Pregnancy and Ebola: Maternal and Infant Health Outcomes in Ebola SurvivorsPregnancy and Ebola: Maternal and Infant Health Outcomes in Ebola Survivors https://pediatricsnationwide.org/wp-content/themes/corpus/images/empty/thumbnail.jpg 150 150 Abbie Miller Abbie Miller https://pediatricsnationwide.org/wp-content/uploads/2023/05/051023BT016-Abbie-Crop.jpg
- July 31, 2023
- Abbie Miller
Ebola virus disease during pregnancy is known to cause fetal demise, and preliminary evidence suggested that pregnancies conceived shortly after recovery from Ebola were also at heightened risk of adverse outcomes. Additionally, the perception that health care providers could contract Ebola from survivors during delivery led to stigmatization and barriers to care for pregnant women during the 2014-2016 Ebola outbreak in West Africa.
These issues are addressed in the July 2023 issue of The Lancet Global Health, in a study by an international team of public health researchers that summarizes findings from a large observational birth cohort study. The study was part of the NIH-funded Partnership for Research on Ebola Virus in Liberia (PREVAIL) III research program that identified and followed survivors of Ebola in Liberia and their close contacts for 5 years. The birth cohort sub-study focused on females of child-bearing age seropositive for prior Ebola infection and age/gender-matched seronegative controls.
Mosoka P. Fallah, PhD, MPH, co-lead author of the paper and principal investigator in the Liberian Ministry of Health in Monrovia, and Stephen G. Kaler, MD, MPH, co-corresponding author and principal investigator in the Center for Gene Therapy at Nationwide Children’s Hospital, and colleagues from the National Institutes of Allergy and Infectious Diseases, the John F. Kennedy Medical Center in Monrovia, and the University of Minnesota Division of Biostatistics analyzed pregnancy outcomes in 209 seropositive Ebola survivors and 390 seronegative close contacts from the outbreak. No statistically significant difference in pregnancy outcome was noted between the two groups; the odds of adverse pregnancy outcomes among survivors and close contacts were indistinguishable (OR 1∙13; 95% CI 0∙71-1∙79). The median time between acute Ebola infection and pregnancy conception in the seropositive group was 14 months.
The researchers also used polymerase chain reaction (PCR) to assess the presence of Ebola RNA in samples of the placenta, maternal and umbilical cord blood, and breast milk. Ebola RNA was found in two of 355 breast milk samples and in zero of 205 birth specimens. Therefore, the risk of Ebola virus reactivation in the peri- and post-partum period was low. All newborn babies studied (n=105) showed high levels of anti-Ebola IgG, which declined after 6 months. During a two-year infant follow-up period, the researchers observed subtle differences in growth, fine motor development and language development in this cohort compared to World Health Organization standards, however.
Fear and stigmatization of pregnant Ebola survivors in West Africa had a significant impact in the aftermath of the acute epidemic and led to inadequate care and services for this vulnerable population, report the authors.
“The PREVAIL III birth cohort study goes a long way toward reassuring health care providers and others that such fears are ungrounded in women who recover from Ebola approximately 1 year before conception,” adds Dr. Kaler. “A caveat to the findings is that conception closer chronologically to acute Ebola infection may impose a greater risk of adverse pregnancy outcome. For the current cohort of infants born to Ebola survivors, longer-term assessment of growth and development will also be important as future research.”
The study was sponsored by the National Institute of Allergy and Infectious Diseases.
Fallah MP, Reilly C, Van Ryn C, Badio M, Camanor SW, Kaler SG, Johnson B, Orone R, Flumo H, Moses SJ, Johnson KL, Gorpudolo N, Gayedyu-Dennis D, Dighero-Kemp B, Fayiah J, Marron L, Hensley LE, Taylor RJ, Higgs ES, Lane HC, Neaton JD, Sneller MC. Pregnancy, pregnancy outcomes, and infant growth and development after surviving Ebola virus disease in Liberia: an observational cohort study. The Lancet Global Health. Jul 2023;11(7):E1053-1060.
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