Via The Lancet Global Health: Pregnancy outcomes in Liberian women who conceived after recovery from Ebola virus disease. The conclusion:
The overall miscarriage rate in clinically identified pregnancies for this cohort of Ebola survivors (15/68; 22·1%) was slightly higher than the ranges expected for healthy women in developed countries (10–15%) and women in west Africa (11–13%), although published data on miscarriages are sparse.
Taken together, the rate of adverse pregnancy outcomes in the present cohort (19/68; 27·9%) suggests the possibility that EVD engendered reproductive health risks after clinical disease resolved, especially when pregnancy occurred within 2 months of recovery. Prospective evaluation of additional pregnancy outcomes in EVD survivors compared to age-matched controls from west Africa will be helpful to further quantify the relative risks of adverse pregnancy outcomes.
We disclose a number of caveats to the interpretation of these findings. Liberia-specific miscarriage rates among uninfected women before, during, or after the acute epidemic were not available. EVD survivors who noted or suspected problems with their pregnancy may have been more likely to seek medical attention than those who did not. Indeed, the vast difference in miscarriage frequencies between Margibi (9/16; 56·3%) and Montserrado (6/52; 11·5%) counties suggests a possible case-finding artifact; we are unaware of a biologically plausible explanation.
Conversely, it is conceivable that our findings underestimate the number of stillbirths and miscarriages among EVD survivors; for example, under-reporting may have occurred due to fear of stigmatisation or because of disrupted health services in the aftermath of the Ebola outbreak.
It has been postulated that Ebola virus persistence in immune-privileged sites such as brain and retina may pose risks to the developing fetus of the gravid EVD survivor. Male survivors have been shown to shed Ebola virus RNA in semen for at least 18 months after onset of EVD. There has been one report of Ebola virus relapse in the central nervous system of a 39-year-old female EVD survivor. Evidence of Ebola virus persistence in other female survivors of childbearing age would heighten the concerns raised here.
If confirmed, potential mechanistic questions include whether the reduced immune response during pregnancy and the immunological functions of the placenta, which allow fetus and mother to co-exist, may increase risk of reactivation, and whether genetic risk factors play a role.