plus, Web of Science, and grey literature from inception to 13th March 2024, with no language or date restrictions (PROSPERO: CRD42022380678). Interventional and observational studies assessing the effectiveness of any intervention to improve perinatal care for migrant women and their infants in HICs delivered in the pregnancy, peripartum, or postpartum period (up to one year after birth) were included. Quantitative outcomes were extracted. Qualitative studies were excluded. The main outcomes of interest were preterm birth, birthweight, and appointment attendance. Quantitative synthesis was conducted using Harvest plots and binomial exact calculations. 15,689 records were retrieved, 29 studies comprising data from 16,763,837 women were included. 22 studies (75.9%) included multiple interventions. Five interventions had strong evidence of effectiveness. Two clinical interventions: 100.0% of studies including specialist multidisciplinary teams improved one or more of the main outcomes of interest, namely preterm birth, birthweight, and appointment attendance (95% confidence interval 73.5–100.0%; p < 0.001); and 90.9% of studies including specialist in-person interpreting improved one or more of the main outcomes of interest (58.7–100.0%; p = 0.012). Three public health or policy interventions: 100.0% of social welfare interventions (75.3%–100.0%; p < 0.001) improved one or more of the main outcomes of interest; 100.0% of maternal education interventions (71.5–100.0%. p < 0.001), and 83.3% of studies assessing access to free healthcare (51.6–97.9%; p = 0.039). The findings suggest that multicomponent interventions comprising multidisciplinary teams, in-person interpreting, maternal education, and social welfare support can improve perinatal outcomes for migrant women and their infants. Removing financial barriers to care may improve perinatal outcomes and be cost saving to healthcare systems. However, these findings should be interpreted with caution given that most included studies were of poor quality and that sensitivity analysis restricting to interventional studies only did not demonstrate any effect on the main outcomes of interest. KS is supported by a 10.13039/501100000272 National Institute for Health Research (NIHR) Doctoral Fellowship (NIHR302577). HRJ is supported by an NIHR Advanced Fellowship (NIHR303183). HRJ is supported by NIHR Applied Research Collaboration (ARC) South London. MM is supported by a 10.13039/501100000265 Medical Research Council Clinical Research Training Fellowship (Grant number MR/W01498X/1). GF is supported by a 10.13039/501100024811 Nuffield Department of Population Health Clinical Research Fellowship. MK is an NIHR Senior Investigator (NIHR303806). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Congenital Zika virus (ZIKV) infection may present with a broad spectrum of clinical manifestations. Some sequelae, particularly neurodevelopmental problems, may have a later onset. We conducted a prospective cohort study of 799 high-risk pregnant women who were followed up until delivery. Eighty-three women and/or newborns were considered ZIKV exposed and/or infected. Laboratory diagnosis was made by polymerase chain reaction in the pregnant mothers and their respective newborns, as well as Dengue virus, Chikungunya virus, and ZIKV serology. Serology for toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and syphilis infections were also performed in microcephalic newborns. The newborns included in the study were followed up until their third birthday. Developmental delay was observed in nine patients (13.2%): mild cognitive delay in three patients, speech delay in three patients, autism spectrum disorder in two patients, and severe neurological abnormalities in one microcephalic patient; sensorineural hearing loss, three patients and dysphagia, six patients. Microcephaly due to ZIKV occurred in three patients (3.6%). Clinical manifestations can appear after the first year of life in children infected/exposed to ZIKV, emphasizing the need for long-term follow-up.

Purpose The Jundiaí Zika Cohort (JZC) is a prospective pregnancy and birth cohort setup in the State of São Paulo, Brazil, to investigate the epidemic of cases of microcephaly and other neurological disorders, presumed to be associated with Zika virus (ZIKV) infection. Participants A total of 748 women with high-risk pregnancies were recruited in the period of March 2016 to August 2017. Findings to date Baseline sociodemographic and medical data were collected at recruitment from 737 pregnant women. Biological samples (ie, blood, saliva and urine) were collected from 695 of the pregnant women (94.3%), of whom 53 (7.6%) were ZIKV-positive on subsequent testing by reverse transcription polymerase chain reaction (RT-PCR) in urine. Biological sample (ie, blood, saliva, urine and cerebrospinal fluid) were collected within 10 days of birth from 409 (57.4%) of the liveborn infants, of whom 19 (4.6%) were ZIKV-positive on subsequent testing by RT-PCR in urine. All remaining biological specimens, as well as colostrum, umbilical cord and placental samples, have been stored in a secure biorepository. Antenatal and postnatal imaging studies and neonatal anthropometry were carried out. Future plans The JZC provides a unique data set which will continue to be explored to study the effects of pregnancy comorbidities on Zika virus infection during pregnancy, the long-term outcomes of children with congenital Zika infection and how physiotherapy and group interventions can improve outcomes for congenitally-infected children. All women in the cohort have reached the end of their pregnancy and currently the oldest children are 2 years old. The study will continue until all the children reach their third birthday (April 2021).

Critical respiratory manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are rare in children, and little is known about how immunocompromised children respond to the infection. We report a case of a 4-year-old boy with activated PI3K delta syndrome type 2 (APDS2) with a protracted and severe COVID-19 course with both inflammatory and acute respiratory features. He was treated with remdesivir, nitazoxanide, high-dose corticosteroids, and tocilizumab and made a full recovery. We propose that remdesivir may be used in combination with nitazoxanide to improve viral clearance and reduce the chance of resistance in treating acute SARS-CoV-2 infection.