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Dengue and Pregnancy

 SubashDengue and Pregnancy:

Backgrounds: Dengue is common in tropical and sub-tropical countries, and is spread to people through the bite of an infected Aedes species mosquito. Infections during pregnancy increase the risk of health problems for both the mother and the unborn child such as preterm birth and fetal death1 collectively known as “adverse birth outcomes”. So far few study about dengue infection during pregnancy and adverse birth outcome has been reported where the author compared infection with dengue and without dengue in pregnancy2.  The author reported near significant association between dengue and inutero death. The author also went on to prove his outcomes with research-based evidences that risk of infection is high in the second or third trimester due to high grade fever caused by dengue virus which may in turn lead to adverse birth outcome including fetal death.  A study published in August 2018 in Nature Communication come up with outcomes of prior exposure of dengue immunity and its effects on maternal and fetal health during ZIKA virus infection in pregnancy3. Even after deliveries neonatal had risk of severe postpartum hemorrhage, subconjunctival hemorrhage, and bilateral pleural effusion.

Risk Factor: In the absence of timely intervention, the risk of infection increases the risk of medical complications like heavy loss of blood during delivery or within the first 24 hours of childbirth.

Symptoms:

People who are infected with dengue will develop symptoms including fever and headache, eye pain, muscle, joint or bone pain, rash or nausea. A pregnant woman with dengue infection will have common symptoms like high grade fever with shivers, abdominal pain and tenderness, persistent vomiting, lethargy, bleeding from the gums, dehydration, loss of taste for food, severe headache and body pain, low platelet count in severe cases & rash. Such rash appears like flushed skin on Day1-2 and later like measles and myalgia4.

Diagnosis:

When platelet count drops, blood pressure lowers and the patient may experience bleeding, this is a condition known as dengue high fever and it can be life threatening.

As opposed to routine dengue managements based on pellets counts, the initially clinical management is started based on subjective judgments of the attending clinician during pregnancy5.

Rapid NS1 antigen can be detected on Day 3 of fever, Dengue IGM detected after Day 5 of fever. Full Blood Count (CBC/FBC) as a baseline, as well as to monitor progress of disease is most important tool.

Treatment:

Tepid sponging is recommended for fever as first aid. A fluid intake of 2.5 lits per day should be aimed which may include ORS, coconut water, juices etc. Solid food should be avoided until condition improves. If Nausea/Vomiting due to pregnancy makes oral intake difficult, IV fluid (NS) at the rate 100 cc/ hour should be administered6. Take medicine only if required and prescribed by authorised medical practitioners.

Prevention:

The best way to prevent a dengue infection is to prevent mosquito bites. As is common knowledge, the dengue virus is the most rapidly spreading virus transmitted by mosquitoes and there are no available vaccines to prevent the infection. All pregnant patients with suspected dengue fever are advised hospital admission for close monitoring. However common precautionary measures that may help prevent dengue fever in pregnant women are the use of mosquito repellents and trying to stay in a cool room, as these mosquitoes prefer warmer environs. The most important thing to be kept in mind is that, when the symptoms are observed, a blood test should be done at the earliest to check whether one has dengue or not.

According to Center for Disease Control and Prevention, USA.

If you or a family member have dengue, it is important to avoid mosquito bites during the first week of illness to prevent further spread of the virus.

Once a week, empty and scrub, turn over, cover, or throw out any item that holds water, such as tires, buckets, planters, toys, pools, birdbaths, or trash containers. Check inside and outside your home.

Subash C. Sonkar, Ph.D

LMIC Fellow at Public Health Research Institute of India, Mysore., GHES Fellow at Florida International University, USA.

Note: The views expressed here are of the author and do not represent the views of the GHES Program, the U.S. Department of State or any of its partner organizations.

February 1, 2019

 

References:

1. Pouliot SH, Xiong X, Harville E, et al. Maternal dengue and pregnancy outcomes: a systematic review. Obstet Gynecol Surv 2010; 65: 107–18.

2. Basurko C, Everhard S, Matheus S, Restrepo M, HildeÂral H, Lambert V, et al. (2018) A prospective matched study on symptomatic dengue in pregnancy. PLoS ONE 13(10): e0202005.

3. Regla-Nava, J. A., Elong Ngono, A., Viramontes, K. M., Huynh, A. T., Wang, Y. T., Nguyen, A. T., Salgado, R., Mamidi, A., Kim, K., Diamond, M. S., … Shresta, S. (2018). Cross-reactive Dengue virus-specific CD8+ T cells protect against Zika virus during pregnancy. Nature communications, 9(1), 3042. doi:10.1038/s41467-018-05458-0

4. Nimmanitya S. Management of dengue and dengue haemorrhagic fever. In: Monograph on dengue/dengue haemorrhagic fever, 1993, WHO/SEARO, New Delhi, Regional Publication No. 22.

5. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control: New Edition. Geneva: World Health Organization; 2009. 4, LABORATORY DIAGNOSIS AND DIAGNOSTIC TESTS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK143156/

6. Handbook for Clinical Management of Dengue, http://www.wpro.who.int/mvp/documents/handbook_for_clinical_management_of_dengue.pdf

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