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Infection with Zika virus, a mosquito-borne flavivirus, during pregnancy can cause birth defects and neurodevelopmental abnormalities. Autism spectrum disorder (ASD) is a neurodevelopmental disability marked by social and communication impairment and restricted or repetitive patterns of behavior or interests; possible associations between exposure before birth to a small number of viruses and ASD have been observed.
The U.S. Zika Pregnancy and Infant Registry (USZPIR) follows children born January 1, 2016–March 31, 2018, to women with laboratory evidence of Zika infection during pregnancy. This report combined its data with the Puerto Rico Autism Registry to estimate how common ASD diagnoses are among these children, and to compare children with and without a diagnosis.
How a diagnosis is made in Puerto Rico
Any child who fails a standardized autism screening — whether or not exposed to Zika — gets a standardized evaluation at the Puerto Rico Children with Special Health Care Needs Pediatric Program and Autism Centers, which confirms ASD by the criteria of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. Children who meet them are entered in the Puerto Rico Autism Registry.
Findings
- Of 3,122 children reported to the registry in Puerto Rico, 109 (3.5%) had an ASD diagnosis.
- Among the 1,968 (63.0%) screened with a social-emotional or autism-specific tool at 18 months or older, 105 (5.3%) had one.
- There were no statistically significant differences between children with and without ASD in the kind of laboratory evidence of Zika, the mother's symptoms, the trimester of exposure, or Zika-associated birth defects.
- A higher share of children with ASD were male.
| All 3,122 children | With ASD (109) | Without ASD (3,013) |
|---|---|---|
| Possible Zika infection (serologic evidence) | 55.0% | 55.4% |
| Confirmed Zika infection (positive NAAT) | 45.0% | 44.6% |
| Mother had signs and symptoms of Zika disease | 40.4% | 42.3% |
| First evidence of exposure in the 1st trimester | 41.3% | 36.6% |
| … in the 2nd trimester | 38.5% | 37.5% |
| … in the 3rd trimester | 20.2% | 26.0% |
| Zika-associated birth defects | 4.6% | 3.9% |
| Male | 67.9% | 50.1% |
NAAT: nucleic acid amplification test.
Among the 109 children with ASD:
- most needed substantial or very substantial support — 79.8% in social communication and 77.0% for restricted, repetitive behaviors;
- the median age at diagnosis was 39 months (range 19–73);
- 33 (30.3%) also had a family member with an ASD diagnosis;
- parents most often first noticed symptoms at 13–18 months (28.4%) or 6–12 months (24.8%).
How it compares
Depending on the denominator, ASD prevalence among these Zika-exposed children was 3.5% to 5.3%. For comparison:
| Population | Estimated ASD prevalence |
|---|---|
| Continental United States, 2018, children aged 4 | 1.3%–4.6% |
| Continental United States, 2018, children aged 8 | 2.3%–4.5% |
| Latin America and the Caribbean, 2016 | 723 per 100,000 (under 1.0%) |
Limitations
- Follow-up to age 5 is not complete, and ASD can be identified even later in childhood.
- Figures for ASD in Puerto Rico's general population are not yet available for comparison. As of 2023, Puerto Rico takes part in the Autism and Developmental Disabilities Monitoring Network, which tracks ASD among children aged 4 and 8.
- COVID-19 delayed referrals for evaluation, which might have lowered the estimate.
What it means
More information is needed to learn whether Zika infection in pregnancy is linked to ASD. Screening was reported for only two thirds of the children exposed to Zika before birth. ASD-specific screening is recommended for all children, to identify concerns as early as possible and keep delays in intervention to a minimum.
Sources
Based on Roth NM, Delgado-López C, Wiggins LD, et al., "Notes from the Field: Autism Spectrum Disorder Among Children with Laboratory Evidence of Prenatal Zika Virus Exposure — Puerto Rico, 2023," MMWR Morbidity and Mortality Weekly Report, volume 72, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Lizenz: CC0 1.0 (gemeinfrei) · Bearbeitet nach www.cdc.gov
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