Seroprevalence of Toxocara spp. in Pregnant Women: A Systematic Review and Meta-Analysis.

Human toxocariasis is a neglected zoonotic disease and its impact on human health is underestimated. Studies investigating the occurrence of toxocariasis in pregnancy are very scarce in Nigeria. This study investigated the seroprevalence of Toxocara spp. antibodies as well as the possible risk factors in pregnant women who routinely attended an antenatal clinic in a university hospital in Ile-Ife, Osun state. Blood samples were collected from 413 participating pregnant women between October 2017 and February 2018. Epidemiological data were obtained through a structured questionnaire. The sera were screened for anti-Toxocara IgG antibodies by western blot technique based on Toxocara canis larval excretory-secretory antigens, targeting low molecular weight bands of 24-35 kDa, specifically for T. canis infection. The overall seroprevalence was 92.49% (382/413). There was no significant difference in the seroprevalence rate of Toxocara spp. infection between pregnant women aged ≤30 y and those aged >30 y (91.63 vs 93.33%; OR 1.28, 95% CI 0.61 to 2.67, p=0.511). The seroprevalence rate increased with the number of miscarriages but there was no statistical significance (p>0.05). Moreover, no significant associations were found between Toxocara spp. seropositivity and other studied risk factors (p>0.05). The high seroprevalence of Toxocara spp. in pregnant Nigerian women needs comprehensive health education regarding personal hygiene and how to avoid exposure to this parasite infection.

In the present study, we performed a systematic review and meta-analysis to assess the global and regional seroprevalence of Toxocara spp. and associated risk factors among children. The present systematic review and meta-analysis was followed based on the Preferred Reporting. Items for Systematic Reviews and Meta-analyses (PRISMA) protocol. We searched the online databases (PubMed, Scopus, and Web of Science) and Google Scholar search engine for studies that measured seroprevalence of Toxocara spp. among children, published between 1 January 2000 and 15 January 2022. Accordingly, the pooled seroprevalence and 95% confidence intervals (CI) were estimated using a random-effects meta-analysis model. A total of 65 articles from 22 countries met the inclusion criteria. The global seroprevalence of Toxocara spp. infection among children was estimated as 25% (95% CI 22-29). Meta-regression analysis showed that the type of population studied (p = 0.002) and year of publication (p = 0.044) it may be the source of heterogeneity. The highest and lowest pooled seroprevalence of Toxocara spp. infection were estimated in Thailand and Colombia as 58.2% (95% CI 50.9-65.5) and 7.04% (95% CI 3.05-11.3), respectively. Male gender was associated with a higher risk of Toxocara spp. compared to females, and this association was statistically significant (OR = 1.24; 95% CI 1.09-1.41, p = 0.001). However, residing in rural areas did not show a statistically significant increase in risk compared to living in urban areas (OR = 1.39; 95% CI 0.88-2.21, p = 0.143). Toxocariasis is common among children, hence, prevention and control scheme of this helminth in children should be considered by health officials and health policymakers, especially in developing countries, where seroprevalence is highest.

Toxocara spp. infection can cause systemic and ocular disease in infants and pregnant women. In this study, the seroprevalence and associated risk factors of Toxocara spp. infection were investigated in pregnant women from Jahrom county, Fars province, southern Iran. A total of 220 serum samples from pregnant women were assessed for the presence of Toxocara spp. IgG by enzyme-linked immunosorbent assay (ELISA). The associated risk factors were obtained using questionnaires. The seroprevalence was 16.36% (36/220) among pregnant women. As such, a statistically significant association was found between age (39 ≤ years old with P-value: 0.009), consuming raw vegetables (P-value: 0.001), and eating raw or undercooked meat (P-value: 0.04). We recommend an appropriate health education program for pregnant women and serological screening for toxocariasis before pregnancy. Moreover, we believed a need for more epidemiological studies for better understand the status of Toxocara spp. in pregnant women.

BackgroundToxocarosis is a widespread zoonosis caused by the ascarid nematodes Toxocara canis and Toxocara cati, which primarily infect dogs and cats, respectively. Most human infections with Toxocara are asymptomatic; however, some infected individuals may develop a serious illness and even death. Nevertheless, epidemiological knowledge regarding the prevalence and risks associated with Toxocara infection is limited in China. Therefore, we performed a cross-sectional pilot study and estimated the seroprevalence of Toxocara infection in humans in Shandong Province, eastern China for the first time, from June 2011 to July 2013, involving clinically healthy individuals, pregnant women and psychiatric patients, aiming to attract public attention to Toxocara infection.Methodology/Principle FindingsSeroprevalence of Toxocara was determined using an enzyme-linked immunosorbent assay based on a cross-sectional study conducted in Qingdao and Weihai, Shandong Province, eastern China. Factors potentially associated with Toxocara infection were identified by logistic regression analysis. The overall Toxocara seroprevalence among the study population (n = 2866) was 12.25%, and a significantly higher seroprevalence in psychiatric patients (16.40%, 73/445) than that in clinically healthy individuals (13.07%, 187/1431) and pregnant women (9.19%, 91/990) was revealed. Univariate analyses suggested that keeping dogs at home (OR = 0.06, 95% CI 0.05–0.08, P<0.001), contact with cats and dogs (OR = 0.42, 95% CI 0.33–0.53, P<0.001) and exposure with soil (OR = 0.37, 95% CI 0.28–0.49, P<0.001) were risk factors associated with Toxocara infection.Conclusions/SignificanceThe present study revealed, for the first time, that human infection with Toxocara is common in eastern China, posing a significant public health concern. Increasing human and dog populations, population movements and climate change all will serve to increase the importance of this zoonosis. Further studies under controlled conditions are necessary to define potential morbidity associated with Toxocara infection.

In spite of the importance of toxoplasmosis and toxocariasis among the high-risk groups, such as pregnant women, the infections are categorized as a neglected tropical disease by the World Health Organization. Toxoplasma gondii and Toxocara spp. infections can cause systemic and ocular diseases in infants during pregnancy. In this study, we investigated seroprevalence and risk factors of toxoplasmosis, toxocariasis and their co-infection in pregnant women and non-pregnant women referred to the healthcare facilities of Ilam province, west of Iran. A total of 378 sera samples (189 pregnant women and 189 non-pregnant women) was investigated for the presence of IgG antibodies against T. gondii and Toxocara spp. by Enzyme-linked immunosorbent assay (ELISA). The samples of all pregnant women with abortion (56 cases) were also evaluated for IgM anti-toxoplasmosis antibody by ELISA method. Moreover, associated factors were obtained from the participant's questionnaires. Data analysis for this study was performed using the spss software version 20. Seroprevalence of T. gondii, Toxocara spp., and their co-infection in pregnant women was 39.7%, 21.2% and 9.5%, respectively. Regarding the risk factors, the contact with a cat (P = 0.04) and dog (P = 0.00) were significantly associated with T. gondii and Toxocara spp., respectively. This study highlighted the importance of serological diagnosis before pregnancy. Moreover, we believe that more epidemiological studies are needed for a better understanding of overlaps between T. gondii and Toxocara spp. in pregnant women.

COVID-19 vaccines in pregnancy.

Perinatal transmission is one of the most common routes of hepatitis B virus (HBV) transmission. This study aims to identify the epidemiological features of HBV among pregnant Iranian women. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Two authors independently searched several online databases without time limit until May 2017. The databases include Magiran, Iranmedex, SID, Medlib, IranDoc, Scopus, PubMed, Science Direct, Cochrane, Web of Science and Google Scholar. The data were analyzed based on a random-effects model using Comprehensive Meta-Analysis software version 2. Thirty-seven studies were included in the meta-analysis. The prevalence of HBV among pregnant Iranian women was 1.18% (95% CI: 0.09%-1.53%). The prevalence of HBV among pregnant women living in urban and rural areas was 1.60% (95% CI: 0.06%-4.30%) and 1.70% (95% CI: 0.09%-3.2%), respectively. The prevalence of HBV among housewives and working pregnant women was 4.3% (95% CI: 1.4%-12.5%) and 1.2% (95% CI: 0.02%-5.8%), respectively. The risk of developing an HBV infection was significantly associated with illiteracy (p=0.013), abortion (p=0.001), blood transfusion (p < 0.001) and addicted spouse (p=0.045). However, no significant relationship was observed between HBV infection and urbanization (p=0.65), occupation (p=0.37), history of surgery (p=0.32) or tattooing (p=0.69). Vaccination coverage (receiving at least a single dose) in pregnant women was 9.8% (95% CI: 5.3%-17.5%). The prevalence of HBV among pregnant women is lower than in the general population of Iran. HBV vaccination coverage was low among pregnant Iranian women. Therefore, health policy-makers are recommended to enforce immunization programs for HBV vaccination among high-risk pregnant women.

Existing evidence on the burden of mental health problems among pregnant and postpartum women living with HIV, a vulnerable population in sub-Saharan Africa (SSA), is limited and fragmented, affecting the development of context-sensitive and integrated interventions. This systematic review aims to provide an up-to-date and comprehensive synthesis of available evidence to estimate the burden and identify the determinants of mental health problems among pregnant and postpartum women living with HIV across countries in sub-Saharan Africa. We will retrieve all relevant studies (published and unpublished) through searches in PubMed, Embase, PsycINFO, CINAHL, LILACS, Google Scholar, Scopus and Web of Science from inception to 30th June 2024, without language restriction. We will use the following search terms 'mental health disorder', 'mental health problem', 'pregnant women', 'postpartum women' and 'HIV' nested with all applicable alternate terms and the names of countries in SSA for running the searches. We will also search HINARI, African Index Medicus, African Journals Online, Academic Search Premier, medRxiv, ProQuest, EBSCO Open Dissertations, and reference lists of relevant studies. We will contact experts in the field for potentially relevant unpublished studies. All retrieved articles from the electronic databases and grey literature will be collated and deduplicated using Endnote and exported to Rayyan QCRI. Two reviewers will independently select studies using a pretested study selection flow chart developed from the pre-specified eligibility criteria. Two reviewers will extract data using a pretested data extraction form and assess the risk of bias in the included studies using the risk of bias tool for prevalence studies by Hoy et al. (2012). Any disagreements will be resolved through discussion between the reviewers. Binary outcomes (prevalence and incidence of mental health problems among pregnant and postpartum women living with HIV) will be evaluated using pooled proportions (for non-comparative studies) and odds ratio (OR) or risk ratio (RR) (for comparative studies), and mean difference for continuous outcomes, all will be reported with their 95% confidence intervals (CIs). Heterogeneity will be assessed graphically for overlapping CIs and statistically using the I2 statistic. If substantial heterogeneity is found, random-effects model meta-analysis will be performed; otherwise, fixed-effect meta-analysis will be employed. We will conduct subgroup analysis (to assess the impact of heterogeneity) and sensitivity analyses to test the robustness of the generated effect estimates to the quality domains. The overall level of evidence will be assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). The review is expected to produce an up-to-date and comprehensive synthesis of the available evidence, allowing for the generation of country-specific estimates of the burden of mental health problems among mothers living with HIV across SSA populations. Also, the review will attempt to identify the determinants of mental health problems among pregnant and postpartum women living with HIV, to shed light on the factors that contribute to the occurrence of mental health problems in this vulnerable population. The systematic review protocol has been registered in the International Prospective Register for Systematic Reviews (PROSPERO), with registration ID CRD42023468537.

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people across the globe. Previous coronavirus outbreaks led to worsened symptoms amongst pregnant women, suggesting that pregnant women are at greater risk. Objectives: Our aim is to investigate the differences in clinical presentation, management, and prognosis of COVID-19 infection in pregnant and non-pregnant women. Methods: We ran a search on electronic databases and analysis of the relevant articles was done using Revie Manager 5.4. Results: The review consists of nine studies comprising 591,058 women (28,797 pregnant and 562,261 non-pregnant), with most of the data derived from two large studies. The risk of experiencing fever (RR: 0.74; 95% CI: 0.64–0.85), headache (RR: 0.77; 95% CI: 0.74–0.79), myalgia (RR: 0.92; 95% CI: 0.89–0.95), diarrhea (RR: 0.40, 95% CI: 0.39–0.43), chest tightness (RR: 0.86; 95% CI: 0.77–0.95), and expectoration (RR: 0.45; 95% CI: 0.21–0.97) were greater amongst non-pregnant COVID-19-infected women. Pregnant women with COVID-19 were less likely to be obese (RR: 0.68; 95% CI: 0.63–0.73) or have a smoking history (RR: 0.32; 95% CI: 0.26–0.39). COVID-19-infected non-pregnant women had a higher frequency of comorbidity such as chronic cardiac disease (RR: 0.58; 95% CI: 0.44–0.77), renal disease (RR: 0.45; 95% CI: 0.29–0.71), and malignancy (RR: 0.82; 95% CI: 0.68–0.98), compared to COVID-19-infected pregnant women. The risk of ICU admission (RR: 2.26; 95% CI: 1.68–3.05) and requirement of invasive mechanical ventilation (RR: 2.68; 95% CI: 2.07–3.47) were significantly higher amongst pregnant women. Conclusions: Although the frequency of risk factors and the risk of experiencing clinical symptoms of COVID-19 were higher among non-pregnant women, COVID-19-infected pregnant women had a higher requirement of ICU admission and invasive mechanical ventilation compared to non-pregnant COVID-19-infected women. More well-conducted studies from varying contexts are needed to draw conclusions. Prospero registration: CRD42020204638.

Background: Prenatal and postnatal mental disorders can exert severe adverse influences on mothers, fetuses, and children. However, the effect of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of pregnant and postpartum women remains unclear.Methods: Relevant studies that were published from January 1, 2019 to September 19, 2020 were identified through the systematic search of the PubMed, EMBASE, and Web of Science databases. Quality assessment of included studies, random-effects meta-analysis, sensitivity analysis, and planned subgroup analysis were performed.Results: A total of 23 studies conducted with 20,569 participants during the COVID-19 pandemic and with 3,677 pregnant women before the COVID-19 pandemic were included. The prevalence rates of anxiety, depression, psychological distress, and insomnia among pregnant women during the COVID-19 pandemic were 37% (95% confidence interval [CI] 25–49%), 31% (95% CI 20–42%), 70% (95% CI 60–79%), and 49% (95% CI 46–52%), respectively. The prevalence of postpartum depression was 22% (95% CI 15–29%). Multigravida women and women in the first and third trimesters of pregnancy were more vulnerable than other pregnant women. The assessment of the associations between the COVID-19 pandemic and mental health problems revealed that the pooled relative risks of anxiety and depression in pregnant women were 1.65 (95% CI: 1.25–2.19) and 1.08 (95% CI: 0.80–1.46), respectively.Conclusions: The prevalence rates of mental disorders among pregnant and postpartum women during the COVID-19 pandemic were high. Timely and tailored interventions should be applied to mitigate mental problems among this population of women, especially multigravida women and women in the first and third trimesters of pregnancy.

Background Based on what is known at this time, pregnant women are at an increased risk of severe illness from COVID-19 compared to nonpregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes. To investigate the effects of coronavirus disease 2019 (COVID-19) on mortality of pregnant and postpartum women, we performed a systematic review of available published literature on pregnancies affected by COVID-19. Methods Web of Science, SCOPUS, and MEDLINE- databases were searched for original studies concerning the effect of COVID-19 on mortality of pregnant and postpartum women published by July 10, 2020. Meta-analyses of proportions were used to combine data and report pooled proportions. Results 117 studies with a total of 11758 pregnant women were included. The age ranged between 15 and 48 years. Most subjects were infected with SARS-CoV-2 in the third trimester. Disease severity was not reported in 1125 subjects. Maternal mortality was 1.3%. In 100% of fatal cases with adequate data, fever alone or with cough was one of the presenting symptoms. Also, dyspnea (58.3%) and myalgia (50%) were the most common symptoms. Sore throat (8.3%) and gastrointestinal symptoms (anorexia, nausea) (8.3%) were rare. The rate of comorbidities was 20% among COVID-19 deaths. The majority of COVID-19-infected women who died had cesarean section (58.3%), 25% had a vaginal delivery, and 16.7% of patients were not full term. Conclusion COVID-19 infection in pregnant women was associated with higher rates (and pooled proportions) of cesarean section and mortality. Because new data are continuously being generated and published, the findings of this study can be complete and updated with new researches. The results of this study can guide and improve prenatal counseling of COVID-19-infected pregnant women.

COVID-19 infection during the third trimester of pregnancy: Current clinical dilemmas

BACKGROUND AND AIM: Several studies have reported that pregnant women involving in motor vehicle crashes (MVCs) are associated with increased risk of adverse health outcomes. Given that pregnant women are more likely than non-pregnant women to seek medical care after MVCs due to precaution, it is still unclear whether MVCs themselves may increase the risk of mortality in pregnant women. This study aimed to provide a systematic review and meta-analysis of mortality risk in association with pregnancy after MVCs. METHODS: This study used relevant keywords and MESH terms to identify epidemiological studies of mortality risk in relation to MVCs from PubMed, Web of Science, Embase, and Cochrane database from 1968 to 2020. Two authors independently screened the titles, reviewed abstracts, and performed data extraction. We used the Newcastle-Ottawa scale for quality assessment. For comparison of mortality from MVCs between women with- and without pregnancy, we calculated the odds ratio (OR) with 95% confidence interval (CI) using a random effect model. The heterogeneity of included studies was estimated with I² statistic. RESULTS:Six studies, 13,830 injured victims with pregnancy and 204,612 victims without pregnancy were included. Compared to non-pregnant women, pregnant women were shown to have moderate but insignificantly increased mortality risk (pooled OR = 1.27, 95% CI=0.92–1.74, I²= 91.76%). However, the pooled OR was significantly increased at 1.64 (95% CI=1.16–2.33, I²=0.00%) for the two studies with similar mean of injured severity score (ISS) between pregnant and non-pregnant women was. In contrast, the pooled OR was significantly reduced at 0.38 (95% CI=0.18–0.80, I²=90.28%) in favour of pregnant women for the four studies in which the diversity of the mean of ISS in non-pregnant women and their pregnant counterparts. CONCLUSIONS:After risk stratifications, the pregnant women tended to experience increased mortality after MVCs. Future studies should be performed to further explore factors associated with MVCs in pregnant women. KEYWORDS: Mortality, Female, Pregnancy outcomes, Traffic-related

Disclosure: M.C. Cruz Akabane: None. M. Yang Yu: None. H. Coelho: None. P. Romeiro: None. L.C. Hespanhol: None. T.L. Correa: None. V.L. De Menezes: None. Introduction: Patients with type 1 diabetes mellitus (T1DM) may experience a heightened fear of hypoglycemia, increasing risk of management and psychological complications. Automated Insulin delivery (AID) has shown improvements in glucose control in pregnant women with T1DM. However, its impact on patients’ concerns about hypoglycemia during gestation remains unclear. This study aimed to evaluate the impact of AID on patient-reported fear of hypoglycemia in pregnant and puerperal women. Methods: PubMed, Embase, and Cochrane Central databases were systematically searched in December 2023 for randomized controlled trials (RCTs) that compared AID to other standard therapies (ST) (sensor-augmented pump, multiple daily insulin injections, continuous glucose monitoring, and predictive low-glucose suspend) in adult pregnant or puerperal women with T1DM and reported the outcomes of (1) Hypoglycemia Fear Survey-II (HFS-II) total; (2) HFS-II worry scale; and (3) HFS-II behavior scale. A systematic review and meta-analysis of the findings were performed. Statistical analysis was performed using R version 4.3.2. Heterogeneity was examined with the Cochran Q test and I² statistics. Results: We included 5 RCTs (4 with pregnant women and 1 including puerperal women) in the final analysis, with a total of 150 participants, of whom 74 (49.34%) were on AID and 76 (50.66%) on ST. The mean age of the AID group was 32.2 (σ±0.8) years, while the ST was 31.74 (σ±0.99). The mean time since diagnosis of T1DM was 20.7 years (σ±1.98) in AID patients and 20.7 (σ±2.95) in ST. The mean gestational age at baseline in AID patients was 11.7 weeks (σ±2.19) and 11.5 weeks (σ±2.26) in ST. The follow-up period ranged between 4 and 12 weeks. The AID group had a baseline HFS-II behavior subscale mean score of 25.2 (σ±2.5), while ST had a mean of 24.9 (σ±2.61). AID patients presented a significant reduction of HFS-II behavior subscale score compared to ST (MD -1.84; 95% CI -3.29, -0.38; p= 0.01; I² = 0%). HFS-II worry scale score (MD -0.75; 95% CI -2.89, 1.38; p= 0.48; I² = 0%) and HFS-II total score (MD -0.19; 95% CI -2.72, 2.34; p= 0.77; I² = 0%) were not significantly different between groups. Conclusion: The significantly higher decrease in HFS-II behavior score while using AID suggests that this technology diminishes the fear of hypoglycemia, possibly enhancing pregnancy and puerperium behavior patterns in patients with T1DM. Nevertheless, there was no significant difference in improvement in the HFS-II total or worry subscale. AID seems to decrease the psychological burden of treatment, potentially improving patients’ quality of life and adherence to management plans. Keywords: Type 1 Diabetes, Hypoglycemia, Pregnancy Presentation: 6/2/2024

Coronavirus disease 2019 (COVID-19) emerged as a global pandemic in March 2020 and caused a big crisis, especially the health crisis. Pregnant and postpartum women experienced significant physical, social, and mental changes that put them at higher risk for several conditions during the pandemic. This study aimed to report the prevalence of depression in pregnant and postpartum women during the COVID-19 pandemic. Eligible studies were identified using several databases. Prevalence analysis was conducted using MedCalc ver. 19.5.1. This systematic review and meta-analysis was registered in PROSPERO on July 12, 2021 with registration number CRD42021266976. We included 54 studies with 95.326 participants. The overall prevalence of depression was 32.60% among pregnant and postpartum women during the COVID-19 pandemic. The rate was higher among pregnant women (31.49%) compared to postpartum women (27.64%). The prevalence of depression among pregnant and postpartum women increased during the COVID-19 pandemic.