Table 2. Systematic literature review searching for Q fever/C.burnetii and pregnancy
Cb-positive
Participants
References
Study
pregnant women
[n]
Objective
Inclusion criteria
Comments
design
[n]
 No significant association between CbAssociation of antibody
Van der Hoek
IgM ± IgG 37
1174
2011
Participation in
CrSS
antibodies in early pregnancy and preterm
positivity and
sole IgG 12
the PSIE
delivery, low birth weight, or perinatal
pregnancy outcome
mortality
 Antibody detection in 4.6%
Prevalence of Cb-
Attendance at a
 No statistical differences between IgG
Baud
infection in pregnant
438
20
Recurrent
CrSS
2009
seroprevalences in women with sporadic or
women in non-endemic
Miscarriage
recurrent miscarriage compared to controls
area
Clinic in London
 Small sample size limits conclusions
Prevalence of Cb-
Women with
 Antibody detection in 26%
infection in women with
spontaneous
 Positive PCR: 22% 1
abortion
abortion in India
 Isolation of C. burnetii in 7% 1
Vaidya
74
19
CrSS
2008
 No control group
 More antibody-positive than -negative
Seroprevalence of Cb
Participation in a
and association between
McCaughey
women had a history of a miscarriage or
cross sectional
2850
136
CrSS
age, sex, social class,
still-birth (19.5% versus 9.8%, P < 0.001)
survey2 in
2008
 Relationship was not adjusted for age,
occupation and
Northern Irland
reproductive history
farming occupation and number of children
 Long-term cotrimoxazole therapy prevents
obstetric complications (p = 0.009)
Efficacy of long-term
Pregnant women
cotrimoxazole therapy in
with QF
 Considering only patients without
53
Carcopino
(17 already described by Stein
CS
2007
complications at the time of diagnosis
women with QF during
diagnosed at the
1998 and Raoult 2002)
(n=37) the difference was p=0.047 for
pregnancy
FNRCR
prevention of IUFD and P=0.039 for
prevention of chronic QF
 Pregnant women were less often
Outbreak surveillance to
Patients at risk for
describe clinical
chronic QF, with
symptomatic than nonpregnant women
expression of acute QF
clinical symptoms
(9%, P < 0.001)
Tissot-Dupont
1064
11
CrSS
2007
depending on host factors or wish to be
and monitor the
tested in the
evolution of chronic QF
French Alps
in patients at risk
outbreak
 All 11 women were treated with long-term
cotrimoxazole therapy
 One developed antibodies typical of
chronic infection under long-term
cotrimoxazol therapy Phase I antibody positivity: significantly
higher incidence of preterm birth, more
likely to have an infant with a birth weight
Pregnant women
≤ 2000g or previous or current neonatal
Determination whether
presenting to the
parturient women
Langley
death of an infant weighing > 500g
labour and
4588
200
CoS
 Phase II antibody titre ≥ 1:32: more likely
seropositive for Cb had
2003
delivery ward at
evidence of adverse birth
to have a current or previous neonatal
the IWKHC Nova
outcomes.
death of an infant weighing > 500g, a
Scotia Canada
lower mean gestational age, and an older
mean age at delivery
 Cb was not identified by PCR or culture in
the placenta from 98 seropositive women
 Seroprevalence was three times higher in
spontaneous abortion, 14 times higher in
Estimation of the
Participation on a
seroprevalence of Cb
HIV survey in
among pregnant women
pregnant women
and the effect on
in South Eastern
pregnancy outcome
France
ectopic pregnancy than in normal
Rey
deliveries without a significant difference
12 716
19
CrSS
2000
(p=0.15; 0.07)
 Seroprevalence was higher among women
≥ 35 years than among younger women
(p=0.04)
Estimation of the
Healthy pregnant
seroprevalence of Cb in
women at 10-20
healthy pregnant women
weeks of
in Japan
gestation in Japan
 Antibody detection in 2%
Numazaki
200
4
 Addional: no antibody detection in cord
CrSS
2000
blood (n =185)
Anstey
Attendance at a antenatal
150
7
CrSS
1997
Prasad
Pregnant women
 Antibody detection in 4.7%
Outdoor and
 14% antibody detection in milk
clinic in Dar es Salaam
153 milk
Unknown
CrSS
Isolation of Cb in human
1986
samples
16 aborted
placentas
milk and aborted
indoor patients of
placenta and
Churamani
demonstration of CB
Maternity
antibodies in human milk
Hospital, Hissar
 Isolation of Cb from milk (n=4) and
aborted placenta (n=1)
 Antibody detection in 25 women (4%) and
none in the control group (n=70)
Influence of QF during
Women with
pregnancy on fetus and
pathologic
 No detection of Cb in placenta (n=130)
Minchev
617
25
CoS
1983
and placental sera (n=89)
newborn
pregnancy.
 In all cases other pathogenic agents were
additionally found
174 blood
Medical workers
 Incidence of QF in medical workers in
Incidence of Q fever in
samples
Ganchev
in obstetric
obstetric departments: 37% (obstetricians:
departments in
57%, midwives: 36%, hospital attendants:
several Bulgarian
34%)
two inadequately
from
0
CrSS
1977
investigated occupational
medical
groups.
workers
Fiset
100
8
CrSS
Is there immunological
towns
 Blood donors 8%
Participants on a
 None of the children with IgM antibodies
1975
evidence of human fetal
seroprevalence
(n=4) against Cb in the cord blood showed
infection with Cb?
survey around
any detectable abnormality at birth
Cairo
Patients with
Serological prevalence of
possible Q fever
 Prevalence in abortions 14.3 % (n = 3/21)
Q fever in man and
complications
 Control group (not adjusted for age and
animals of Punjab
from hospitals of
Randhawa
458
3
CrSS
1972
gender): 2.1 % (n = 47)
the Punjab region
All woman who
 With one exception (partus praematurus
contracted a Cb
imminens but with an uneventful delivery),
infection during
no complications developed during
an outbreak in
pregnancy
Demonstration of C.
burnetii in the placentas
Syrucek
5
5
POS
of women who became
Kraslice ČSR and
1958
 A healthy newborn in four cases (in one
pregnant within one to
became pregnant
case pregnancy was interrupted because of
within one to two
rubella).
two years after infection.
years after
 In four women a positive culture of Cb
infection
from placenta was obtained.
IgM±IgG, IgM-antibody positive with or without IgG; PSIE, Prenatal Screening for Infectious Diseases and Erythrocyte Immunization; 1samples
investigated: placental bits, genital swabs, fecal swabs and urine samples; 2 Change of Heart (COH) Baseline Study of cardiovascular risk factors
CS, case series; CrSS, cross-sectional survey; CoS, cohort study; POS, prospective observational study; FNRCR, French National Reference Centre
for Rickettsioses; IWKHC, Izaak Walton Killam Health Centre Nova Scotia Canada