title: Zika virus infection in pregnancy: a systematic review of disease course and complications.
abstract: OBJECTIVE
  To characterize maternal Zika virus (ZIKV) infection and complement the evidence base for the WHO interim guidance on pregnancy management in the context of ZIKV infection.
  
  
  METHODS
  We searched the relevant database from inception until March 2016. Two review authors independently screened and assessed full texts of eligible reports and extracted data from relevant studies. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS) and the National Institute of Health (NIH) tool for observational studies and case series/reports, respectively.
  
  
  RESULTS
  Among 142 eligible full-text articles, 18 met the inclusion criteria (13 case series/reports and five cohort studies). Common symptoms among pregnant women with suspected/confirmed ZIKV infection were fever, rash, and arthralgia. One case of Guillain-Barré syndrome was reported among ZIKV-infected mothers, no other case of severe maternal morbidity or mortality reported. Complications reported in association with maternal ZIKV infection included a broad range of fetal and newborn neurological and ocular abnormalities; fetal growth restriction, stillbirth, and perinatal death. Microcephaly was the primary neurological complication reported in eight studies, with an incidence of about 1% among newborns of ZIKV infected women in one study.
  
  
  CONCLUSIONS
  Given the extensive and variable fetal and newborn presentations/complications associated with prenatal ZIKV infection, and the dearth of information provided, knowledge gaps are evident. Further research and comprehensive reporting may provide a better understanding of ZIKV infection in pregnancy and attendant maternal/fetal complications. This knowledge could inform the creation of effective and evidence-based strategies, guidelines and recommendations aimed at the management of maternal ZIKV infection. Adherence to current best practice guidelines for prenatal care among health providers is encouraged, in the context of maternal ZIKV infection.
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya ku, 157-8535, Tokyo, Japan. ezinne.chibueze@gmail.com.
authors.forename: Ezinne C
authors.initials: EC
authors.lastname: Chibueze
authors.affiliation: Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Veronika
authors.initials: V
authors.lastname: Tirado
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya ku, 157-8535, Tokyo, Japan.
authors.forename: Katharina da Silva
authors.initials: KD
authors.lastname: Lopes
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya ku, 157-8535, Tokyo, Japan.
authors.forename: Olukunmi O
authors.initials: OO
authors.lastname: Balogun
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya ku, 157-8535, Tokyo, Japan.
authors.forename: Yo
authors.initials: Y
authors.lastname: Takemoto
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya ku, 157-8535, Tokyo, Japan.|Graduate School of Human Sciences, Osaka University, Osaka, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Swa
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya ku, 157-8535, Tokyo, Japan.|Department of Health Informatics, Kyoto University, Yoshida Konoe-cho, Syako-ku, Kyoto, Japan.
authors.forename: Amarjargal
authors.initials: A
authors.lastname: Dagvadorj
authors.affiliation: Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Nagata
authors.affiliation: Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Naho
authors.initials: N
authors.lastname: Morisaki
authors.affiliation: Barcelona Institute for Global Health (ISGlobal)-Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.|Department of Reproductive Health and Research World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland.
authors.forename: Clara
authors.initials: C
authors.lastname: Menendez
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya ku, 157-8535, Tokyo, Japan.|St. Luke's International University, Graduate School of Nursing, Global Health Nursing, Tokyo, Japan.
authors.forename: Erika
authors.initials: E
authors.lastname: Ota
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya ku, 157-8535, Tokyo, Japan.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mori
authors.affiliation: Department of Reproductive Health and Research World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland.
authors.forename: Olufemi T
authors.initials: OT
authors.lastname: Oladapo
mesh_terms: D018450:Disease Progression; D005260:Female; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000209:etiology*; D000071244:Zika Virus / Q000472:pathogenicity*; D000071243:Zika Virus Infection / Q000150:complications*