Screening pregnant women in Q fever areas is unnecessary

Since the outbreak of Q fever in the south of the Netherlands in 2007, experts have been wondering whether all pregnant women, including those without symptoms of Q fever, should be screened for the disease in order to minimize the risk of complications during pregnancy. UMCG researcher Janna Munster has concluded that there is no need to screen this group of women. ‘Screening did not lead to fewer complications in pregnancy and thus need not be introduced as a routine test,’ says Munster. She will be awarded a PhD by the University of Groningen on 10 October 2012.

Munster stresses that her findings do not apply to women presenting with symptoms of Q fever. She suggests that Q fever with and without symptoms should be treated as two separate diseases when it comes to preventing complications in pregnancy.

Research into screening

To study the effect of screening, Munster compared two groups of pregnant women, all without symptoms of Q fever. A phial of blood was taken from more than 1,200 pregnant women in 2010. Half of these samples were immediately tested for antibodies to the Q fever bacteria. The blood in the other samples was tested after the women had given birth. This was the control group needed to compare the outcome of the pregnancies.

Complications of pregnancy

Munster found antibodies to Q fever in the blood of 15% of the pregnant women in both groups. The number of complications was the same for both groups of women with antibodies in their blood. Munster also compared the number of complications among the women with and without antibodies to the Q fever bacteria. Here too, she discovered no difference in the number of complications. Based on her research, Munster concludes that routinely screening pregnant women in Q -fever areas does not help prevent complications during pregnancy.

Acute infection

A small number of the group of women whose blood was tested while they were pregnant were found to have an acute Q fever infection. These women were treated with antibiotics during their pregnancy. None of them women in both groups developed a chronic Q fever infection.

Advice

Munster stressed that pregnant women living in areas where Q fever occurs should be alert to possible symptoms. ‘It is sensible to go to the doctor if you develop symptoms of the disease during pregnancy,’ says Munster. She thinks that her research findings will be of comfort to pregnant women and women who are considering getting pregnant and who live in areas with a high incidence of Q fever. ‘I would advise these women to avoid farms where Q fever has been confirmed, but a visit to a petting farm where the animals have been vaccinated does not pose a problem,’ explains Munster.

Curriculum Vitae

Janna Munster (Goes, 1985) studied Medical Sciences at the University of Groningen. She conducted her PhD research in the Epidemiology and Gynaecology & Obstetrics departments of the UMCG, and the Pharmaco-epidemiology and Pharmaco-economics departments of the University of Groningen. The research was funded by ZonMw. Her thesis is entitled ‘Q fever during pregnancy – lessons from the Dutch epidemic.’ Munster is now training to become a gynaecologist in Medisch Spectrum Twente in Enschede, Cluster Groningen, UMCG.