Dengue during pregnancy: risk of death is 4 times higher – 02/20/2024 – Health

With the rise in dengue cases, concern has increased about pregnant women, a group with four times the risk of death, especially if the disease occurs in the third trimester of pregnancy. In maternal dengue, there is also a three times greater chance of death of the fetus or baby.

The alert is from Sogesp (Association of Obstetrics and Gynecology of the State of São Paulo), published last Thursday (15), and brings recommendations for the assistance of pregnant women with dengue.

According to the document, due to the physiological changes caused by pregnancy, many of the signs and symptoms of dengue can be confused, delaying hydration measures and causing more serious conditions.

Therefore, Sogesp recommends, it is important to make a differential diagnosis with other diseases, for example, flu (influenza), measles, rubella, malaria, viral hepatitis, leptospirosis, meningococcemia, sepsis and pre-eclampsia.

Once dengue is confirmed, the pregnant woman already jumps one place in the risk classification. The clinical picture of dengue ranges from mild to more severe and is classified with the letters A, B, C and D. Pregnant women fall into group B, because pregnancy itself is a risk factor.

The Sogesp document advises that the infected pregnant woman stays in an observation bed, is hydrated orally and kept under strict control of vital signs until the test results are collected and checked.

“They must be hospitalized and managed with a greater level of attention, regardless of whether or not a sign of severity has been identified”, says infectious disease specialist André Siqueira, a researcher at Fiocruz and coordinator of a recent review on dengue.

According to doctor Rossana Pulcineli, deputy head of the obstetrics and gynecology department at the Faculty of Medicine of USP (University of São Paulo), even if the pregnant woman has few symptoms, she needs to be closely monitored. “This is the biggest mistake that can happen in a health service: treating pregnant women with dengue as if they were not pregnant,” she says.

Pulcineli explains that during pregnancy there is a greater chance of bleeding. Dengue, by modifying and reducing the number of platelets, further increases this risk. “This increases the difficulty for us to control this hemorrhage.”

Hypertension, which leads to pre-eclampsia, another important cause of maternal death, can also be a confounding factor in the care of pregnant women.

According to Pulcineli, like dengue fever, one of the forms of pre-eclampsia, Hellp syndrome, also causes a reduction in platelets, and these conditions can be confused.

“The person sees that the platelets are low and thinks it is high blood pressure. The treatment for Hellp syndrome is to bring the baby forward. But if the child is delivered and the woman has dengue hemorrhagic fever, there is a risk of death.”

According to Sogesp, a quarter of pregnant women with dengue have at least one warning sign (group C) that will require hospitalization for at least 48 hours and intravenous hydration and clinical and laboratory reassessment every two hours.

Signs include intense and continuous abdominal pain, constant vomiting, postural hypotension, mucosal bleeding, abrupt drop in platelets and respiratory discomfort.

Pregnant women in group D, the most serious, with circulatory shock, require an ICU bed. A 2018 Fiocruz study shows that when a pregnant woman presents with dengue hemorrhagic fever, there is a 450-fold increase in maternal death.

“Although dengue has been with us for so many years, every time there is a new wave it is important to repeat the training of health teams so that they can quickly recognize the signs of severity. At the same time, quick access to structures is needed. suitable to receive these pregnant women”, says Pulcinelli.

Other research shows that if a woman is infected with the dengue virus close to the time of the baby’s birth, the child may be born infected or acquire the disease at the time of birth.

There may also be a threat of miscarriage in the first three months of pregnancy and the risk of the baby being born prematurely. “The more serious the disease, the greater the risk of fetal death and premature birth”, says the doctor.

Even when mild, dengue infection can cause low birth weight and an increased risk of hospitalization for children up to three years after birth.

The disease is not associated with fetal malformations, as is the case with the Zika virus. “If a pregnant woman catches dengue very close to birth, less than ten days, the risk of the child being exposed to dengue increases, due to the fact that the mother has not had time to produce antibodies, and has a serious condition.”

For Fiocruz researcher Enny Paixão, assistant professor at the London School of Hygiene & Tropical Medicine, infections during pregnancy are still a neglected subject and pregnant women and their fetuses are being affected by this.

“Our group has a tradition of studying not only the effects of dengue but also Zika and syphilis. And we have observed adverse effects in children exposed in the womb to these infections,” he says.