Initially, all the reported cases of pregnant women with suspected ZIKV infections in the National Notifiable Diseases Information System (SINAN) between 2015 and 2016 were investigated, and those who did not have laboratory confirmations were excluded. Subsequently, children who did not present with microcephaly at birth were selected through the Live Birth Information System (SINASC) from the field of the declaration of live births (DNV), which provided information of the malformations presented by the newborns at birth. We then identified all pregnant women who presented with laboratory-confirmed ZIKV infections and gave birth to children without microcephaly.

The HCs were evaluated using the INTERGROWTH-21st curve 9 to confirm that none of the children had HCs at birth that were below 2 standard deviations for their sex and gestational age.

For data collection, the mothers were contacted via telephone to schedule home visits. When the mother's telephone number was unavailable, the visit was undertaken during business hours at the address provided on the notification form. In cases where the families were not available at their residences, the cases were classified as missing after three attempts were made on alternate days and at different times. Additionally, the children whose families were living in the interior of the State of Ceará were excluded. During the home visits, the mothers were interviewed, and the children were clinically evaluated to assess the anthropometric data and developmental milestones according to the child's health booklet.

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