Main Findings
We aimed to investigate adverse pregnancy and early neonatal outcomes according to gestational age of maternal infection in all 511 notified ZIKV-infected women and their offspring from one of the most affected Brazilian regions. Most pregnancies evolved uneventfully. Pregnancy losses occurred in 4.7% of cases, and abnormalities potentially related to ZIKV infection in 25.0% of the stillbirths and 3.9% of the live-born infants. The typical CZS phenotype occurred in 2.9% of infants (CI95%:1.7-4.7) without comorbidities. As other congenital infections, the ZIKV congenital disease had a broad spectrum with possible subclinical findings. Apparently asymptomatic infants thoroughly evaluated within 3 months of age had ZIKV-related eye abnormalities (1.3%), significant imaging brain abnormalities (0.5%), and potential neurologic/neurodevelopment dysfunctions (8.0%). Furthermore, early (< 11 weeks of gestation) ZIKV maternal infection was strongly associated with the presence of severe neurological impairment.