Burden of hepatitis E virus infection in pregnancy and maternofoetal outcomes: a systematic review and meta-analysis.
BMC Pregnancy Childbirth
; 20(1): 426, 2020 Jul 28.
Article
en En
| MEDLINE
| ID: mdl-32723309
ABSTRACT
BACKGROUND:
There is still a dearth of knowledge on the burden of HEV infection in the global population of pregnant women. Therefore, we conducted a systematic review and meta-analysis to estimate the global burden of HEV infection in pregnancy.METHODS:
We searched PubMed, Embase, Web of Knowledge, and Global Index Medicus to identify articles published until January 26, 2020. We considered cross-sectional, case-control, and cohort studies reporting the immunoglobulins M HEV seroprevalence in asymptomatic and symptomatic (jaundice or elevated transaminases) pregnant women or investigating the association between HEV infection and maternofoetal outcomes. We used a random-effects model to pool studies. This review was registered with PROSPERO, CRD42018093820.RESULTS:
For HEV prevalence estimates, we included 52 studies (11,663 pregnant women). The seroprevalence was 3.5% (95% confidence interval 1.4-6.4) in asymptomatic women (most of whom from high endemic areas). The prevalence in symptomatic women was 49.6% (42.6-56.7) with data only from HEV high endemic countries. In the multivariable meta-regression model, the prevalence was higher in symptomatic women compared to asymptomatic (adjusted prevalence odds ratio [aPOR] 1.76; 95%CI 1.61-1.91) and decreased with increasing year of publication (by 10-year) (aPOR 0.90; 95%CI 0.84-0.96). The proportion of HEV vertical transmission was 36.9% (13.3-64.2). Risk of bias was low, moderate and high respectively in 12 (23%), 37 (70%), and 4 studies (7%) addressing HEV prevalence estimation. HEV infection was associated with maternal deaths (pooled OR 7.17; 3.32-15.47), low birth weight (OR 3.23; 1.71-6.10), small for gestational age (OR 3.63; 1.25-10.49), preterm < 32 weeks (OR 4.18; 1.23-14.20), and preterm < 37 weeks (OR 3.45; 2.32-5.13), stillbirth (OR 2.61; 1.64-4.14), intrauterine deaths (OR 3.07; 2.13-4.43), and not with miscarriage (OR 1.74; 0.77-3.90). All studies which assessed the association between HEV infection and maternofoetal outcomes had a moderate risk of bias.CONCLUSIONS:
Findings from this study are suggestive of a high burden of HEV infection in pregnancy in high endemic countries, its association with poor maternofoetal outcomes, and a high rate of vertical transmission. This study supports the need for specific strategies to prevent exposure of pregnant women to HEV infection, especially in high endemic areas.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Complicaciones Infecciosas del Embarazo
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Hepatitis E
Tipo de estudio:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prevalence_studies
/
Prognostic_studies
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Risk_factors_studies
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Systematic_reviews
Límite:
Adult
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Female
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Humans
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Newborn
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Pregnancy
Idioma:
En
Revista:
BMC Pregnancy Childbirth
Asunto de la revista:
OBSTETRICIA
Año:
2020
Tipo del documento:
Article
País de afiliación:
Camerún