Global prevalence of Neisseria gonorrhoeae infection in pregnant women: a systematic review and meta-analysis

Abstract

BACKGROUND: Neisseria gonorrhoeae infection (gonorrhea) is associated with several pregnancy complications, including preterm labor, spontaneous abortion, stillbirth, miscarriage, growth retardation, and intrauterine death. OBJECTIVE: We performed a systematic review and meta-analysis to estimate the global and regional prevalences of gonorrhea in pregnant women as a scientific basis for further studies. DATA SOURCES: We systematically searched PubMed/MEDLINE, Web of Science, Embase, Scopus, and SciELO databases from inception to July 10, 2022. STUDY ELIGIBILITY CRITERIA: We included cross-sectional, cohort, and case-control studies that reported the prevalence of gonorrhea in pregnant women. In addition, we included baseline data for randomized controlled trials. PARTICIPANTS: Pregnant women who were tested for gonorrhea. METHODS: Pooled prevalence estimates at 95 confidence intervals (CIs) were calculated using a random-effects meta-analysis model. We stratified countries according to WHO-defined regions and socio-economic factors. Moreover, subgroup-, meta-regression- and sensitivity-analyses were conducted to investigate the effects of pre-determined factors on prevalence estimates and heterogeneity. RESULTS: We identified 235 studies (249 datasets) on 19,104,175 pregnant women from 71 countries. The worldwide prevalence of gonorrhea in pregnant women was estimated at 1.85 (95 CI: 1.73-1.97), with the highest rate in the African region (3.53, 2.84-4.29) and the lowest rate in the European region (0.52, 0.27-0.84). Overall, the prevalence estimates were higher in low-income countries (3.03), HIV-infected pregnant women (2.81), and pregnant women <20 years old (8.06). A significant decreasing trend in prevalence was observed over time (β= -0.0008, 95 CI: -0.0012 to -0.0004, p= 0.001). CONCLUSION: Our findings indicate that a substantial number of pregnant women have been infected with gonorrhea globally, which calls for immediate public health measures to reduce the potential risk of infection. The study highlights the inadequacy or lack of data for many countries, emphasizing the need to expand systematic data collection efforts at national and regional levels.