• JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
 
  Bookmark and Share
 
 
Tesis Doctoral
DOI
https://doi.org/10.11606/T.6.2019.tde-22032019-085015
Documento
Autor
Nombre completo
Nuria Sánchez Clemente
Instituto/Escuela/Facultad
Área de Conocimiento
Fecha de Defensa
Publicación
São Paulo, 2019
Director
Tribunal
Almeida, Marcia Furquim de (Presidente)
Luna, Expedito José de Albuquerque
Turchi, Marilia Dalva
Waldman, Eliseu Alves
Título en portugués
Infecção vertical pelo vírus Zika e suas repercussões feto-maternais: achados de uma coorte de gestantes em Jundiaí, São Paulo
Palabras clave en portugués
Not available
Resumen en portugués
Not available
Título en inglés
Zika virus infection in pregnancy and its fetomaternal repercussions: findings from a prospective cohort study in São Paulo, Brazil
Palabras clave en inglés
Not available
Resumen en inglés
Prior to its arrival in The Americas in 2014, Zika Virus was thought to cause only mild disease. Following the outbreak in Brazil and the declaration of a Public Health Emergency of International Concern by WHO in February 2016, epidemiological and biological evidence has been published which supports a causal link between prenatal Zika Virus (ZIKV) infection and congenital brain abnormalities including microcephaly. This doctoral thesis uses data from The Jundiaí Zika Cohort, a prospective pregnancy and birth cohort which was set up in The State of São Paulo in 2016 to investigate this causal hypothesis further. A total of 748 pregnant women were recruited from the high-risk pregnancy clinic at Jundiaí University Hospital in the period March 2016 to August 2017. Baseline sociodemographic and medical data were collected at recruitment. Biological samples (blood, saliva, urine) were collected from women at enrolment and regular intervals throughout pregnancy. Women were asked to report any symptoms consistent with ZIKV infection (as per the WHO clinical case definition) and to attend the hospital to be assessed clinically and for samples to be taken. Further biological specimens (colostrum, umbilical cord, placenta, neonatal blood, saliva, urine and cerebro-spinal fluid when appropriate) were obtained at delivery. Urine samples were processed for ZIKV RT-PCR and the rest of the biological material has been stored in a secure biorepository. Anthropometric measures were obtained from the neonates at birth. After creating the master database and carrying out the first thorough analysis of the dataset, I created a cohort profile manuscript which thoroughly detailed the creation, the specific methodology and the preliminary findings of The Jundiaí Zika Cohort. I then employed a prospective cohort study design to investigate the extent to which specific symptoms can be utilized to differentiate ZIKV-infected pregnant women from those with other pregnancy-related problems. Finally, I compared the prevalence of adverse fetal outcomes (prematurity, low birth weight, small-forgestational- age, fetal death and microcephaly) by prenatal Zika Virus (ZIKV) exposure status. The main findings are that most pregnant women positive for ZIKV in urine are asymptomatic and do not deliver a baby with microcephaly, that physical symptoms alone do not differentiate between high risk pregnant women positive or negative for ZIKV and that current clinical case definitions have a low sensitivity for detecting ZIKVpositive women living in active ZIKV transmission areas. In addition, ZIKV infection in high risk pregnant women substantially increases the risk of disproportionate microcephaly but not other adverse fetal outcomes. As a result of this research, we propose clinical case definitions for use in pregnant women living in areas with active ZIKV transmission be revised and that disproportion between head circumference and weight during fetal development should be considered as a diagnostic tool for the presence of a ZIKV-infected fetus.
 
ADVERTENCIA - La consulta de este documento queda condicionada a la aceptación de las siguientes condiciones de uso:
Este documento es únicamente para usos privados enmarcados en actividades de investigación y docencia. No se autoriza su reproducción con finalidades de lucro. Esta reserva de derechos afecta tanto los datos del documento como a sus contenidos. En la utilización o cita de partes del documento es obligado indicar el nombre de la persona autora.
Fecha de Publicación
2019-03-22
 
ADVERTENCIA: Aprenda que son los trabajos derivados haciendo clic aquí.
Todos los derechos de la tesis/disertación pertenecen a los autores
CeTI-SC/STI
Biblioteca Digital de Tesis y Disertaciones de la USP. Copyright © 2001-2020. Todos los derechos reservados.