Dengue virus infection during pregnancy increased the risk of adverse fetal outcomes? An updated meta-analysis

Objective: To evaluate the effect of maternal dengue virus (DENV) infection during pregnancy in premature birth, low birth weight, miscarriage and stillbirth. Methods: Systematic electronic literature searches were conducted including PubMed, Medline, Embase, Web of science, Scopus and the Cochrane Library database, up until July 5, 2017. Effect sizes were estimated by using the relative risk (RR) or odds ratio (OR) with theirs corresponding 95% confidence interval (CI). Subgroup analyses were conducted for study design (prospective or retrospective) and clinical symptom of participants (symptomatic or asymptomatic). Statistical analysis was conducted by STATA 12.0. Results: The initial systematic literature searches identified 1048 studies. After screening, fourteen studies were included. The pooled results did not suggest maternal DENV infection might increase the risk of adverse fetal outcomes with a pooled RR of 0.96 (95% CI: 0.85-1.09, I-2 = 49.6%) for premature birth, RR of 0.99 (95% CI: 0.87-1.12, I-2 = 35.1%) for low birth weight, OR of 1.77 (95% CI: 0.99-3.15, I-2 = 17.5%) for miscarriage and RR of 3.42 (95% CI: 0.76-15.49, I-2 = 54.8%) for stillbirth. Subgroup analysis of studies in symptomatic participants still did not indicate DENV infection appeared to be a risk factor for premature birth, low birth weight and miscarriage with pooled effect size of 0.99 (95% CI: 0.87-1.13, I-2 = 49.3%), 1.22 (95% CI: 0.827-1.80, I-2 = 55.1%) and 1.19 (95% CI: 0.56-2.55, I-2= 4.7%), respectively. Conclusions: Current evidence did not suggest that maternal DENV infection during pregnancy might increase the risk of premature birth, low birth weight, miscarriage and stillbirth.