Dengue fever, a mosquito-borne viral infection, has emerged as a serious public health concern globally, affecting nearly 400 million people worldwide. In India, where the burden of mosquito-borne diseases is significant, dengue poses a particular threat, especially to pregnant women. Recent research has shed light on the alarming statistics: dengue in pregnancy adversely affects both maternal and foetal outcomes, leading to a high maternal mortality rate of 15.9 percent.
The symptoms of dengue in pregnancy often manifest as fever and muscle aches, making it challenging to diagnose promptly. This is because pregnancy is often accompanied by bodily aches and pains. Dengue fever during pregnancy is primarily treated conservatively, but complications such as pre-term labour become a common concern, particularly in the third trimester. The ambiguity of symptoms and the physiological changes in pregnancy can lead to delayed diagnosis, highlighting the urgent need for effective management strategies to improve both maternal and foetal outcomes.
One of the significant challenges in managing dengue in pregnancy is the under-reporting of cases and the lack of comprehensive studies. Available literature consists mostly of small cross-sectional studies or case series, indicating a gap in understanding the complexities of dengue infection during pregnancy. A recent meta-analysis emphasised the need to monitor pregnancies diagnosed as dengue-positive, as the most common adverse effects reported are preterm birth and low birth weight babies.
When a person is infected with dengue, their immune system responds by releasing various substances like cytokines and chemokines. These substances, along with processes like endothelial cell autophagy and T cell apoptosis, lead to problems in the body. One significant issue is endothelial cell dysfunction, where the cells that line blood vessels don’t work properly. This dysfunction causes plasma leakage, which is the seeping of fluid from blood vessels into surrounding tissues. It also leads to a decrease in the volume of blood circulating in the body (intravascular volume contraction) and fluid loss.
These complications can have severe consequences, including plasma leakage, reduced blood volume, and fluid loss can result in shock, a critical condition where vital organs don’t receive enough blood and oxygen, leading to organ failure. This multi-organ dysfunction can be fatal if not addressed promptly.
In pregnant women, these problems are particularly concerning. Conditions like acute respiratory distress syndrome (ARDS), where the lungs can’t provide the body’s vital organs with enough oxygen, and acute kidney injury (AKI), where the kidneys can’t filter waste products from the blood, become significant risks. To combat these complications and increase the chances of survival, pregnant women with dengue need careful and constant monitoring. Intensive management, often provided in the Intensive Care Unit (ICU), becomes essential to salvage lives in these critical situations.
In the context of childbirth, dengue-positive pregnant women face unique challenges. Surprisingly, the rate of caesarean deliveries in pregnant women with dengue is not significantly higher than in those without the infection. This finding suggests that dengue infection does not necessarily increase the rate of caesarean sections, providing a somewhat reassuring aspect amid the grim statistics. Additionally, the safety of regional anaesthetic techniques, even in cases of mild thrombocytopenia, has been reported, offering viable options for pain management during childbirth for dengue-positive women.
The period after childbirth can be especially risky for women who have had dengue. One significant concern arises from dengue-associated thrombocytopenia, a condition where the number of platelets in the blood is abnormally low. This makes women more susceptible to postpartum haemorrhage, a condition where there is excessive bleeding after childbirth.
Studies in India have shown that 25% of women with dengue experience postpartum haemorrhage, underlining the critical need for active and attentive management during labour and intense monitoring in the postpartum period. Ensuring that these women receive special care and attention is essential to prevent severe complications during this vulnerable time.
To address the growing concern of dengue in pregnancy, it is crucial to implement robust vector control strategies in affected areas. Preventive measures such as mosquito nets, insect repellents, and community education can play a pivotal role in reducing the incidence of dengue. Additionally, healthcare providers need to be vigilant about the signs and symptoms of dengue in pregnant women, enabling early diagnosis and prompt management.
In conclusion, dengue in pregnancy poses substantial risks to both mothers and their unborn babies, with high maternal mortality rates and severe foetal complications. The challenges faced during pregnancy and childbirth necessitate comprehensive and specialised care for dengue-positive pregnant women. By enhancing awareness, improving diagnostic methods, and implementing stringent preventive measures, India can take significant strides towards mitigating the impact of dengue on pregnant women, ensuring healthier outcomes for both mothers and their newborns.
Prasad Phadke is the Founder and CEO of Eco BioTraps.