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            <funder>Simon CAUCHEMEZ acknowledges funding from the European Union ZikAlliance program, LABEX-IBEID, the NIGMS MIDAS initiative, AXA Research Fund, Association Robert Debré, the EU- PREDEMICS.</funder>
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                <term xml:lang="en">pregnant women</term>
                <term xml:lang="en">French Guiana</term>
                <term xml:lang="en">Zika virus</term>
                <term xml:lang="en">epidemiology</term>
                <term xml:lang="en">outbreak</term>
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              <classCode scheme="mesh">Reverse Transcriptase Polymerase Chain Reaction</classCode>
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              <p>Zika virus (ZIKV) infection has been associated with complications during pregnancy. Although the presence of symptoms might be a risk factor for complication, the proportion of ZIKV-infected pregnant women with symptoms remains unknown. Following the emergence of ZIKV in French Guiana, all pregnancies in the territory were monitored by RT-PCR and/or detection of ZIKV antibodies. Follow-up data collected during pregnancy monitoring interviews were analysed from 1 February to 1 June 2016. We enrolled 3,050 pregnant women aged 14-48 years and 573 (19%) had laboratory-confirmed ZIKV infection. Rash, arthralgia, myalgia and conjunctival hyperaemia were more frequently observed in ZIKV-positive women; 23% of them (95% confidence interval (CI): 20-27) had at least one symptom compatible with ZIKV infection. Women 30 years and older were significantly more likely to have symptoms than younger women (28% vs 20%). The proportion of symptomatic infections varied from 17% in the remote interior to 35% in the urbanised population near the coast (adjusted risk ratio: 1.6; 95% CI: 1.4-1.9.). These estimates put findings on cohorts of symptomatic ZIKV-positive pregnant women into the wider context of an epidemic with mainly asymptomatic infections. The proportion of symptomatic ZIKV infections appears to vary substantially between populations.</p>
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