Reproductive health sequelae in women who survived Ebola Virus Disease in Sierra Leone and Liberia

SUMMARY STATEMENT The growing body of research on Ebola virus disease (EVD) suggests that female survivors of the virus may be at increased risk of miscarriage or stillbirth in new pregnancies conceived after recovery from acute EVD-infection. In addition, recent reports suggest that the Ebola virus may persist in the uteruses of survivors who were pregnant during acute Ebola infection (PDAEI) and that the virus may become reactivated during subsequent pregnancies, creating the potential for pregnant survivors to spread the virus to others, long after they have recovered from initial acute EVD infection. Previous research on pregnancies in female EVD survivors have not explored associations between pregnancy outcomes after EVD with pregnancy history prior to EVD or whether or not the woman was PDAEI. Understanding the post-EVD pregnancies of survivorsâ€Â" especially those who were PDAEI and may be vulnerable to viral recrudescenceâ€Â"is a critical first step in assessing risk of EVD’s re-emergence after outbreaks. The proposed study will compare the incidence and outcomes of pregnancies conceived post- EVD among: PDAEI EVD survivors, non-PDAEI EVD survivors, and a comparison group. This proposed study will utilize self-reported, questionnaire-based data from female EVD survivors and other women of reproductive age (comparison group) in Liberia and Sierra Leone and is currently being collected through an NIH-funded R01 study (NIAID #1R01AI123535-01A1). The specific aims of this study are: 1) to estimate the incidence of recognized pregnancies conceived after Ebola by EVD-survivors; and 2) among women with a recognized pregnancy after Ebola, to estimate the incidence of failed pregnancy reported by EVD-survivors and to describe host and disease-specific factors associated with pregnancy outcomes. This study has the potential to expand our understanding of how, if at all, EVD may differentially impact the post-EVD pregnancies of survivors, including those who were PDAEI. Results may be used to inform guidelines for the management of EVD in pregnant women and management of pregnancy in EVD survivors.