Cesarean Delivery More Common When CDI Is Present, Study Finds

A new study has found that infection with Clostridioides difficile (CDI) around the time of pregnancy can significantly increase the risk that a patient delivers via cesarean section.

The study also found, however, that pregnant women with CDI are at a lower risk of Group B Streptococcus (GBS) infection or colonization. The report was published in the journal Therapeutic Advances in Gastroenterology.

CDI brings with it a significant risk of morbidity and mortality, noted corresponding author Sahil Khanna, MBBS, MS, of the Mayo Clinic, and colleagues. However, pregnant women have traditionally been considered at low risk of contracting the infection, they said.

Recently, however, rates of CDI among peripartum women have doubled. Despite that increase, the question of how CDI affects maternal neonatal outcomes has not been extensively studied.

Khanna and colleagues decided to retrospectively analyze a cohort of 101 women who contracted CDI in the 12 weeks before they become pregnant, during their pregnancy, or in the 6 weeks following pregnancy. The cases ranged from the years January 1996 through February 2018. Half of the women (51.5%) were infected with CDI during their pregnancy, 32.7% became infected postpartum, and the remaining 15.8% became infected shortly before their pregnancy.

A control cohort was also created, composed of 100 women who were pregnant between 1997 and 2018. The median age of the case cohort was 27 years, and the median age of the control cohort was 28 years. From those 2 cohorts, 67 matches were created and analyzed for pregnancy and neonatal outcomes.

The authors found a significantly higher risk of cesarean delivery among the CDI group, with 26.5% of pregnancies in the CDI group ending with cesarean, compared to 10.2% of cases in the control group. After conducting a multivariable analysis and controlling for labor arrest disorders, the investigators calculated an odds ratio of cesarean delivery of 17.23 (95% CI, 2.19-543.19; P < .004).

In terms of pregnancy complications, the authors found the risk of GBS was significantly lower in the CDI group (7.5% versus 23.9% in the control group). After adjusting for antibiotic use, the CDI group had a 0.25 odds ratio (95% CI, 0.04-0.99; P = 0.049).

The investigators said most of the cases in the study were health care-associated infections.

“Most patients had healthcare contact prior to CDI; conceivably several of these visits were part of antenatal care. Future studies should explore the frequency of healthcare exposure as a risk factor for CDI,” the authors said.

Metronidazole was the most common treatment for CDI in the cohort, though the investigators said treatment choice did not appear to affect treatment-related outcomes or delivery outcomes. They also noted that neonatal outcomes did not appear to be affected by peripartum CDI. However, Khanna and colleagues noted that there was a lack of linkage between maternal and neonatal records, which limited the conclusions they could draw regarding neonatal outcomes. The authors said larger studies are needed to confirm their findings.

“Increased awareness of peripartum CDI is warranted among both clinicians and patients to prevent adverse events,” they said.

Reference

Saha S, Pardi R, Theiler RN, Pardi DS, Khanna S. Effect of peripartum Clostridioides difficile infection on pregnancy and neonatal outcomes: an observational study. Therap Adv Gastroenterol. Published online April 27, 2023. doi:10.1177/17562848231170479