Effect of peripartum Clostridioides difficile infection on pregnancy and neonatal outcomes: an observational study

doi:10.1177/17562848231170479

. 2023 Apr 27:16:17562848231170479.

doi: 10.1177/17562848231170479. eCollection 2023.

Effect of peripartum Clostridioides difficile infection on pregnancy and neonatal outcomes: an observational study

Srishti Saha¹, Ryan Pardi¹, Regan N Theiler², Darrell S Pardi¹, Sahil Khanna³

Affiliations

¹ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
² Division of Obstetrics, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
³ Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.

PMID: 37124369
PMCID: PMC10141253
DOI: 10.1177/17562848231170479

Effect of peripartum Clostridioides difficile infection on pregnancy and neonatal outcomes: an observational study

Srishti Saha et al. Therap Adv Gastroenterol. 2023.

. 2023 Apr 27:16:17562848231170479.

doi: 10.1177/17562848231170479. eCollection 2023.

Authors

Srishti Saha¹, Ryan Pardi¹, Regan N Theiler², Darrell S Pardi¹, Sahil Khanna³

Affiliations

¹ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
² Division of Obstetrics, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
³ Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.

PMID: 37124369
PMCID: PMC10141253
DOI: 10.1177/17562848231170479

Abstract

Background: The incidence of Clostridioides difficile infection (CDI) in peripartum women is rising, but limited data on its effect on maternal and neonatal outcomes are available.

Objective: To study the effect of peripartum CDI on pregnancy and neonatal outcomes.

Design: Retrospective cohort study.

Methods: Patients with peripartum CDI 12 weeks before pregnancy through 6 weeks postpartum (January 1996-February 2018) were matched with controls (peripartum women without CDI) 1:1 by age, year of delivery, and prior pregnancies. McNemar's test and conditional logistic regression were used to analyze the effect of CDI on pregnancy and neonatal outcomes (complications, mode of delivery). p < 0.05 was considered statistically significant.

Results: Overall, 101 cases and 100 controls (1997-2018) were included; median age 27 (range, 20-41) years. Timing of CDI was as follows: pre-pregnancy: 15.8% (n = 16), during pregnancy: 51.5% (n = 52), and postpartum: 32.7% (n = 33). The commonest risk factor was outpatient/emergency room visits. Pregnancy and neonatal outcomes were analyzed for 67 matched pairs with CDI before or during pregnancy. Cases had higher odds of cesarean delivery (p = 0.02) and lower odds of Group B Streptococcus (GBS) infection/colonization (p = 0.03). Odds of cesarean delivery remained high after controlling for labor arrest disorders [odds ratio (OR): 17.23 (95% confidence interval (CI), 2.19-543.19; p = 0.004)]; odds of GBS remained low after controlling for antibiotic use (OR: 0.25, 95% CI, 0.04-0.99; p = 0.049). Neonatal outcomes were similar in cases and controls. CDI treatment did not affect treatment-related or delivery outcomes.

Conclusion: Peripartum CDI was associated with higher odds of cesarean delivery and lower odds of GBS infections. Larger studies exploring the effect of CDI on pregnancy and neonatal outcomes are needed.

Keywords: FMT; antibiotic; children; diarrhea; infection; microbiome obstetric; microbiota transplant; pediatric.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

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[1] Lessa FC, Mu Y, Bamberg WM, et al.. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015; 372: 825–834. - PMC - PubMed

[2] Lessa FC, Mu Y, Bamberg WM, et al.. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015; 372: 825–834. - PMC - PubMed

[3] Ruiter-Ligeti J, Vincent S, Czuzoj-Shulman N, et al.. Risk factors, incidence, and morbidity associated with obstetric Clostridium difficile infection. Obstet Gynecol 2018; 1: 387–391. - PubMed

[4] Ruiter-Ligeti J, Vincent S, Czuzoj-Shulman N, et al.. Risk factors, incidence, and morbidity associated with obstetric Clostridium difficile infection. Obstet Gynecol 2018; 1: 387–391. - PubMed

[5] Kuntz JL, Yang M, Cavanaugh J, et al.. Trends in Clostridium difficile infection among peripartum women. Infect Control Hosp Epidemiol 2010; 31: 532–534. - PubMed

[6] Kuntz JL, Yang M, Cavanaugh J, et al.. Trends in Clostridium difficile infection among peripartum women. Infect Control Hosp Epidemiol 2010; 31: 532–534. - PubMed

[7] von Elm E, Altman DG, Egger M, et al.. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573–577. - PubMed

[8] von Elm E, Altman DG, Egger M, et al.. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573–577. - PubMed

[9] Harris PA, Taylor R, Thielke R, et al.. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381. - PMC - PubMed

[10] Harris PA, Taylor R, Thielke R, et al.. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381. - PMC - PubMed

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Effect of peripartum Clostridioides difficile infection on pregnancy and neonatal outcomes: an observational study

Affiliations

Effect of peripartum Clostridioides difficile infection on pregnancy and neonatal outcomes: an observational study

Authors

Affiliations

Abstract

Conflict of interest statement

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Abstract

Conflict of interest statement

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