Managing Q fever during pregnancy: The benefits of long-term cotrimoxazole therapy

Background. Q fever is a zoonosis caused by Coxiella burnetii. During pregnancy, it may result in obstetric complications, such as spontaneous abortion, intrauterine growth retardation, intrauterine fetal death, and premature delivery. Pregnant women are exposed to the risk of chronic Q fever. Methods. We included 53 pregnant women who received a diagnosis of Q fever. We compared the incidence of obstetric and maternal Q fever complications for women who received long-term cotrimoxazole treatment (n = 16) with that for women who did not receive long-term cotrimoxazole treatment (n = 37); long-term cotrimoxazole treatment was defined as oral administration of trimethoprim- sulfamethoxazole during at least 5 weeks of pregnancy. Results. Obstetric complications were observed in 81.1% of pregnant women who did not receive long-term cotrimoxazole therapy: 5 (13.5%) women experienced spontaneous abortions, 10 (27%) experienced intrauterine growth retardation, 10 ( 27%) experienced intrauterine fetal death, and 10 ( 27%) experienced premature delivery. Oligoamnios was observed in 4 patients ( 10.8%). Obstetric complications were found to occur significantly more often in patients infected during their first trimester of pregnancy than in those infected later (P = .013). The outcome of the pregnancy was found to depend on placental infection by C. burnetii (P = .013). Long-term cotrimoxazole treatment protected against maternal chronic Q fever (P = .001), placental infection (P = .038), and obstetric complications (P = .099), especially intrauterine fetal death (P = .018), which was found to be related to placental infection (P = .008). Conclusions. Q fever during pregnancy results in severe obstetric complications, including oligoamnios. Because of its ability to protect against placental infection, intrauterine fetal death, and maternal chronic Q fever, long-term cotrimoxazole treatment should be used to treat pregnant women with Q fever.