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Research article
Patrick Gérardin
Centre Hospitalier Universitaire de la Réunion
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3276-5919
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Background Q fever has been associated with perinatal complications. We conducted a prospective follow-up study to assess both the incidence of adverse pregnancy outcomes (APOs) associated with Coxiella burnetii infection and the contribution of Q fever to APOs. Methods Between May 1 and October 31, 2013, within the regional perinatal health care centre of Saint Pierre, Reunion island, we investigated unexplained miscarriages, stillbirths, preterm births or small-for-gestational age children. Seropositivity for C. burnetii antibodies was defined using indirect immunofluorescence for a phase 2 IgG titre ≥1:64. Acute Q fever was defined for a high phase 2 IgG titre ≥1:256 (compatible with recent or active infection) or the detection of C. burnetii genome in miscarriage products and placentas. Incidence rate ratios (IRR) for Q fever related APOs (taken as a composite outcome or individually) were assessed using Poisson regression models for dichotomous outcomes controlling major confounders. Results Over a 6-month period, 179 pregnant women suspected or diagnosed with an APO were investigated for Q fever, of whom 118 met the definition for an APO. Of these, 19 were seropositive and 10 presented a profile indicative of an acute infection. For three women with an acute Q fever, the chronology between the onset of infection, the APO (2 miscarriages, 1 preterm birth) and the seroconversion suggested causality in the pathogenesis. The cumulative incidence of Q fever related APOs was estimated between 2.2‰ and 5.2‰, whether causality was required or not. Both C. burnetii exposure and acute Q fever were independently associated with APOs (IRR 1.55, 95% CI 1.31-1.84; IRR 1.47, 95% CI 1.15-1.89, respectively). Conclusions In the endemic context of Reunion island, acute Q fever may lead to APOs. To limit the burden of Q fever on reproduction, pregnant women should be kept away from farms and avoid direct contact with ruminants.
Keywords
serology, immunofluorescence, cohort studies, Q fever, Coxiella burnetii, zoonosis, incidence, pregnancy, miscarriage, stillbirth
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CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
Community comments: 1
Editorial decision: Accept
On 01 Nov, 2019
Editor assigned
On 31 Oct, 2019
Submission checks complete
On 30 Oct, 2019
Editor invited
On 30 Oct, 2019
No comments provided
Editorial decision: Minor revision
On 31 Oct, 2019
Editor assigned
On 28 Oct, 2019
Submission checks complete
On 27 Oct, 2019
Editor invited
On 27 Oct, 2019
Version 2
Posted 11 Oct, 2019
No comments provided
Editorial decision: Minor revision
On 23 Oct, 2019
Review #2 received
Received 16 Oct, 2019
Reviewer #3 agreed
On 15 Oct, 2019
Reviewer #2 agreed
On 14 Oct, 2019
Review #1 received
Received 11 Oct, 2019
Reviewers invited
Invitations sent on 10 Oct, 2019
Reviewer #1 agreed
On 10 Oct, 2019
Editor assigned
On 09 Oct, 2019
Submission checks complete
On 08 Oct, 2019
Editor invited
On 08 Oct, 2019
No comments provided
Review #3 received
Received 09 Sep, 2019
Editorial decision: Major revision
On 09 Sep, 2019
Review #2 received
Received 03 Sep, 2019
Review #1 received
Received 03 Sep, 2019
Reviewer #3 agreed
On 28 Aug, 2019
Reviewers invited
Invitations sent on 23 Aug, 2019
Reviewer #1 agreed
On 23 Aug, 2019
Reviewer #2 agreed
On 23 Aug, 2019
Editor assigned
On 22 Aug, 2019
Submission checks complete
On 21 Aug, 2019
Editor invited
On 21 Aug, 2019
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Subject Areas
Infectious Diseases
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A new preprint design is coming!
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See the published version of this preprint at BMC Infectious Diseases.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Patrick Gérardin
Centre Hospitalier Universitaire de la Réunion
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3276-5919
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
Community comments: 1
Editorial decision: Accept
On 01 Nov, 2019
Editor assigned
On 31 Oct, 2019
Submission checks complete
On 30 Oct, 2019
Editor invited
On 30 Oct, 2019
No comments provided
Editorial decision: Minor revision
On 31 Oct, 2019
Editor assigned
On 28 Oct, 2019
Submission checks complete
On 27 Oct, 2019
Editor invited
On 27 Oct, 2019
Version 2
Posted 11 Oct, 2019
No comments provided
Editorial decision: Minor revision
On 23 Oct, 2019
Review #2 received
Received 16 Oct, 2019
Reviewer #3 agreed
On 15 Oct, 2019
Reviewer #2 agreed
On 14 Oct, 2019
Review #1 received
Received 11 Oct, 2019
Reviewers invited
Invitations sent on 10 Oct, 2019
Reviewer #1 agreed
On 10 Oct, 2019
Editor assigned
On 09 Oct, 2019
Submission checks complete
On 08 Oct, 2019
Editor invited
On 08 Oct, 2019
No comments provided
Review #3 received
Received 09 Sep, 2019
Editorial decision: Major revision
On 09 Sep, 2019
Review #2 received
Received 03 Sep, 2019
Review #1 received
Received 03 Sep, 2019
Reviewer #3 agreed
On 28 Aug, 2019
Reviewers invited
Invitations sent on 23 Aug, 2019
Reviewer #1 agreed
On 23 Aug, 2019
Reviewer #2 agreed
On 23 Aug, 2019
Editor assigned
On 22 Aug, 2019
Submission checks complete
On 21 Aug, 2019
Editor invited
On 21 Aug, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Infectious Diseases.
Background Q fever has been associated with perinatal complications. We conducted a prospective follow-up study to assess both the incidence of adverse pregnancy outcomes (APOs) associated with Coxiella burnetii infection and the contribution of Q fever to APOs. Methods Between May 1 and October 31, 2013, within the regional perinatal health care centre of Saint Pierre, Reunion island, we investigated unexplained miscarriages, stillbirths, preterm births or small-for-gestational age children. Seropositivity for C. burnetii antibodies was defined using indirect immunofluorescence for a phase 2 IgG titre ≥1:64. Acute Q fever was defined for a high phase 2 IgG titre ≥1:256 (compatible with recent or active infection) or the detection of C. burnetii genome in miscarriage products and placentas. Incidence rate ratios (IRR) for Q fever related APOs (taken as a composite outcome or individually) were assessed using Poisson regression models for dichotomous outcomes controlling major confounders. Results Over a 6-month period, 179 pregnant women suspected or diagnosed with an APO were investigated for Q fever, of whom 118 met the definition for an APO. Of these, 19 were seropositive and 10 presented a profile indicative of an acute infection. For three women with an acute Q fever, the chronology between the onset of infection, the APO (2 miscarriages, 1 preterm birth) and the seroconversion suggested causality in the pathogenesis. The cumulative incidence of Q fever related APOs was estimated between 2.2‰ and 5.2‰, whether causality was required or not. Both C. burnetii exposure and acute Q fever were independently associated with APOs (IRR 1.55, 95% CI 1.31-1.84; IRR 1.47, 95% CI 1.15-1.89, respectively). Conclusions In the endemic context of Reunion island, acute Q fever may lead to APOs. To limit the burden of Q fever on reproduction, pregnant women should be kept away from farms and avoid direct contact with ruminants.
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
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