Dengue in pregnant women in Paraguay: third-trimester predominance and low maternal mortality in a highly endemic setting

Abstract

Introduction: Paraguay is the second country with the highest incidence of dengue in Latin America according to the Pan American Health Organization. During pregnancy, this endemic disease can present serious maternal-fetal complications; however, there is limited evidence regarding its clinical characteristics in the Paraguayan context.

Objective: To characterize the clinical manifestations and complications of dengue during pregnancy in patients treated at the National Hospital of Itauguá, Paraguay.

Materials and methods: A retrospective, descriptive, observational study of 112 pregnant women with dengue confirmed by clinical and laboratory criteria (NS1 antigen, IgM/IgG-ELISA, PCR) during the period from June 2023 to June 2024. Sociodemographic characteristics, clinical manifestations by gestational trimester, comorbidities, and maternal-fetal complications were analyzed using descriptive statistics.

Results: The predominant age group was 26-33 years (42.9%), with 70.5% of urban residence. Most cases occurred in the third trimester (52.7%), contrasting with previous studies that report predominance in the first and second trimesters. The main manifestations were fever (90.2%), headache (66.1%), and myalgia (49.1%). Vomiting predominated in the first trimester (47.6%), while myalgia and abdominal pain increased toward the third trimester. Spontaneous abortions were recorded in 2.7% of cases (exclusively first trimester) and maternal mortality in 1.8% (only third trimester). The prevalent comorbidities were arterial hypertension (16.1%) and diabetes mellitus (8.0%).

Conclusion: This study documents a higher frequency of gestational dengue in the third trimester, contrasting with previous literature. Maternal mortality (1.8%) was lower than international reports (5.8-13.6%). The symptomatic variation according to gestational trimester demonstrates the need to develop specific protocols for gestational dengue in Paraguay, providing national evidence for the development of clinical guidelines adapted to the endemic context.