Zika has been demonstrated to affect the development of the fetus. To date, a direct association between intrauterine Zika infection and severe congenital malformations, such as microcephaly, has been recognized as a public health emergency worldwide. In spite of multiple international efforts, there is still a significant gap in the state of scientific knowledge regarding the extent of the effects of intrauterine Zika exposure at different periods of gestation. Given that transmission of the virus does not require vector transmission, the need to understand the effects of intrauterine Zika exposure on fetal development is critical. Evidence of the causal role of congenintal Zika virus infection is clear as the virus has been identified in the brains of affected fetuses. Given that 30% of pregnant women in Puerto Rico may have asymptomatic Zika virus infections. For fetus? born to these women, we do not know that actual rate of impact of the virus on fetal craniofacial and dental development. The increasing understanding regarding congenital Zika point to a range of anomalies, but the effects on craniofacial and dental development remains undefined. We also do not know what other conditions may alter the virulence of the Zika virus. There is strong evidence that maternal oral health status is associated to adverse pregnancy outcomes, but the role maternal periodontal disease on the health outcomes in Zika-exposed mothers is currently unknown and unexplored. The role of other aspects of maternal and infant oral health in the craniofacial phenotype and oromotor function of infants born to Zika-affected women requires further study. It is the main objective of this study to characterize the outcome of maternal Zika virus infection on craniofacial skeletal and dental phenotype in infants with or without microcephaly at birth. Clinical, radiographic and 3dMD Facial Surface Imaging techniques will be used to develop a vastly documented craniofacial phenotype of a sample of affected infants; their assessments will be compared to matched controls. Data from oral health examinations and biological samples from both the mother and the infant up to 12 months post-partum will be collected. These data will allow the examination of the concomitant aspects of oral health that may impact the capacity of the virus to cause an adverse effect in the infant. The infant?s oromotor function assessment will be completed at 6 and 12 months. Findings will be discussed among members of the craniofacial team in blinded fashion to be able to determine whether there is an effect of congenital Zika infection on craniofacial and dental development.

Public Health Relevance

In many regions, such as Puerto Rico and some states in the mainland with tropical climates (e.g., South Florida), the Zika virus is projected to become endemic. The greatest burden of intrauterine Zika infection is to the fetus, through increased risks of craniofacial and dental development abnormalities. This interdisciplinary study will define the craniofacial and dental phenotypes of children exposed to the Zika virus during gestation, with biological samples collected for future studies related to the impact of the virus.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Exploratory/Developmental Grants (R21)
Project #
Application #
Study Section
Special Emphasis Panel (ZDE1)
Program Officer
Shum, Lillian
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Puerto Rico Med Sciences
San Juan
United States
Zip Code