title: Anthrax cases in pregnant and postpartum women: a systematic review.
abstract: OBJECTIVE
  To describe the worldwide experience of Bacillus anthracis infection reported in pregnant, postpartum, and lactating women.
  
  
  METHODS
  Studies were identified through MEDLINE, Web of Science, Embase, and Global Health databases from inception until May 2012. The key words (["anthrax" or "anthracis"] and ["pregna*" or "matern*" or "postpartum" or "puerperal" or "lact*" or "breastfed*" or "breastfeed*" or "fetal" or "fetus" or "neonate" or "newborn" or "abort*" or "uterus"]) were used. Additionally, all references from selected articles were reviewed, hand searches were conducted, and relevant authors were contacted.
  
  
  METHODS
  The inclusion criteria were: published articles referring to women diagnosed with an infection due to exposure to B anthracis during pregnancy, the postpartum period, or during lactation; any article type reporting patient-specific data; articles in any language; and nonduplicate cases. Non-English articles were professionally translated. Duplicate reports, unpublished reports, and review articles depicting previously identified cases were excluded.
  
  
  RESULTS
  Two authors independently reviewed articles for inclusion. The primary search of the four databases yielded 1,340 articles, and the secondary crossreference search revealed 146 articles. Fourteen articles met the inclusion criteria. In total, 20 cases of B anthracis infection were found, 17 in pregnant women, two in postpartum women, and one case in a lactating woman. Among these reports, 16 women died and 12 fetal or neonatal losses were reported. Of these fatal cases, most predated the advent of antibiotics.
  
  
  CONCLUSIONS
  Based on these case reports, B anthracis infection in pregnant and postpartum women is associated with high rates of maternal and fetal death. Evidence of possible maternal-fetal transmission of B anthracis infection was identified in early case reports.
authors.affiliation: Emory University, Atlanta, Georgia, USA. vmo0@cdc.gov.
authors.forename: Dana
authors.initials: D
authors.lastname: Meaney-Delman
authors.forename: Marianne E
authors.initials: ME
authors.lastname: Zotti
authors.forename: Sonja A
authors.initials: SA
authors.lastname: Rasmussen
authors.forename: Sheryl
authors.initials: S
authors.lastname: Strasser
authors.forename: Sean
authors.initials: S
authors.lastname: Shadomy
authors.forename: Reina M
authors.initials: RM
authors.lastname: Turcios-Ruiz
authors.forename: George D
authors.initials: GD
authors.lastname: Wendel
authors.forename: Tracee A
authors.initials: TA
authors.lastname: Treadwell
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
mesh_terms: D000881:Anthrax / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001408:Bacillus anthracis / Q000187:drug effects / Q000302:isolation & purification; D001942:Breast Feeding; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation; D063130:Maternal Death / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents