What are the management guidelines for dengue (Dengue Virus) in pregnancy?

Management Guidelines for Dengue in Pregnancy

For pregnant women with suspected dengue infection, diagnostic testing should include concurrent dengue and Zika virus nucleic acid amplification tests (NAATs) and IgM antibody testing on serum and urine specimens collected as soon as possible within 12 weeks of symptom onset. 1

Diagnostic Approach

• Collect serum and urine specimens from symptomatic pregnant women as soon as possible within 12 weeks of symptom onset for concurrent dengue and Zika virus NAATs and IgM antibody testing 2, 1
• Positive IgM antibody test results with negative NAAT results should be confirmed by neutralizing antibody tests for all pregnant women 1
• Consider epidemiological factors of viruses circulating at the location of exposure and clinical findings when interpreting test results 2, 1

Clinical Assessment and Monitoring

• Monitor closely for warning signs of severe dengue, including:
  • Persistent vomiting
  • Abdominal pain/tenderness
  • Clinical fluid accumulation
  • Mucosal bleeding
  • Lethargy/restlessness
  • Liver enlargement
  • Rising hematocrit with concurrent thrombocytopenia 1
• Pregnant women with dengue are at higher risk for severe dengue, preeclampsia, gestational hypertension, and anemia 3
• Consider hospitalization for closer monitoring, especially for patients presenting during the critical phase (days 3-6 of illness) 4

Management Principles

• Provide appropriate supportive care to monitor for and treat shock and hemorrhage without waiting for diagnostic test results 1
• Use acetaminophen/paracetamol for fever and pain management; strictly avoid NSAIDs and aspirin due to increased bleeding risk 1
• Ensure adequate hydration with fluids containing electrolytes 1
• Consider hospitalization for intravenous fluid therapy if persistent vomiting occurs 1
• Monitor fetal well-being with appropriate surveillance based on gestational age 5
• Pregnant women with dengue should be treated at centers with adequate resources for monitoring and emergency procedures 4

Special Considerations

• Dengue infection in pregnancy can lead to adverse maternal and fetal outcomes including:
  • Preterm delivery (reported in up to 17% of cases) 4
  • Low birth weight 6
  • Vertical transmission of dengue virus to the fetus 3
  • Maternal complications including hemorrhage and shock 3
• Pregnant women who contract dengue may present at earlier gestational ages compared to those with other mosquito-borne infections 6
• The risk of maternal death is increased in severe dengue cases 3

Prevention

• Advise pregnant women to take precautions to avoid mosquito bites when traveling to or living in endemic areas 5
• Early diagnosis and prompt medical attention are essential to reduce maternal and fetal morbidity and mortality 3

Follow-up

• Continue monitoring after acute infection resolves for potential pregnancy complications 5
• Close monitoring of fetal growth and development is recommended for pregnancies affected by dengue 3