Epidemiology of Chagas disease in pregnant women and congenital transmission of Trypanosoma cruzi in the Americas: systematic review and meta‐analysis

• Published in: Tropical medicine & international health 2020-07, Vol.25 (7), p.752-763
• Main Authors: Santana, Kaio Henrique, Oliveira, Luiz Gustavo Rodrigues, Barros de Castro, Daniel, Pereira, Marcos
• Format: Article
• Language: English
• Subjects: Chagas disease; Confidence intervals; congenital infection; Diagnostic systems; Disease transmission; Epidemiology; femmes enceintes; Geopolitics; Heterogeneity; Identification methods; infection congénitale; maladie de Chagas; Meta-analysis; Observational studies; Population studies; Pregnancy; pregnant women; revue systématique; Statistical analysis; systematic review; Trypanosoma cruzi; Vector-borne diseases
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.13398

Objective To estimate the prevalence of Chagas disease in pregnant women and the vertical transmission of the disease. Methods Observational studies were identified from eight electronic databases, and details on study design, population and prevalence of Chagas disease were extracted. The data were pooled using a random‐effects model, and choropleth maps were created based on geopolitical regions and countries. Results The search identified 7788 articles, of which 50 were eligible. We observed a 9% prevalence of Chagas disease among pregnant women in the Americas (95% confidence interval [CI]: 8–10, I2 = 99.96%). High disease prevalence was identified in pregnant women in South American countries (12%, 95% CI: 11–13), while lower values were identified in pregnant women in North America (2%, 95% CI: 1–3). Countries with medium Human Development Index (HDI) had a higher prevalence of Chagas disease in pregnant women (15%, 95% CI: 13–16, I2 = 99.98%) than countries with high HDI (3%, 95% CI: 2–3). The rate of vertical transmission in the continent was 2% (95% CI: 1–2). The statistical analysis showed that this heterogeneity was explained by the study design, region of the Americas and mean income of the country. Conclusion South and Central American countries have a high prevalence and vertical transmission of Chagas disease. Therefore, systematic screens for this disease during the prenatal period are necessary in addition to the diagnosis and treatment of children at risk for Trypanosoma cruzi infection. Objectif Estimer la prévalence de la maladie de Chagas chez les femmes enceintes et la transmission verticale de la maladie. Méthodes Des études d'observation ont été identifiées à partir de huit bases de données électroniques et des détails sur la concept de l'étude, la population et la prévalence de la maladie de Chagas ont été extraits. Les données ont été regroupées à l'aide d'un modèle à effets aléatoires et des cartes choroplèthes ont été créées en fonction des régions et des pays géopolitiques. Résultats La recherche a identifié 7.788 articles, dont 50 étaient éligibles. Nous avons observé une prévalence de 9% de la maladie de Chagas chez les femmes enceintes dans les Amériques (intervalle de confiance [IC] à 95%: 8–10, I2 = 99,96%). Une prévalence élevée de la maladie a été identifiée chez les femmes enceintes dans les pays d'Amérique du Sud (12%, IC95%: 11‐13), tandis que des valeurs plus faibles ont été identifiées chez les femmes enceintes d’Am