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Meta-Analysis
. 2019 Oct 14;13(10):e0007807.
doi: 10.1371/journal.pntd.0007807. eCollection 2019 Oct.

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

Ali Rostami  1   2 , Seyed Mohammad Riahi  3 , Despina G Contopoulos-Ioannidis  4 , H Ray Gamble  5 , Yadolah Fakhri  6 , Malihe Nourollahpour Shiadeh  7 , Masoud Foroutan  8 , Hamed Behniafar  9 , Ali Taghipour  8 , Yvonne A Maldonado  4   10 , Ali H Mokdad  11 , Robin B Gasser  12
Affiliations
Meta-Analysis

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

Ali Rostami et al. PLoS Negl Trop Dis. .

Abstract

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flowchart showing the search and study selection strategy.
Fig 2
Fig 2. Forest Plot of the prevalence of acute Toxoplasma infection (ATI) by WHO-region and globally.
ES: estimated prevalence of ATI for WHO regions and individual countries.
Fig 3
Fig 3. Prevalence of acute Toxoplasma infection (ATI) in pregnant women in different countries using geographic information system (GIS).
We used ArcGIS program (version 10.2.2; ESRI, Redlands, California, USA) to draw this figure.
Fig 4
Fig 4. Meta-regression analysis showing a non-significant ecological upward trend in the rates of acute Toxoplasma infection (ATI) with increasing overall population T. gondii seroprevalence rates (latent Toxoplasma infection) in pregnant women.
See this image and copyright information in PMC

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