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Dengue during pregnancy and live birth outcomes: a cohort of linked data from Brazil
  1. Enny S Paixão1,
  2. Oona M Campbell1,
  3. Maria Gloria Teixeira2,
  4. Maria CN Costa2,
  5. Katie Harron3,
  6. Mauricio L Barreto4,
  7. Maira B Leal2,
  8. Marcia F Almeida5,
  9. Laura C Rodrigues1
  1. 1 IDE, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
  2. 2 Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
  3. 3 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
  4. 4 Centro de Integração de Dados e Conhecimento para Saúde, Fiocruz, Salvador, Bahia, Brazil
  5. 5 School of Public Health, Universidade de São Paulo, São Paulo, Brazil
  1. Correspondence to Dr Enny S Paixão; npaixaoenfo{at}


Objectives Dengue is the most common viral mosquito-borne disease, and women of reproductive age who live in or travel to endemic areas are at risk. Little is known about the effects of dengue during pregnancy on birth outcomes. The objective of this study is to examine the effect of maternal dengue severity on live birth outcomes.

Design and setting We conducted a population-based cohort study using routinely collected Brazilian data from 2006 to 2012.

Participating We linked birth registration records and dengue registration records to identify women with and without dengue during pregnancy. Using multinomial logistic regression and Firth method, we estimated risk and ORs for preterm birth (<37 weeks’ gestation), low birth weight (<2500 g) and small for gestational age (<10thcentile). We also investigated the effect of time between the onset of the disease and each outcome.

Results We included 16 738 000 live births. Dengue haemorrhagic fever was associated with preterm birth (OR=2.4; 95% CI 1.3 to 4.4) and low birth weight (OR=2.1; 95% CI 1.1 to 4.0), but there was no evidence of effect for small for gestational age (OR=2.1; 95% CI 0.4 to 12.2). The magnitude of the effects was higher in the acute disease period.

Conclusion This study showed an increased risk of adverse birth outcomes in women with severe dengue during pregnancy. Medical intervention to mitigate maternal risk during severe acute dengue episodes may improve outcomes for infants born to exposed mothers.

  • dengue
  • pregnancy
  • birth outcomes

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  • Contributors ESP, KH and MBL carried out the analysis. ESP wrote the first draft of the article. LCR and MGT conceived the study. MCNC, MLB, OMC and MFA contributed to the study design and interpretation. All authors revised the manuscript and approved the final version.

  • Funding ESP was funded by National Council for Scientific and Technological Development (CNPq-Brazil); LR is partially funded by the European Union’s Horizon 2020 research and innovation program under Zika-PLAN grant agreement No. 734584; KH is funded by the Wellcome Trust (grant number 103975/Z/14/Z).

  • Disclaimer The funder of this study had no role in study design, data collection, data analysis, data interpretation or writing of the report.

  • Competing interests None declared.

  • Ethics approval Ethical approval was obtained from The Federal University of Bahia, Salvador, Brazil (CAAE: 26797814.7.0000.5030) and from The London School of Hygiene & Tropical Medicine (Ethics Ref:10269).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data used in this study are identified, therefore confidential, because they include patient personal information that can be traced back to individual. They are obtainable in the Brazilian Ministry of Health, but restrictions apply to the availability of these data, which were used under licence for the current study, and so are not publicly accessible. Data are however available from the Brazilian Ministry of Health on reasonable request for researchers who meet the criteria for access to confidential data, approved by the Ethics Committee. Email of a contact point in the Department of Health Information Ministry of Health Brazil:

  • Patient consent for publication Not required.

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