Listeriosis in Pregnant Women and Neonates in China: A Systematic Review.

Authors

Baorong Gao, Yali Miao, Rui Miao, Hui Ye

Published in

Journal of clinical medicine. Volume 15. Issue 15. Jul 29, 2026. Epub Jul 29, 2026.

Abstract

Background: Pregnancy-related listeriosis typically causes mild, self-limited maternal symptoms but can lead to severe fetal and neonatal outcomes, posing a significant public health concern given its rising incidence. However, data on the epidemiology of this infection and its impact on maternal and neonatal outcomes in China remain scarce and fragmented. Methods: A systematic search was conducted in the following three Chinese-language databases (CNKI, Wanfang, and CBM) and two English-language databases (PubMed and Embase) for studies performed in China from 1 January 2018 to 14 March 2026. Relevant studies published before 2018 were identified from two previous systematic reviews. Information on the epidemiology, clinical manifestations, and outcomes of pregnancy-related listeriosis was extracted. For inclusion in pooled incidence estimates for pregnant women, studies were required to have the number of pregnant women or pregnancies as the denominator; for pooled neonatal case fatality risk estimates, studies were required to report the total number of neonatal listeriosis cases. The methodological quality of each included study was appraised using the Joanna Briggs Institute critical appraisal tool. Heterogeneity among the studies was quantified by the I² statistic. All statistical analyses were performed using STATA version 12 and Microsoft Excel 365 (PROSPERO: CRD420261326136). Results: Of 389 abstracts initially identified, 160 full-text articles were retrieved for detailed evaluation, and 73 studies (including two previous systematic reviews) ultimately met the inclusion criteria. These studies, which were conducted across 19 provinces, provided sufficient data for analysis, encompassing 956 pregnant women and 749 neonates. Pregnancy-related listeriosis showed regional variation, with Beijing (n = 215), Zhejiang (n = 143), and Shaanxi (n = 142) contributing the most cases. The pooled incidence of obstetric listeriosis was 11.57 per 100,000 pregnancies (95% CI, 7.63-15.50; I² = 73%) based on nine studies, and the pooled incidence of neonatal listeriosis was 7.55 per 100,000 live births (95% CI, 4.44-10.67; I² = 60%) based on six studies. Fever (53.7%, 513/956) was the most common symptom among pregnant women, whereas respiratory distress (34.8%, 261/749) predominated in neonates. For empirical therapy, only 6.0% (57/956) of pregnant women received a penicillin-based regimen, whereas 32.5% (311/956) received cephalosporins. Two maternal deaths were recorded, whereas major adverse outcomes (miscarriage, stillbirth, prematurity, or low birth weight) occurred in 58.3% of pregnancies. Among neonates, 27.5% (206/749) received empirical penicillin therapy and 15.6% (117/749) received cephalosporins. The neonatal case fatality rate was 11% (95% CI, 0.06-0.17; I² = 60%). Conclusions: Pregnancy-related listeriosis in China carries a substantial burden, with high rates of adverse fetal and neonatal outcomes. Suboptimal surveillance and inappropriate empirical antibiotic therapy likely contribute to these poor outcomes, highlighting the urgent need for enhanced surveillance, prompt recognition, and appropriate antibiotic use when Listeria infection is suspected.

PMID:
42590019
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

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