Abstract
Background
Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results.
Methods
We aimed to assess neurodevelopmental outcomes among normocephalic children born from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study, July–December 2016. Enrollment occurred during the first prenatal visit. Exposure was defined as prenatal ZIKV IgM and/or ZIKV RNA result at enrollment. Normocephalic children, >6 months old, were selected for longitudinal follow-up using the Bayley Scales of Infant and Toddler Development (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE-2).
Results
One hundred fifty-two children were assessed; after exclusion, 60 were exposed and 72 were unexposed to ZIKV during pregnancy. Twenty children in the exposed group and 21 children in the unexposed group had a composite score <85 in any of the BSID-III domains. Although exposed children had lower cognitive and language scores, differences were not statistically significant. For ASQ:SE-2 assessment, there were not statistically significant differences between groups.
Conclusions
This study found no statistically significant differences in the neurodevelopment of normocephalic children between in utero ZIKV exposed and unexposed. Nevertheless, long-term monitoring of children with in utero ZIKV exposure is warranted.
Impact
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This study found no statistically significant differences in the neurodevelopment in normocephalic children with in utero Zika virus exposure compared to unexposed children, although the exposed group showed lower cognitive and language scores that persisted after adjustment by maternal age and education and after excluding children born preterm and low birth weight from the analysis.
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Children with prenatal Zika virus exposure, including those normocephalic and have no evidence of abnormalities at birth, should be monitored for neurodevelopmental delays. Follow-up is important to be able to detect developmental abnormalities that might not be detected earlier in life.
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Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
We thank Karla Rivera and Renato Valenzuela, Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras, for their administrative support. We thank Andrea Meyer, Center for Emerging Reproductive and Perinatal Epidemiology (CERPE), Tulane University, New Orleans, Louisiana, USA, for editing this manuscript and administrative support.
Funding
The Zika in Pregnancy in Honduras (ZIPH) study is partially funded by Vysnova Partners SC-2018–3045-TU.
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Contributions
P.B., V.T.T., J.A., M.L.C., E.W.H., S.M.G. and D.W. contributed to the conception and design of the research. R.L. examined the children and performed BSID-III and ASQ:SE-2 assessments. L.W., Allison C., M.C., J.F., F.R., Diana V., Douglas V., Z.A., M.B., H.B., C.B., Alejandra C., Alvaro C., J.G.A., K.G., L.G., S.M.G., E.W.H., G.H., W.L., M.T.L., Carlos M., Cynthia M., C.O., K.P., H.R., A.P.C., C.S., D.W., C.Z. and A.F.T. contributed to the acquisition, analysis and/or interpretation of data. K.G., I.L., L.P. and D.W. contributed to the performance and analysis of the laboratory tests. J.A., M.L.C., V.T.T., P.B., L.W., Diana V., S.M.G. and E.W.H. drafted and revised the manuscript. All authors reviewed and approved the submitted version of the manuscript.
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The authors declare no competing interests.
Ethics approval and consent to participate
The study was approved by the Tulane University, New Orleans, USA and the Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras, institutional review boards. Informed consent was obtained from parents or caretakers of all participating children. As described, all methods and procedures were performed in accordance with the relevant guidelines and regulations.
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Alger, J., Cafferata, M.L., López, R. et al. Neurodevelopmental assessment of normocephalic children born to Zika virus exposed and unexposed pregnant people. Pediatr Res 95, 566–572 (2024). https://doi.org/10.1038/s41390-023-02951-1
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DOI: https://doi.org/10.1038/s41390-023-02951-1
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