Zika in Infants and Pregnancy (ZIP) study: results from a prospective international cohort study of prenatal Zika virus infection and adverse fetal and infant outcomes
- Published on 07/07/2026
- Reading time: 7 min.
Lebov Jill Farnell 1, Nason Martha 2, Stolka Kristen B. 1, Ximenes Ricardo 3, Mussi-Pinhata Marisa M. 4, Moye Jack 5, Zorrilla Carmen D. 6, Velez Vega Carmen M. 8, Cordero José F. 7, Scalabrin Deolinda M. F. 9,10, Ko Albert I. 9,10, Moreira Maria Elisabeth Lopes 11, Galvão Luiz Augusto 12, Britt William 13, Marques Ernesto T. A. 14,15, Balmaseda Angel 16, Harris Eva 17, Arias Juan F. 18, Schultz-Cherry Stacey 19, Garces Ana Lucía 20, Krebs Nancy F. 21, Ochoa Theresa J. 22, Ugarte-Gil César Augusto 22,23, Fogleman Elizabeth 1, Gabriel Erin 24, Welton Michael 7, Irizarry Carmen M. 25, de Moura Negrini Silvia Biason 4, Coutinho Conrado Milani 4, de Barros Miranda-Filho Demócrito 26, Montarroyos Ulisses Ramos 26, Cordeiro Marli Tenorio 15, Gajewski Anna 27, Osorio Jorge E. 28, Figueroa Lester 20
1 https://ror.org/052tfza37 Social, Statistical and Environmental Health Sciences RTI International Durham NC England
2 https://ror.org/02ycvrx49 Center for Vaccine Innovation and Access PATH Washington, DC USA
3 https://ror.org/047908t24 Departamento de Medicina Tropical da Universidade Federal de Pernambuco, Microcephaly Epidemic Research Group Recife Recife Brazil
4 https://ror.org/036rp1748 Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil
5 https://ror.org/04byxyr05 Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, DHHS Bldg. 6710B Rm. 2130MSC 7002 9000 Rockville Pike Bethesda 20892-7002 Bethesda MD USA
6 https://ror.org/02yg0nm07 Maternal-Infant Studies Center (CEMI) UPR School of Medicine San Juan Puerto Rico
7 https://ror.org/00te3t702 Department of Epidemiology and Biostatistics College of Public Health University of Georgia Athens GA USA
8 https://ror.org/00h25w961 University of Puerto Rico Medical Sciences Campus San Juan Puerto Rico
9 https://ror.org/03v76x132 Department of Epidemiology of Microbial Diseases Yale School of Public Health New Haven CT USA
10 https://ror.org/04jhswv08 Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS Salvador Brazil
11 https://ror.org/04jhswv08 Instituto Fernandes Figueira–Fiocruz Rio de Janeiro Brazil
12 Global Health Center–CRIS Fiocruz Rio de Janeiro Brazil
13 https://ror.org/008s83205 Department of Pediatrics University of Alabama at Birmingham Birmingham AL USA
14 https://ror.org/01an3r305 School of Public Health University of Pittsburgh Pittsburgh PA USA
15 Department of Virology and Experimental Therapeutics Instituto Aggeu Magalhães, Fiocruz-Pernambuco Recife Brazil
16 https://ror.org/03c09x508 Laboratorio Nacional de Virología Centro Nacional de Diagnóstico y Referencia Ministerio de Salud Managua Nicaragua
17 https://ror.org/01an7q238 Division of Infectious Diseases and Vaccinology, School of Public Health University of California Berkeley CA USA
18 https://ror.org/02r3e0967 Department of Infectious Diseases St Jude Children’s Research Hospital 262 Danny Thomas Place 38105 Memphis TN USA
19 https://ror.org/02r3e0967 Department of Host-Microbe Interactions St Jude Children’s Research Hospital Memphis TN USA
20 https://ror.org/03wzeak38 Fundación Para La Alimentación y Nutrición de Centro América y Panamá (INCAP) Guatemala City Guatemala
21 https://ror.org/04cqn7d42 Section of Nutrition, Department of Pediatrics University of Colorado School of Medicine Denver CO USA
22 https://ror.org/03yczjf25 Instituto de Medicina Tropical Alexander Von Humboldt and Facultad de Medicina, Universidad Peruana Cayetano Heredia Lima Peru
23 https://ror.org/016tfm930 Department of Epidemiology University of Texas Medical Branch Galveston TX USA
24 https://ror.org/035b05819 Section of Biostatistics Department of Public Health University of Copenhagen Copenhagen Denmark
25 Puerto Rico-AIDS CRS Medical Science Campus, Pathology San Juan San Juan Puerto Rico
26 https://ror.org/00gtcbp88 Programa de Pós-Graduação em Ciências da Saúde (PPGCS) da Universidade de Pernambuco, Microcephaly Epidemic Research Group Recife Brazil
27 Sustainable Sciences Institute Managua Managua Nicaragua
28 https://ror.org/01y2jtd41 Department of Pathobiological Sciences University of Wisconsin Madison WI USA
Abstract
Background Before Zika virus (ZIKV) infections were observed in the Americas, an association between ZIKV and microcephaly or other congenital malformations was not well documented. Initial reports suggested strong associations between ZIKV and congenital malformations, but plausible estimates of causal effects from prospective studies with adequate sample size and covariate data were few.
Methods From 2016–2018, the Zika in Infants and Pregnancy...
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