title: Ebola Virus Disease and Pregnancy: A Retrospective Cohort Study of Patients Managed at 5 Ebola Treatment Units in West Africa.
abstract: BACKGROUND
  Reliable data are lacking on pregnancy outcomes during Ebola virus disease (EVD) epidemics. We aimed to characterize symptoms and outcomes among pregnant women admitted to Ebola treatment units (ETUs) with suspected and confirmed EVD to better inform obstetric management.
  
  
  METHODS
  We analyzed a retrospective cohort of reproductive-aged women presenting to 5 West African ETUs from September 2014 to September 2015. We compared clinical symptoms, risk of EVD diagnosis, and mortality between pregnant and nonpregnant women.
  
  
  RESULTS
  Of 729 reproductive-aged women admitted to study ETUs, 44 (6%) reported pregnancy. Thirteen of 44 pregnant women (30%) tested EVD positive; 6 of 13 (46%) died. Pregnant women were less likely than nonpregnant women to report anorexia, asthenia, diarrhea, fever, myalgias/arthralgias, nausea, or vomiting (P < .05) at admission. Pregnant women with suspected EVD had the same risk, however, of laboratory-confirmed EVD (30% vs 24%, P = .38). While pregnant women with confirmed EVD had similar Ebola viral loads on presentation to nonpregnant women, as measured by initial cycle threshold (26.4 vs 23.2, P = .16), they were less likely to have myalgias/arthralgias (P< .001) and vomiting (P = .02). Both all-cause mortality (14% vs 19%, P = .39) and EVD-specific mortality (46% vs 54%, P = .60) were not significantly different between pregnant and nonpregnant women. Two neonates born live in the ETU died within 8 days.
  
  
  CONCLUSIONS
  We find no evidence to support a difference in the risk of death between pregnant women with suspected or confirmed EVD compared to nonpregnant women. Limited data suggest poor fetal and neonatal outcomes in EVD-affected pregnancies.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.|International Medical Corps, Los Angeles, California.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Henwood
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, and Massachusetts General Hospital Center for Global Health, Boston.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bebell
authors.affiliation: International Medical Corps, Los Angeles, California.
authors.forename: Reshma
authors.initials: R
authors.lastname: Roshania
authors.affiliation: International Medical Corps, Los Angeles, California.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Wolfman
authors.affiliation: International Medical Corps, Los Angeles, California.
authors.forename: Michaela
authors.initials: M
authors.lastname: Mallow
authors.affiliation: International Medical Corps, Los Angeles, California.
authors.forename: Anushka
authors.initials: A
authors.lastname: Kalyanpur
authors.affiliation: International Medical Corps, Los Angeles, California.|Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Levine
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004196:Disease Outbreaks; D029043:Ebolavirus / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D005334:Fever / Q000453:epidemiology; D019142:Hemorrhagic Fever, Ebola / Q000401:mortality / Q000628:therapy / Q000821:virology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007988:Liberia / Q000453:epidemiology; D008428:Maternal Mortality; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000401:mortality / Q000628:therapy / Q000821:virology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012807:Sierra Leone / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
keywords: Ebola virus disease; Liberia; Sierra Leone; maternal mortality; pregnant