title: Ebola virus disease and pregnancy: A review of the current knowledge of Ebola virus pathogenesis, maternal, and neonatal outcomes.
abstract: The 2014 to 2016 Ebola virus disease (EVD) outbreak in West Africa devastated local health systems and caused thousands of deaths. Historical reports from Zaire ebolavirus outbreaks suggested pregnancy was associated with an increased risk of severe illness and death, with mortality rates from 74 to 100%. In total, 111 cases of pregnant patients with EVD are reported in the literature, with an aggregate maternal mortality of 86%. Pregnancy-specific data published from the recent outbreak include four small descriptive cohort studies and five case reports. Despite limitations including reporting bias and small sample size, these studies suggest mortality in pregnant women may be lower than previously reported, with five of 13 (39%) infected women dying. Optimal treatments for pregnant women, and differences in EVD course between pregnant women and nonpregnant individuals, are major scientific gaps that have not yet been systematically addressed. Ebola virus may be transmitted from mother to baby in utero, during delivery, or through contact with maternal body fluids after birth including breast milk. EVD is almost universally fatal to the developing fetus, and limited fetal autopsy data prevent inferences on risk of birth defects. Decisions about delivery mode and other obstetric interventions should be individualized. WHO recommends close monitoring of survivors who later become pregnant, but does not recommend enhanced precautions at subsequent delivery. Although sexual transmission of Ebola virus has been documented, birth outcomes among survivors have not been published and will be important to appropriately counsel women on pregnancy outcomes and inform delivery precautions for healthcare providers. Birth Defects Research 109:353-362, 2017. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Department of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.|Massachusetts General Hospital Center for Global Health, Boston, Massachusetts.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bebell
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.|Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Titilope
authors.initials: T
authors.lastname: Oduyebo
authors.affiliation: Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Riley
mesh_terms: D000354:Africa, Western / Q000453:epidemiology; D015331:Cohort Studies; D003588:Cytopathogenic Effect, Viral; D004196:Disease Outbreaks / Q000517:prevention & control; D029043:Ebolavirus / Q000472:pathogenicity*; D005260:Female; D006282:Health Personnel; D019142:Hemorrhagic Fever, Ebola / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008428:Maternal Mortality; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D011256:Pregnancy Outcome
keywords: birth; ebola; fetus; hemorrhagic; outcomes; pregnancy; pregnant; sexually; transmission; women