Chikungunya and Pregnancy: How does Chikungunya affect pregnant women?

Introduction
Chikungunya fever (CHIKV) is an arboviral pandemic disease. It is caused by the chikungunya virus, an RNA virus that belongs to the Togaviridae family. Chikungunya is primarily transmitted by the bite of a female Aedes Species, which can be Aedes aegypti or Aedes albopictus. These mosquitoes are also the source of dengue fever in humans, and the disease is more prominent during the monsoon season.

Older people of 60 years and above, pregnant women, newly born children whose mother has Chikungunya, people who do not keep their surroundings clean, and people who do not use mosquito nets while sleeping despite living in Chikungunya endemic regions are more vulnerable or at high risk of getting the disease.

Pregnant women should report to the doctor immediately if they experience any sign of Chikungunya, or dengue, or malaria. Early diagnosis leads to better management and faster patient recovery, thereby saving the life of both mother and child. In this article, we have put light on the effect, symptoms, and preventive methods of Chikungunya in pregnant women.

How Chikungunya affects pregnant women?
Chikungunya is a disease of concern for pregnant women because, in rare cases, they pass the virus on to their newborns around the time of birth. Furthermore, newborn babies infected with Chikungunya are at a higher risk of developing a severe case of the disease.
A study at a private clinic in India sought to examine the short-term effects of Chikungunya infection on pregnancy. It published the results in the Journal of Family Medicine and Primary Care in March 2019. One hundred fifty subjects participated in the survey, of which nine subjects showed persistent arthralgia, eleven subjects showed preterm delivery, five subjects had premature rupture of membranes, four subjects had decreased fetal movement, four subjects had intrauterine death, three subjects had oligohydramnios, and three subjects displayed preterm labor pain. Most of the adverse events were found in subjects in their third semester of pregnancy. The study’s authors concluded that Chikungunya in pregnant women is associated with pregnancy morbidity and fetal mortality.
A systemic review carried out to evaluate the risk for mother to child transmission, antepartum fetal deaths, symptomatic neonatal disease, and neonatal deaths due to mother having Chikungunya during the gestation period found the following complications in infected newborns within their first week of life:

• Fever
• Hyperalgesia
• Diffuse limb edema
• Rashes
• Sepsis-like illness
• Meningoencephalitis
• Irritability

The study’s authors concluded that perinatal infection is possible and occurs at a high rate during the intrapartum period. This can lead to long-term disabilities and deaths in neonates.
Similarly, a retrospective study published in the International Journal of Obstetrics and Gynecology, 2020, evaluated the severity, the effect of the disease on pregnant women and neonates, and mother-to-child transmission in pregnant women having Chikungunya infection. The retrospective study involved 416 mother-infant pairs that gave birth during the Chikungunya outbreak between January 2014 and September 2015. Among the 416 mother-infant pairs, 36% had Chikungunya during pregnancy, 33% never had Chikungunya, and the remaining 31% were not pregnant when they had Chikungunya. The findings from the study include:

• Joint pain was of shorter duration among infected pregnant women than women who were not pregnant when they had Chikungunya.
• Women, who had Chikungunya during that period, irrespective of pregnancy, suffered from pregnancy complications, intrapartum infections, and neonatal health complications.
• Mother-to-child transmission of the Chikungunya virus was observed in two mother-infant pairs and two of eight intrapartum infections.
  The study concluded that Chikungunya did not appear to be a severe risk for pregnancy complications or neonatal health during pregnancy. Still, maternal infection just before delivery may increase the risk of Chikungunya transmission from mother to child.

What are the symptoms of Chikungunya during pregnancy?
The signs and symptoms of Chikungunya in pregnant women include:

• Severe pain in the joints and muscles and swelling may persist for a week or more than a month.
• Early morning stiffness and pain in the elbow & wrist joints and ankle.
• Severe and recurring fever ( up to 1040F)
• Chills ( feeling of extreme cold)
• Severe headache and pain in the lower back region
• Upset stomach along with vomiting
• Tired and lacking in energy
• Abdominal Cramps
• Big and flat skin rashes between two and five days after getting infected by Chikungunya
• Sore throat

What preventive actions should pregnant women take to prevent Chikungunya?
A pregnant woman should take the following steps to prevent Chikungunya infection:

• Cover the windows and doors of the house with nets. This keeps mosquitos out of your home in the evenings and early mornings.
• Keep your surroundings clean by removing old tyres, cups, plates, and other items that collect and hold rainwater.
• Sleep under mosquito nets. However, before applying any mosquito repellent cream to your body, take the advice of your physician.
• Wear long-sleeved shirts and pants to keep mosquitoes at bay when you travel out.
• Use electric mosquito bats to kill the mosquitoes that somehow get into your house.
• Ensure that your house receives proper sunlight and is mopped regularly to clean the house.
• Spray DDT on stagnant water and near drains to prevent mosquito breeding.
• The diet should be high in proteins, fiber, and Vitamin C; however, before embarking on any diet plan due to Chikungunya during pregnancy, consult your family doctor or physician.
• Intake a sufficient amount of fluids, coconut water, and orange juice.
• Do not take any herbal medicine to prevent mosquito bites or get a cure for mosquito-borne diseases without consulting your physician.

REFERENCES

1. Chikungunya in pregnancy. Accessed at
   https://www.babycenter.com/pregnancy/health-and-safety/chikungunya-in-pregnancy_10412711
2. Gupta, S., & Gupta, N. (2019). Short-term pregnancy outcomes in patients chikungunya infection: An observational study. Journal of family medicine and primary care, 8(3), 985–987. https://doi.org/10.4103/jfmpc.jfmpc_274_18
3. Escobar, M., Nieto, A. J., Loaiza-Osorio, S., Barona, J. S., & Rosso, F. (2017). Pregnant Women Hospitalized with Chikungunya Virus Infection, Colombia, 2015. Emerging infectious diseases, 23(11), 1777–1783. https://doi.org/10.3201/eid2311.170480
4. Foeller ME, Nosrat C, Krystosik A, Noel T, Gérardin P, Cudjoe N, Mapp-Alexander V, Mitchell G, Macpherson C, Waechter R, LaBeaud AD. Chikungunya infection in pregnancy – reassuring maternal and perinatal outcomes: a retrospective observational study. BJOG. 2021 May;128(6):1077-1086. doi: 10.1111/1471-0528.16562. Epub 2020 Nov 19. PMID: 33040457; PMCID: PMC8035284.
5. Chikungunya Virus Infection in Pregnancy. Accessed at
   https://parenting.firstcry.com/articles/chikungunya-virus-infection-pregnancy-causes-symptoms-treatment/
6. Contopoulos-Ioannidis D, Newman-Lindsay S, Chow C, LaBeaud AD. Mother-to-child transmission of Chikungunya virus: A systematic review and meta-analysis. PLoS Negl Trop Dis. 2018 Jun 13;12(6):e0006510. doi: 10.1371/journal.pntd.0006510. PMID: 29897898; PMCID: PMC6075784.