DENGUE IN PREGNANT WOMEN: A POTENTIAL THREAT TO MATERNAL-FETAL OUTCOMES?

Abstract

INTRODUCTION: Dengue is an acute febrile disease, caused by the DENV virus and transmitted mainly by mosquitoes of the genus Aedes. It is an endemic pathology mostly in countries in Asia and America. The clinical course is usually divided into three phases: febrile, critical and recovery, with fever being the initial symptom, sometimes accompanied by anorexia, vomiting, diarrhea and maculopapular rash. The critical phase is characterized by increased capillary permeability, which results in hemorrhage, shock, and organ dysfunction due to the accumulation of fluid, which is gradually reabsorbed in the recovery phase. The diagnosis of dengue is made after the detection of the NS1 antigen; genome, by RT-PCR; or IgM or IgG antibodies. Treatment is symptomatic only. During pregnancy, studies suggest that there is an increase in adverse maternal-fetal outcomes in the face of DENV infection, in addition to challenging diagnosis, due to pregnancy physiological adaptations. In this context, this systematic review aims to analyze how dengue behaves in pregnant women and the outcome of the infection. METHODS: searches were performed in PubMed, with the keywords "dengue pregnancy", in LILACS, using "dengue pregnancy" and "dengue embarazo", and in Scielo, using "dengue pregnancy". A total of 188, 18, 21 and 1 results were obtained, respectively, and after exclusion by title and abstract, and by full text, 32 articles were included. RESULTS: Of the maternal outcomes, severe thrombocytopenia and death were the most cited in the articles, followed by postpartum hemorrhage, more severe forms of the disease, need for cesarean section, and preeclampsia. The most prevalent fetal repercussion was prematurity, in addition to stillbirths, neonatal deaths, low birth weight, and oligohydramnios. DISCUSSION: The articles analyzed suggest that dengue fever in pregnancy increases the risk of severe forms of the disease, postpartum hemorrhage, maternal death, miscarriage, stillbirths, fetal growth restriction, prematurity and oligohydramnios, especially in the face of infections acquired in the 3rd trimester of pregnancy. Vertical transmission also increases at the end of pregnancy. CONCLUSION: this review highlights that dengue is especially relevant during pregnancy, with a significant negative impact on maternal and fetal outcomes. However, more studies are still needed for further study, since there is no consensus.