{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T19:24:19Z","timestamp":1771529059677,"version":"3.50.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014009","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000}}],"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["AI140718, AI129534, AI172252 and EY028318"],"award-info":[{"award-number":["AI140718, AI129534, AI172252 and EY028318"]}]},{"name":"Brazilian National Council for Scientific and Technological Development, CNPq","award":["311657\/2023-5, 441098\/2016-9 and 305090\/2016-0"],"award-info":[{"award-number":["311657\/2023-5, 441098\/2016-9 and 305090\/2016-0"]}]},{"name":"Carlos Chagas Filho Foundation Research Support for the State of Rio de Janeiro, FAPERJ","award":["E_18\/2015TXB"],"award-info":[{"award-number":["E_18\/2015TXB"]}]},{"name":"Doximity Foundation"},{"name":"UCSF Resident Clinical and Translational Research"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Zika virus (ZIKV) is primarily known for its impact on the fetal central nervous system potentially leading to Congenital Zika Syndrome (CZS). Emerging evidence suggests ZIKV may also affect cardiac development. We conducted a follow-up study evaluating cardiologic findings in infants from ZIKV-exposed mothers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Infants born to mothers with PCR-confirmed ZIKV infection during pregnancy and\/or who had positive ZIKV PCR results at birth received echocardiograms in the first year of life. Repeat imaging within 12 months was requested for infants with identified abnormalities. Frequencies of cardiovascular (CV) abnormalities were evaluated using Pearson \u03c72 test, Fisher\u2019s exact test, and descriptive statistics. Predictors of CV abnormalities were assessed using multivariate logistic regression, as well as univariate and multivariate prevalence estimates. Sensitivity analysis assessed the robustness of associations when stratified by age at echocardiography (early vs late).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One hundred sixty-nine children with antenatal ZIKV-exposure had echocardiograms; 30.8% were microcephalic (MC). Thirty (17.8%) had cardiac anomalies. MC children had a higher frequency of CV abnormalities than normocephalic (NC) children (26.9% vs 13.7%, p\u2009=\u20090.04). Twenty-four of 30 children (80.0%) returned for repeat imaging; of that group, 25.0% continued to demonstrate defects. Rates of persistent defects between the MC vs. NC cohorts were 33.3% vs 16.7%, respectively (p\u2009=\u20090.64). Presence of CV defects was significantly associated with MC (OR=3.40, 95% CI 1.15-10.02; p\u2009=\u20090.03). Among those with echocardiography performed later, MC was still associated with higher risk of abnormalities (OR=6.0, 95% CI 1.03-34.94; p\u2009=\u20090.046).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A higher frequency of cardiac defects was noted in ZIKV-exposed infants than the general population. Most defects resolved on follow-up. The presence of a congenital heart defect (CHD) could be considered a parameter of CZS given its association with MC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014009","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T18:41:04Z","timestamp":1770921664000},"page":"e0014009","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiac findings in infants with in utero exposure to Zika virus \u2013 a follow up longitudinal study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0775-4572","authenticated-orcid":true,"given":"Brian N.","family":"Dang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Kikuta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trevon","family":"Fuller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Brasil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zilton","family":"Vasconcelos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dulce H. G.","family":"Orofino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Elizabeth L.","family":"Moreira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1742-5211","authenticated-orcid":true,"given":"Karin","family":"Nielsen-Saines","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"issue":"5","key":"pntd.0014009.ref001","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/0035-9203(52)90042-4","article-title":"Zika virus. I. Isolations and serological specificity","volume":"46","author":"GWA Dick","year":"1952","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"10","key":"pntd.0014009.ref002","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.3201\/eid2110.150847","article-title":"Zika Virus Outbreak, Bahia, Brazil","volume":"21","author":"GS Campos","year":"2015","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"pntd.0014009.ref003","first-page":"20","article-title":"Zika Virus infection, basic and clinical aspects: A review article","volume":"48","author":"F Noorbakhsh","year":"2019","journal-title":"Iran J Public Health"},{"issue":"1","key":"pntd.0014009.ref004","doi-asserted-by":"crossref","first-page":"96","DOI":"10.3390\/ijerph15010096","article-title":"The zika virus epidemic in Brazil: From discovery to future implications","volume":"15","author":"R Lowe","year":"2018","journal-title":"Int J Environ Res Public Health"},{"issue":"11","key":"pntd.0014009.ref005","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s11910-020-01072-0","article-title":"Congenital zika virus infection: A review with emphasis on the spectrum of brain abnormalities","volume":"20","author":"L Vhp","year":"2020","journal-title":"Curr Neurol Neurosci Rep"},{"issue":"7","key":"pntd.0014009.ref006","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.9303","article-title":"Association between antenatal exposure to zika virus and anatomical and neurodevelopmental abnormalities in children","volume":"3","author":"JS Cranston","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"1","key":"pntd.0014009.ref007","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2018.7235","article-title":"Association of infants exposed to prenatal Zika virus infection with their clinical, neurologic, and developmental status evaluated via the General Movement Assessment Tool","volume":"2","author":"C Einspieler","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"24","key":"pntd.0014009.ref008","doi-asserted-by":"crossref","first-page":"2321","DOI":"10.1056\/NEJMoa1602412","article-title":"Zika virus infection in pregnant women in Rio de Janeiro","volume":"375","author":"P Brasil","year":"2016","journal-title":"N Engl J Med"},{"issue":"9","key":"pntd.0014009.ref009","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1001\/jamapediatrics.2017.1474","article-title":"Screening criteria for ophthalmic manifestations of congenital zika virus infection","volume":"171","author":"AA Zin","year":"2017","journal-title":"JAMA Pediatr"},{"issue":"24","key":"pntd.0014009.ref010","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.1056\/NEJMc1800098","article-title":"Neurodevelopment in infants exposed to zika virus in utero","volume":"379","author":"ME Lopes Moreira","year":"2018","journal-title":"N Engl J Med"},{"issue":"7","key":"pntd.0014009.ref011","article-title":"Association between neonatal neuroimaging and clinical outcomes in zika-exposed infants from Rio de Janeiro, Brazil","volume":"2","author":"KL Pool","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"3","key":"pntd.0014009.ref012","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1097\/INF.0000000000003379","article-title":"Early predictors of poor neurologic outcomes in a prospective cohort of infants with antenatal exposure to Zika Virus","volume":"41","author":"SF Tiene","year":"2022","journal-title":"Pediatr Infect Dis J"},{"issue":"2","key":"pntd.0014009.ref013","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2024-067552","article-title":"Early and long-term adverse outcomes of in utero zika exposure","volume":"155","author":"FA Venancio","year":"2025","journal-title":"Pediatrics"},{"issue":"6","key":"pntd.0014009.ref014","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/S1473-3099(16)00095-5","article-title":"Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study","volume":"16","author":"G Calvet","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"pntd.0014009.ref015","first-page":"100395","article-title":"Risk of adverse outcomes in offspring with RT-PCR confirmed prenatal Zika virus exposure: An individual participant data meta-analysis of 13 cohorts in the Zika Brazilian Cohorts Consortium","volume":"17","author":"RA de Alencar Ximenes","year":"2023","journal-title":"Lancet Reg Health Am"},{"issue":"4","key":"pntd.0014009.ref016","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2018-1104","article-title":"Eye findings in infants with suspected or confirmed antenatal zika virus exposure","volume":"142","author":"I Tsui","year":"2018","journal-title":"Pediatrics"},{"issue":"12","key":"pntd.0014009.ref017","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.1093\/cid\/ciz704","article-title":"Early clinical infancy outcomes for microcephaly and\/or small for gestational age zika-exposed infants","volume":"70","author":"K Adachi","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pntd.0014009.ref018","doi-asserted-by":"crossref","first-page":"19198","DOI":"10.1038\/s41598-019-55598-6","article-title":"Zika virus infection in pregnancy and infant growth, body composition in the first three months of life: a cohort study","volume":"9","author":"F Soares","year":"2019","journal-title":"Sci Rep"},{"issue":"2","key":"pntd.0014009.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0229434","article-title":"Neurodevelopment of children exposed intra-uterus by Zika virus: A case series","volume":"15","author":"PM Pe\u00e7anha","year":"2020","journal-title":"PLoS One"},{"key":"pntd.0014009.ref020","doi-asserted-by":"crossref","first-page":"699115","DOI":"10.3389\/fpsyt.2021.699115","article-title":"Time to evaluate the clinical repercussions of Zika virus vertical transmission? A systematic review","volume":"12","author":"YNDVD Amaral","year":"2021","journal-title":"Front Psychiatry"},{"issue":"1","key":"pntd.0014009.ref021","doi-asserted-by":"crossref","first-page":"3510","DOI":"10.1038\/s41467-020-17331-0","article-title":"Zika virus vertical transmission in children with confirmed antenatal exposure","volume":"11","author":"P Brasil","year":"2020","journal-title":"Nat Commun"},{"issue":"4","key":"pntd.0014009.ref022","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1002\/ajmg.a.38170","article-title":"The phenotypic spectrum of congenital Zika syndrome","volume":"173","author":"M Del Campo","year":"2017","journal-title":"Am J Med Genet A"},{"issue":"8","key":"pntd.0014009.ref023","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1038\/s41591-019-0496-1","article-title":"Delayed childhood neurodevelopment and neurosensory alterations in the second year of life in a prospective cohort of ZIKV-exposed children","volume":"25","author":"K Nielsen-Saines","year":"2019","journal-title":"Nat Med"},{"issue":"3","key":"pntd.0014009.ref024","article-title":"Cardiac findings in infants with in utero exposure to Zika virus- a cross sectional study","volume":"12","author":"DHG Orofino","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pntd.0014009.ref025","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.jpeds.2008.05.059","article-title":"Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005","volume":"153","author":"MD Reller","year":"2008","journal-title":"J Pediatr"},{"issue":"7","key":"pntd.0014009.ref026","article-title":"Incidence of congenital heart disease: The 9-year experience of the guangdong registry of congenital heart disease, China","volume":"11","author":"Y Qu","year":"2016","journal-title":"PLOS ONE"},{"issue":"2","key":"pntd.0014009.ref027","doi-asserted-by":"crossref","first-page":"367","DOI":"10.4314\/ahs.v16i2.5","article-title":"A systematic review of trends and patterns of congenital heart disease in children in Nigeria from 1964-2015","volume":"16","author":"M Abdulkadir","year":"2016","journal-title":"Afr Health Sci"},{"issue":"2","key":"pntd.0014009.ref028","first-page":"219","article-title":"Epidemiology of congenital heart disease in Brazil","volume":"30","author":"VC Pinto J\u00fanior","year":"2015","journal-title":"Rev Bras Cir Cardiovasc"},{"issue":"17","key":"pntd.0014009.ref029","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1136\/hrt.2008.152017","article-title":"Paediatric and congenital heart disease in South America: An overview","volume":"95","author":"CAC Pedra","year":"2009","journal-title":"Heart"},{"issue":"12","key":"pntd.0014009.ref030","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1016\/S0735-1097(02)01886-7","article-title":"The incidence of congenital heart disease","volume":"39","author":"JIE Hoffman","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"pntd.0014009.ref031","doi-asserted-by":"crossref","first-page":"15086","DOI":"10.1038\/nrdp.2015.86","article-title":"Patent foramen ovale","volume":"2","author":"S Homma","year":"2016","journal-title":"Nat Rev Dis Primers"},{"issue":"8","key":"pntd.0014009.ref032","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.cmi.2019.03.020","article-title":"Congenital Zika syndrome: Is the heart part of its spectrum?","volume":"25","author":"MB Santana","year":"2019","journal-title":"Clin Microbiol Infect"},{"issue":"4","key":"pntd.0014009.ref033","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0175065","article-title":"Echocardiographic findings in infants with presumed congenital Zika syndrome: Retrospective case series study","volume":"12","author":"DD Cavalcanti","year":"2017","journal-title":"PLoS One"},{"issue":"5","key":"pntd.0014009.ref034","first-page":"301","article-title":"Clinical-epidemiologic indications for echocardiographic assessment in the neonatal period. Value of risk groups","volume":"69","author":"S Sadeck L dos","year":"1997","journal-title":"Arq Bras Cardiol"},{"issue":"9779","key":"pntd.0014009.ref035","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1016\/S0140-6736(11)60054-8","article-title":"The Brazilian health system: History, advances, and challenges","volume":"377","author":"J Paim","year":"2011","journal-title":"Lancet Lond Engl"},{"issue":"1","key":"pntd.0014009.ref036","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0227676","article-title":"A neonatal nonhuman primate model of gestational Zika virus infection with evidence of microencephaly, seizures and cardiomyopathy","volume":"15","author":"RJ Steinbach","year":"2020","journal-title":"PLoS One"},{"issue":"8","key":"pntd.0014009.ref037","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1056\/NEJMoa2101195","article-title":"Mortality from congenital zika syndrome - nationwide cohort study in Brazil","volume":"386","author":"ES Paixao","year":"2022","journal-title":"N Engl J Med"},{"issue":"1","key":"pntd.0014009.ref038","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.tcm.2020.11.003","article-title":"Zika & heart: A systematic review","volume":"32","author":"CE Scatularo","year":"2022","journal-title":"Trends Cardiovasc Med"},{"issue":"11","key":"pntd.0014009.ref039","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/S0735-1097(17)34295-X","article-title":"Myocarditis, heart failure and arrhythmias in patients with Zika","volume":"69","author":"KAG Carta","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"pntd.0014009.ref040","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jcv.2017.11.002","article-title":"Cardiovascular complications in patients with Zika virus-induced Guillain-Barr\u00e9 syndrome","volume":"98","author":"D Resiere","year":"2018","journal-title":"J Clin Virol"},{"key":"pntd.0014009.ref041","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.ebiom.2015.11.050","article-title":"Immunolocalization and distribution of rubella antigen in fatal congenital rubella syndrome","volume":"3","author":"M Lazar","year":"2015","journal-title":"EBioMedicine"},{"key":"pntd.0014009.ref042","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s12985-016-0475-9","article-title":"Gene expression profiling of rubella virus infected primary endothelial cells of fetal and adult origin","volume":"13","author":"H Geyer","year":"2016","journal-title":"Virol J"},{"key":"pntd.0014009.ref043","doi-asserted-by":"crossref","first-page":"100268","DOI":"10.1016\/j.lansea.2023.100268","article-title":"Profile of cardiac lesions among laboratory confirmed congenital rubella syndrome (CRS) infants: a nationwide sentinel surveillance, India, 2016-22","volume":"16","author":"PK Gunasekaran","year":"2023","journal-title":"Lancet Reg Health Southeast Asia"},{"issue":"2","key":"pntd.0014009.ref044","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.017995","article-title":"Coxsackievirus B3 infection early in pregnancy induces congenital heart defects through suppression of fetal cardiomyocyte proliferation","volume":"10","author":"V Sharma","year":"2021","journal-title":"J Am Heart Assoc"},{"issue":"5","key":"pntd.0014009.ref045","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1093\/cid\/ciw802","article-title":"Transient myocarditis associated with acute Zika virus infection","volume":"64","author":"M Aletti","year":"2017","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"issue":"6","key":"pntd.0014009.ref046","article-title":"Association of Zika virus with myocarditis, heart failure, and arrhythmias: A literature review","volume":"9","author":"AM Minhas","year":"2017","journal-title":"Cureus"},{"issue":"4","key":"pntd.0014009.ref047","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004636","article-title":"Zika virus outbreak in Rio de Janeiro, Brazil: Clinical characterization, epidemiological and virological aspects","volume":"10","author":"P Brasil","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014009.ref048","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.yjmcc.2020.08.014","article-title":"Zika virus induces myocardial immune response and myocarditis in mice","volume":"148","author":"C Bai","year":"2020","journal-title":"J Mol Cell Cardiol"},{"issue":"8","key":"pntd.0014009.ref049","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1093\/pch\/5.8.463","article-title":"Congenital syphilis: A guide to diagnosis and management","volume":"5","author":"SR Arnold","year":"2000","journal-title":"Paediatr Child Health"},{"issue":"5","key":"pntd.0014009.ref050","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1002\/rmv.1790","article-title":"Universal newborn screening for congenital CMV infection: what is the evidence of potential benefit?","volume":"24","author":"MJ Cannon","year":"2014","journal-title":"Rev Med Virol"},{"issue":"8","key":"pntd.0014009.ref051","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1056\/NEJMoa2101195","article-title":"Mortality from Congenital Zika Syndrome \u2014 Nationwide Cohort Study in Brazil","volume":"386","author":"ES Paixao","year":"2022","journal-title":"N Engl J Med"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0014009","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T18:48:17Z","timestamp":1771526897000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014009"}},"subtitle":[],"editor":[{"given":"Remi N.","family":"Charrel","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":51,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0014009","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]}}}