{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T11:46:23Z","timestamp":1774352783186,"version":"3.50.1"},"reference-count":27,"publisher":"BMJ","issue":"7","funder":[{"DOI":"10.13039\/501100003593","name":"National Council for Scientific and Technological Development","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European Union horizon 2020"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,5,22]]},"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Dengue is the most common viral mosquito-borne disease, and women of reproductive age who live in or travel to endemic areas are at risk. Little is known about the effects of dengue during pregnancy on birth outcomes. The objective of this study is to examine the effect of maternal dengue severity on live birth outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>We conducted a population-based cohort study using routinely collected Brazilian data from 2006 to 2012.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participating<\/jats:title>\n                    <jats:p>We linked birth registration records and dengue registration records to identify women with and without dengue during pregnancy. Using multinomial logistic regression and Firth method, we estimated risk and ORs for preterm birth (&lt;37 weeks\u2019 gestation), low birth weight (&lt;2500\u2009g) and small for gestational age (&lt;10thcentile). We also investigated the effect of time between the onset of the disease and each outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 16 738 000 live births. Dengue haemorrhagic fever was associated with preterm birth (OR=2.4; 95%\u2009CI 1.3 to 4.4) and low birth weight (OR=2.1; 95%\u2009CI 1.1 to 4.0), but there was no evidence of effect for small for gestational age (OR=2.1; 95%\u2009CI 0.4 to 12.2). The magnitude of the effects was higher in the acute disease period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study showed an increased risk of adverse birth outcomes in women with severe dengue during pregnancy. Medical intervention to mitigate maternal risk during severe acute dengue episodes may improve outcomes for infants born to exposed mothers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-023529","type":"journal-article","created":{"date-parts":[[2019,7,25]],"date-time":"2019-07-25T07:35:12Z","timestamp":1564040112000},"page":"e023529","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Dengue during pregnancy and live birth outcomes: a cohort of linked data from Brazil"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4797-908X","authenticated-orcid":false,"given":"Enny S","family":"Paix\u00e3o","sequence":"first","affiliation":[{"name":"IDE, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oona M","family":"Campbell","sequence":"additional","affiliation":[{"name":"IDE, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Gloria","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Coletiva, Federal University of Bahia, Salvador, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria CN","family":"Costa","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Coletiva, Federal University of Bahia, Salvador, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3418-2856","authenticated-orcid":false,"given":"Katie","family":"Harron","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauricio L","family":"Barreto","sequence":"additional","affiliation":[{"name":"Centro de Integra\u00e7\u00e3o de Dados e Conhecimento para Sa\u00fade, Fiocruz, Salvador, Bahia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maira B","family":"Leal","sequence":"additional","affiliation":[{"name":"Instituto de Sa\u00fade Coletiva, Federal University of Bahia, Salvador, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcia F","family":"Almeida","sequence":"additional","affiliation":[{"name":"School of Public Health, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura C","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"IDE, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,7,24]]},"reference":[{"key":"2025121604530591000_9.7.e023529.1","unstructured":"World Health Organization. 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SINAN online- dengue and chikungunya instrucoes para preenchimento. http:\/\/portalsinan.saude.gov.br\/images\/documentos\/Agravos\/Dengue\/Instrucional_DENGUE_CHIK.pdf (Accessed 4 May 2017)."},{"key":"2025121604530591000_9.7.e023529.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60932-6"},{"key":"2025121604530591000_9.7.e023529.18","unstructured":"Brazil\u00a0Ministry of Health. Dengue diagnostic e manejo clinic- adulto e crianca\/Ministerio da Saude, Secretaria de Vigilancia em Saude, Diretoria Tecnica de gestao. 3rd edn. 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Analyzing rare events with logistic regression. 2016. https:\/\/www3.nd.edu\/~rwilliam\/stats3\/RareEvents.pdf (Accessed 4 May 2017)."},{"key":"2025121604530591000_9.7.e023529.22","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0079040","article-title":"Maternal and neonatal outcomes among pregnant women with 2009 pandemic influenza A(H1N1) illness in Florida, 2009-2010: a population-based cohort study","volume":"8","author":"Doyle","year":"2013","journal-title":"PLoS One"},{"key":"2025121604530591000_9.7.e023529.23","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu037"},{"key":"2025121604530591000_9.7.e023529.24","doi-asserted-by":"crossref","first-page":"e33","DOI":"10.1016\/S2352-3018(15)00207-6","article-title":"Perinatal outcomes associated with maternal HIV infection: a systematic review and meta-analysis","volume":"3","author":"Wedi","year":"2016","journal-title":"Lancet HIV"},{"key":"2025121604530591000_9.7.e023529.25","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1016\/S2214-109X(13)70006-8","article-title":"National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010","volume":"1","author":"Lee","year":"2013","journal-title":"Lancet Glob Health"},{"key":"2025121604530591000_9.7.e023529.26","doi-asserted-by":"crossref","first-page":"557","DOI":"10.5123\/S1679-49742013000400002","article-title":"Improved estimates of preterm birth prevalence in Brazil, 200-2011","volume":"22","author":"Matijasevich","year":"2013","journal-title":"Epidemiol Serv Saude"},{"key":"2025121604530591000_9.7.e023529.27","unstructured":"Brazil Ministry of Health. 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