Prevalence of human immunodeficiency virus, syphilis, and hepatitis B and C virus infections in pregnant women: a systematic review and meta-analysis

Abstract

Background: At the 74th World Health Assembly, the WHO issued a strategy for the prevention and control of several major infectious diseases. To achieve the WHO-initiated targets for these infectious diseases, the elimination of mother-to-child transmission is essential. To date, a systematic review of the global and regional prevalence of infections with relevant mother-to-child transmission and outside the spectrum of congenital infections is lacking.

Objectives: We aimed to systematically review the prevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis in pregnant women.

Data sources: MEDLINE, Embase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang database and China Biology Medicine disc database, and five WHO Regional Index Medicus databases.

Study eligibility criteria: Original studies reporting the prevalence of infection or coinfection of HIV, HBV, HCV, and syphilis in pregnant women.

Methods: This systematic review followed the preferred reporting items for systematic reviews and meta-analyses 2020 checklist. We used random-effects models to generate pooled prevalence estimates for each infection.

Results: The global pooled prevalence in pregnant women of HIV, HBV, HCV, and syphilis was 2.9% (95% CI, 2.4-3.4%), 4.8% (3.8-5.8%), 1.0% (0.8-1.3%), and 0.8% (0.7-0.9%). The pooled prevalence of HIV, HBV, HCV, and syphilis in low-income countries was higher than the global level (HIV: 5.2% [1.6-10.5%); HBV: 6.6% (5.4-7.9%); HCV: 2.7% (1.6-4.1%); syphilis: 3.3% (2.2-4.6%]). The pooled prevalence of HIV, HBV, HCV, and syphilis in lower-middle-income countries was higher than the global level (HIV: 2.9% [0.8-6.1%]; HBV: 4.9% [3.8-6.1%]; HCV: 2.3% [1.2-3.6%]; syphilis: 1.5% [1.0-2.2%]).

Conclusions: The prevalence of these infections among pregnant women was particularly high in resource-poor settings. The relevance and feasibility of current global practice guidelines for the prevention of mother-to-child transmission of these infections in lower-middle-income countries must be evaluated, including timely access to screening and therapeutics.

Keywords: Hepatitis B; Hepatitis C; Human immunodeficiency virus; Pregnancy; Syphilis; Systematic review.