Academic and social-behavioral assessment in a prospective cohort of normocephalic school-aged children with antenatal Zika virus exposure

Objectives

Long-term outcomes in children with antenatal Zika virus (ZIKV) exposure without microcephaly are unknown. We assessed academic and social-behavioral outcomes among normocephalic school-aged children with antenatal ZIKV exposure and controls.

Methods

School-aged children exposed to Zika (ZEC) and unexposed controls (ZUCs) were recruited in Rio de Janeiro, Brazil. The academic performance and strengths and difficulties questionnaire was evaluated through parental interviews. Clinical/demographic data were abstracted from medical records/interviews. Potential associations with trimester of infection, early neurodevelopment, and neuro-sensory findings were explored in ZEC.

Results

In total, 147 children were enrolled: 78 ZEC and 69 ZUCs. The mean age for ZEC was 8.1 years and the mean age for ZUCs was 7.7 years; 50.0% of ZEC and 44.9% of ZUCs were male. Reading (21.8% vs 7.2%, P = 0.0193) difficulties, writing (20.5% vs 5.8%, P = 0.0144) difficulties, and suspected/diagnosed neurodevelopmental disorders (39.7% vs 17.4%, P = 0.0036) were greater in ZEC than ZUCs. ZEC had higher scores in total difficulties (13.32 vs 10.10, P = 0.0099), emotional symptoms (4.33 vs 2.90, P = 0.0011), and hyperactivity (4.95 vs 3.41, P = 0.0037). ZIKV exposure was a predictor of reading (adjusted odds ratio [aOR] = 3.39, 95% confidence interval [CI] = 1.17-9.79), writing (aOR = 4.02, 95% CI = 1.27-12.74), emotional (aOR = 3.51, 95% CI = 1.72-7.18), and hyperactivity (aOR = 2.43, 95% CI = 1.18-4.98) problems. Early developmental delay was more frequent in ZEC with academic difficulties (P = 0.0018).

Conclusions

Antenatal ZIKV exposure is associated with increased risk of academic difficulties, neurodevelopmental diagnoses, and social-behavioral problems in school-aged normocephalic children.