Fig. 7: Mediation analysis of prenatal ZIKV exposure effects on neurodevelopmental outcomes.

a Conceptual framework testing whether prenatal ZIKV exposure affects behavioral outcomes (ventral contact duration and approach to novel stimuli) through sensory impairments (visual evoked potential deficits at 3 months, hearing loss at 12 months) or through direct brain effects. b Results showing ZIKV exposure significantly predicted visual evoked potential deficits (p = 0.020) but not hearing loss (p = 0.475). Neither visual nor auditory impairments predicted behavioral outcomes (all p > 0.1), while ZIKV exposure had significant direct effects on both outcomes (p = 0.012 and p = 0.003). Sobel tests confirmed no significant mediation through sensory pathways (p = 0.56, p = 0.86). Red solid lines, significant relationships (p < 0.05); gray lines, non-significant relationships; red dashed lines, significant direct effects. Light cyan, predictor; light blue, mediators; golden yellow, outcomes. See Table S11 for complete statistics.