Leptospirosis in Pregnancy: Prevalence, Risk Factors, Clinical Characteristics, and Outcomes in a North Indian Population

IntroductionLeptospirosis, a neglected zoonotic disease bears a significant global burden and is endemic in India. Leptospirosis in pregnancy can lead to severe adverse outcomes but is often misdiagnosed and underreported as clinical presentation is masked by the symptoms of common obstetric complications and other endemic infectious diseases. Our aim was to generate epidemiological information on the prevalence and distribution, risk factors, and outcomes (both maternal and fetal) of the disease among a population of pregnant and post-partum women in northern India. MethodsWe conducted a cross-sectional study on a random sample of 170 pregnant and post-partum women in 10 hospitals across three northern states of India in whom ELISA IgG and IgM antibody tests were done. Women were categorised as seropositive if they had high levels of either IgG or IgM. We identified study variables based on an available systematic review of leptospirosis in pregnancy. Fishers Exact and Wilcoxon rank-sum non-parametric tests were used to analyse the association between leptospirosis in pregnancy and a range of socio-demographic and clinical factors. An analysis of the geographical distribution of the seropositive cases was undertaken using Geographical Information System mapping. ResultsThe prevalence of leptospirosis in pregnancy was 5.9% (95% CI: 2.85 - 10.55%) with 80% of the seropositive cases living near water sources and lowlands. Proportions of cardiac problems, raised liver enzymes, anaemia and adverse fetal outcomes were higher among women who were seropositive compared with women who were seronegative. Adverse maternal and fetal outcomes were more common among seropositive pregnant and post-partum women compared with seronegative women. ConclusionsThis is the first descriptive epidemiological study of leptospirosis in pregnancy in India that generates important hypotheses emphasizing the need for further research. Pregnant women in endemic regions should be screened for leptospirosis for early diagnosis and treatment to avoid adverse outcomes. Author SummaryLeptospirosis bears a significant global burden and is endemic in India. In pregnancy, it can lead to serious complications, but leptospirosis in pregnancy is often misdiagnosed and underreported as clinical presentation of the disease is masked by the symptoms of common obstetric complications and other endemic infectious diseases. There are no detailed studies about leptospirosis in pregnancy in India with almost all published studies being case reports. In recognition of this limitation, this cross-sectional study was undertaken to understand the rates, risk factors and outcomes of leptospirosis in pregnancy in India. ELISA IgG and IgM antibody tests were conducted to determine the seroprevalence of leptospirosis in the population. The rate of leptospirosis in pregnancy in our study population was found to be 5.9%. A majority of the seropositive cases lived near water sources and lowlands. The adverse clinical presentation of cardiac problems, raised liver enzymes, anaemia and adverse fetal outcomes were observed to be more common among seropositive pregnant and post-partum women compared with seronegative women. The study highlights the need for more research and for screening of leptospirosis in pregnant women living in endemic regions for early diagnosis and treatment to avoid adverse outcomes.