{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:05:14Z","timestamp":1791266714634,"version":"4.1.0"},"reference-count":39,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2015,2,23]]},"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Whether areas affected by Q fever during a large outbreak (2008\u20132010) had higher rates of adverse pregnancy outcomes than areas not affected by Q fever.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Nationwide registry-based ecological study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Pregnant women in areas affected and not affected by Q fever in the Netherlands, 2003\u20132004 and 2008\u20132010.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Index group (N=58\u2005737): pregnant women in 307 areas with more than two Q fever notifications. Reference group (N=310\u2005635): pregnant women in 921 areas without Q fever notifications. As a baseline, pregnant women in index and reference areas in the years 2003\u20132004 were also included in the reference group to estimate the effect of Q fever in 2008\u20132010, and not the already existing differences before the outbreak.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Preterm delivery, small for gestational age, perinatal mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 2008\u20132010, there was no association between residing in a Q fever-affected area and both preterm delivery (adjusted OR 1.01 (95% CI 0.94 to 1.08)), and perinatal mortality (adjusted OR 0.87 (95% CI 0.72 to 1.05)). In contrast, we found a weak significant association between residing in a Q fever-affected area in 2008\u20132010 and small for gestational age (adjusted OR 1.06 (95% CI 1.01 to 1.12)), with a population-attributable fraction of 0.70% (95% CI 0.07% to 1.34%). We observed no dose\u2013response relation for this outcome with increasing Q fever notifications, and we did not find a stronger association for women who were in their first trimester of pregnancy during the months of high human Q fever incidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study found a weak association between residing in a Q fever-affected area and the pregnancy outcome small for gestational age. Early detection of infection would require mass screening of pregnant women; this does not seem to be justified considering these results, and the uncertainties about its efficacy and the adverse effects of antibiotic treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2014-006821","type":"journal-article","created":{"date-parts":[[2015,4,10]],"date-time":"2015-04-10T22:21:57Z","timestamp":1428704517000},"page":"e006821","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Nationwide registry-based ecological analysis of Q fever incidence and pregnancy outcome during an outbreak in the Netherlands"],"prefix":"10.1136","volume":"5","author":[{"given":"Marit M A","family":"de Lange","sequence":"first","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal W P M","family":"Hukkelhoven","sequence":"additional","affiliation":[{"name":"The Netherlands Perinatal Registry, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janna M","family":"Munster","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M","family":"Schneeberger","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, \u2018s-Hertogenbosch, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"van der Hoek","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,4,10]]},"reference":[{"key":"2025120518185050000_5.4.e006821.1","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1128\/CMR.12.4.518","article-title":"Q fever","volume":"12","author":"Maurin","year":"1999","journal-title":"Clin Microbiol Rev"},{"key":"2025120518185050000_5.4.e006821.2","first-page":"60","article-title":"Placentitis and abortion in goats and sheep in Ontario caused by Coxiella burnetii","volume":"24","author":"Palmer","year":"1983","journal-title":"Can Vet J"},{"key":"2025120518185050000_5.4.e006821.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1574-695X.2011.00876.x"},{"key":"2025120518185050000_5.4.e006821.4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1017\/S0950268810001032","article-title":"In search of hidden Q-fever outbreaks: linking syndromic hospital clusters to infected goat farms","volume":"139","author":"van den Wijngaard","year":"2011","journal-title":"Epidemiol Infect"},{"key":"2025120518185050000_5.4.e006821.5","doi-asserted-by":"publisher","DOI":"10.1086\/520661"},{"key":"2025120518185050000_5.4.e006821.6","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.448"},{"key":"2025120518185050000_5.4.e006821.7","first-page":"54","article-title":"Chronic or fatal Q-fever infection: a review of 16 patients seen in North-East Scotland (1967\u201380)","volume":"52","author":"Ellis","year":"1983","journal-title":"Q J Med"},{"key":"2025120518185050000_5.4.e006821.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(88)80355-3"},{"key":"2025120518185050000_5.4.e006821.9","doi-asserted-by":"crossref","first-page":"925","DOI":"10.3201\/eid2006.130584","article-title":"Adverse pregnancy outcomes and Coxiella burnetii antibodies in pregnant women, Denmark","volume":"20","author":"Nielsen","year":"2014","journal-title":"Emerg Infect Dis"},{"key":"2025120518185050000_5.4.e006821.10","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu259"},{"key":"2025120518185050000_5.4.e006821.11","doi-asserted-by":"publisher","DOI":"10.1086\/514698"},{"key":"2025120518185050000_5.4.e006821.12","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/j.1469-0691.2011.03562.x","article-title":"Q fever and spontaneous abortion","volume":"18","author":"Quijada","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"2025120518185050000_5.4.e006821.13","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-11-44"},{"key":"2025120518185050000_5.4.e006821.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(00)00276-1"},{"key":"2025120518185050000_5.4.e006821.15","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-13-87"},{"key":"2025120518185050000_5.4.e006821.16","doi-asserted-by":"crossref","first-page":"20504","DOI":"10.2807\/ese.18.24.20504-en","article-title":". 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