{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T08:19:09Z","timestamp":1790410749195,"version":"4.1.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Yersinia pestis continues to cause sporadic cases and outbreaks of plague worldwide and is considered a tier 1 bioterrorism select agent due to its potential for intentional use. Knowledge about the clinical manifestations of plague during pregnancy, specifically the maternal, fetal, and neonatal risks, is very limited.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We searched 12 literature databases, performed hand searches, and consulted plague experts to identify publications on plague during pregnancy. Articles were included if they reported a case of plague during pregnancy and at least 1 maternal or fetal outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Our search identified 6425 articles, of which 59 were eligible for inclusion and described 160 cases of plague among pregnant women. Most published cases occurred during the preantibiotic era. Among those treated with antimicrobials, the most commonly used were sulfonamides (75%) and streptomycin (54%). Among cases treated with antimicrobials, maternal mortality and fetal fatality were 29% and 62%, respectively; for untreated cases, maternal mortality and fetal fatality were 67% and 74%, respectively. Five cases demonstrated evidence of Y. pestis in fetal or neonatal tissues.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Untreated Y. pestis infection during pregnancy is associated with a high risk of maternal mortality and pregnancy loss. Appropriate antimicrobial treatment can improve maternal survival, although even with antimicrobial treatment, there remains a high risk of pregnancy loss. Limited evidence suggests that maternal-fetal transmission of Y. pestis is possible, particularly in the absence of antimicrobial treatment. These results emphasize the need to treat or prophylax pregnant women with suspected plague with highly effective antimicrobials as quickly as possible.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciz1228","type":"journal-article","created":{"date-parts":[[2020,1,3]],"date-time":"2020-01-03T20:19:43Z","timestamp":1578082783000},"page":"S30-S36","source":"Crossref","is-referenced-by-count":13,"title":["Plague During Pregnancy: A Systematic Review"],"prefix":"10.1093","volume":"70","author":[{"given":"Shannon","family":"Fleck-Derderian","sequence":"first","affiliation":[{"name":"Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA"},{"name":"Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Fellowship Program, Oak Ridge, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina A","family":"Nelson","sequence":"first","affiliation":[{"name":"Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine M","family":"Cooley","sequence":"first","affiliation":[{"name":"Synergy America, Contracting Agency for Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Russell","sequence":"first","affiliation":[{"name":"Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Fellowship Program, Oak Ridge, Tennessee, USA"},{"name":"Emergency Preparedness and Response Branch, Division of Preparedness and Emerging Infections, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shana","family":"Godfred-Cato","sequence":"first","affiliation":[{"name":"Infant Outcomes Monitoring, Research and Prevention Branch, Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia L","family":"Oussayef","sequence":"first","affiliation":[{"name":"Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titilope","family":"Oduyebo","sequence":"first","affiliation":[{"name":"Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja A","family":"Rasmussen","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA"},{"name":"Department of Epidemiology, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise J","family":"Jamieson","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Meaney-Delman","sequence":"first","affiliation":[{"name":"Infant Outcomes Monitoring, Research and Prevention Branch, Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,5,21]]},"reference":[{"key":"2020052103181738400_CIT0001","first-page":"43","volume-title":"Diagnosis and clinical manifestations. 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