Management of Listeriosis During Pregnancy

Target Population: Clinicians who provide obstetric care

Background and Objective

Listeria monocytogenes infection can cause gastrointestinal illness followed by fever, myalgia, backache, and headache. Risk for listeriosis is about 13 times higher in pregnant women than the general population, and about one in five such women who develop symptomatic disease experience spontaneous abortion or stillbirth. Because listeriosis is predominantly foodborne, the CDC has indicated that pregnant women should avoid certain foods. Pregnancy-associated listeriosis is substantially more common among Latina women, probably reflecting dietary risks associated with Mexican-style cheeses.

Key Recommendations

The following recommendations apply to pregnant women with presumptive exposure to listeria:

• Asymptomatic women: No testing or treatment is indicated; such women should be counseled to return promptly if symptoms develop.

• Mildly symptomatic, afebrile women: Expectant management without testing.

• Febrile women (temperature >38.1°C or >100.6°F): Treat preemptively while results of blood or placental culture are pending.

• High-dose intravenous ampicillin is standard (≥6 g daily for ≥14days); trimethoprim plus sulfamethoxazole may be given to penicillin-allergic women.