Adverse Outcomes and Clinical Associations of Dengue in Pregnancy: Findings from a Retrospective Cohort Study

Aims and background: Dengue fever (DF) is a mosquito-borne viral infection causing significant morbidity and mortality globally, especially in tropical regions.In Sri Lanka, dengue is a leading cause of maternal mortality, with physiological changes during pregnancy complicating diagnosis and management.This study evaluated maternal, fetal, and neonatal outcomes associated with dengue in pregnancy and identified predictors of adverse outcomes.Materials and methods: This retrospective cohort study included 115 pregnant women with laboratory-confirmed dengue admitted to two tertiary hospitals in Sri Lanka from January to December 2017.Data on clinical presentation, laboratory findings, and obstetric outcomes were collected from medical records.Chi-squared and Mann-Whitney U tests were used to analyze associations between variables.Results: Adverse maternal outcomes occurred in 27.8% of cases, including intensive care unit (ICU) admissions (19.1%), dengue-related organ dysfunction (4.5%), and one maternal death (0.9%).Predictors of adverse maternal outcomes included severe dengue (dengue hemorrhagic fever (DHF) and dengue expanded syndrome (DES); p < 0.001), third-trimester infection (p = 0.028), low platelet counts (p < 0.001), and elevated aspartate aminotransferase levels (p = 0.01).Fetal outcomes (8.1%) included intrauterine fetal deaths (IUD) and miscarriages, while neonatal outcomes (28.7%) included low birth weight, Neonatal Intensive Care Unit (NICU) admissions, and two cases of vertical transmission.Most cases (74.8%) occurred during the monsoon period.Conclusion: Dengue infection in pregnancy is linked to significant maternal, fetal, and neonatal morbidity and mortality.Early risk identification through clinical and laboratory markers is essential.Enhanced surveillance and management strategies are critical in dengue-endemic regions.Clinical significance: This study highlights the critical need for enhanced surveillance, risk stratification, and management strategies for dengue in pregnancy to improve maternal and neonatal outcomes, especially in dengue-endemic regions.