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

Introduction: Leptospirosis, 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. Methods: We 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. Results: The 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. Conclusions: This 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.