Maternal and obstetric outcomes of listeria pregnancy: insights from a national cohort

Abstract

Objective

We sought to evaluate and describe the maternal and obstetric morbidity associated with Listeria infection in pregnancy.

Methods

Retrospective cohort of pregnant women using the 2007-2018 National Inpatient Sample. Pregnant women with discharge diagnosis codes consistent with Listeria infection were identified. Outcomes of deliveries complicated by Listeria infection were compared to those of delivery without this infection. The primary outcome was a composite of severe maternal morbidity. Secondary outcomes included components of the composite, maternal length of stay, mode of delivery, stillbirth, and preterm delivery.

Results

We identified 134 maternity associated hospitalizations for Listeria (weighted national estimate 666), of which 72 (weighted national estimate of 358) were delivery admissions. Delivery admissions complicated by Listeria resulted in higher rates of severe maternal morbidity than those without, (30.9% vs. 1.6%, p<.001). In adjusted analyses, women with Listeria had 21.2-fold higher risk of severe maternal morbidity (95% CI: 14.0, 31.9) when compared to those without Listeria. Specifically, Listeria delivery admissions had higher rates of acute respiratory distress syndrome (2.8% vs. 0.1%, p<.001), mechanical ventilation (1.4% vs. 0.0%, p<.001), sepsis (28.1% vs. 0.1%, p<.001), and shock (1.4% vs. 0.0%, p<.001). Listeria delivery admissions also had higher rates of preterm birth (61.3% vs. 7.7%, p < 0.001) and stillbirth (13.5% vs. 0.7%, p<.001). Women hospitalized or delivered with Listeria infection were also more likely to have a cesarean delivery (57.9% vs. 32.9, p<.001) and the average length of stay for women with Listeria was also longer (4.0 days vs. 2.3 days, p<.001).

Conclusions

Women with Listeria infection in pregnancy have higher rates of severe maternal morbidity, specifically increased risk of sepsis, septic shock, and acute respiratory distress syndrome. Among delivery hospitalizations, these women also have higher rates of preterm birth and stillbirth.

Keywords:

• Listeria
• Listeriosis
• maternal morbidity
• preterm delivery
• sepsis

Acknolwedgements

The authors appreciate the HCUP Data Partners who contribute data to the NIS. A complete list of partners can be found at (www.hcup-us.ahrq.gov/hcupdatapartners.jsp)

Disclosure statement

Jennifer Thompson is a coauthor for “Treatment and Prevention of Listeria monocytogenes infection” on UpToDate. All other author(s) report(s) no conflict of interest. The authors alone are responsible for the content and writing of this manuscript.

Additional information

Funding

Work contained in this manuscript were made possible by the following grant from the National Institutes of Health: TL1-TR002555 [JJF]. Data acquisition was also supported by funding from the Foundation for Women and Girls with Blood Disorders to JJF. The funding sources had no role in the design, conduct, or publication of this study.