PLoS Neglected Tropical Diseases (Oct 2019)

Acute Toxoplasma infection in pregnant women worldwide: A systematic review and meta-analysis.

  • Ali Rostami,
  • Seyed Mohammad Riahi,
  • Despina G Contopoulos-Ioannidis,
  • H Ray Gamble,
  • Yadolah Fakhri,
  • Malihe Nourollahpour Shiadeh,
  • Masoud Foroutan,
  • Hamed Behniafar,
  • Ali Taghipour,
  • Yvonne A Maldonado,
  • Ali H Mokdad,
  • Robin B Gasser

DOI
https://doi.org/10.1371/journal.pntd.0007807
Journal volume & issue
Vol. 13, no. 10
p. e0007807

Abstract

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BACKGROUND:Acute Toxoplasma infection (ATI) during pregnancy, if left untreated, can cause severe adverse outcomes for the fetus and newborn. Here, we undertook a meta-analysis to estimate the worldwide prevalence of ATI in pregnant women. METHODS:We searched international databases for studies published between January 1988 and November 2018. We included population-based cross-sectional and prospective cohort studies that reported the prevalence of ATI in pregnant women. Data were synthesized using a random effect model to calculate the overall prevalence of ATI (with a 95% CI) in six WHO regions and globally. We also performed linear meta-regression analyses to investigate associations of maternal, socio-demographic, geographical and climate parameters with the prevalence of ATI. RESULTS:In total, 217 studies comprising 902,228 pregnant women across 74 countries were included in the meta-analysis. The overall prevalence of ATI in pregnant women globally was 1.1% (95% CI: 0.9-1.2%). In studies where more strict criteria for ATI were used, the overall prevalence was 0.6% (95% CI: 0.4-0.7%). The prevalence was highest in the Eastern Mediterranean region (2.5%; 95%CI: 1.7-3.4%) and lowest in the European region (0.5%; 95% CI: 0.4-0.7%). A significantly higher prevalence of ATI was found in countries with lower income levels (P = 0.027), lower human development indices (P = 0.04), higher temperatures (P = 0.02) and lower latitudes (P = 0.005) and longitudes (P = 0.02). CONCLUSIONS:The risk of acquiring ATI during gestation is clinically important and preventive measures to avoid exposure of pregnant women to Toxoplasma infection should be strictly applied.