监测实现世卫组织到2030年消除丙型肝炎病毒(HCV)感染的全球目标的进展,需要对不同人群的HCV感染进行可靠的患病率估计。关于孕妇HCV感染的全球负担知之甚少。这里,据我们所知,这是第一次,我们估计了孕妇中HCV抗体(Ab)的全球和地区血清阳性率和决定因素.
■在这项系统评价和荟萃分析研究中,我们搜索了PubMed/MEDLINE,WebofScience,Embase,Scopus,和SciELO数据库,用于2000年1月1日至2023年4月1日之间的同行评审观察研究,没有语言或地理限制。汇集的全球血清阳性率(和95%置信区间,CI)使用随机效应荟萃分析进行估计,并根据世界卫生组织区域和分区域对血清价值进行分类,出版年,国家收入和人类发展指数(HDI)水平。我们使用敏感性分析,通过“留一法”评估四项大样本量研究对合并全球患病率的影响。我们还通过亚组和荟萃回归分析调查了孕妇中潜在危险因素与HCV血清阳性的关联。该协议已在PROSPEROCRD42023423259中注册。
■我们纳入了192项符合条件的研究(208个数据集),数据来自53个国家的148,509,760名孕妇。在总体和敏感性分析中,孕妇HCVAb的全球血清阳性率为1.80%(95%CI,1.72-1.89%)和3.29%(3.01-3.57%),分别。血清阳性率在东地中海地区最高(6.21%,4.39-8.29%),西太平洋地区最低(0.75%,0.38-1.22%)。亚组分析表明,对于阿片类药物使用障碍的孕妇,HCVAb的血清阳性率明显更高(51.94%,95%CI:37.32-66.39)和HIV感染(4.34%,95%CI:2.21-7.06%)比一般人群的孕妇(1.08%,95%CI:1.02-1.15%),如多变量meta回归所证实(p<0.001)。随着人类发展指数水平的提高,观察到显着的下降趋势。HCV血清阳性的其他重要危险因素包括年龄,教育水平较低,多性行为,输血史,住院治疗,手术,堕胎和性传播疾病,有疤痕/纹身或穿孔,乙型肝炎检测呈阳性.
■这项荟萃分析显示,全球孕妇暴露于HCV感染的负担相对较高(220-530万)。然而,由于研究之间的巨大异质性,我们的估计可能与真实的血清阳性率不同.我们的研究结果强调有必要扩大对育龄妇女或怀孕期间的HCV筛查,特别是在患病率高的国家;以及更多评估妊娠期现有治疗药物安全性或可能支持孕妇药物开发的研究。
■这项研究没有资金来源。
UNASSIGNED: Monitoring progress towards the WHO global target to eliminate hepatitis C virus (HCV) infection by 2030, entails reliable prevalence estimates for HCV infection in different populations. Little is known about the global burden of HCV infection in pregnant women. Here, for the first time to our knowledge, we estimated the global and regional seroprevalence of HCV antibody (Ab) and determinants in pregnant women.
UNASSIGNED: In this systematic review and meta-analysis study, we searched PubMed/MEDLINE, Web of Science, Embase, Scopus, and SciELO databases for peer-reviewed observational studies between January 1, 2000 and April 1, 2023, without language or geographical restrictions. Pooled global seroprevalence (and 95% confidence interval, CI) were estimated using random-effects meta-analysis and seroprevalences were categorised according to World Health Organization regions and subregions, publishing year, countries\' income and human development index (HDI) levels. We used sensitivity analysis to assess the effect of four large sample size studies on pooled global prevalence through the \"leave-one-out\" method. We also investigated the association of potential risk factors with HCV seropositivity in pregnant women by subgroup and meta-regression analyses. The Protocol was registered in PROSPERO CRD42023423259.
UNASSIGNED: We included 192 eligible studies (208 datasets), with data for 148,509,760 pregnant women from 53 countries. The global seroprevalence of HCV Ab in pregnant women was 1.80% (95% CI, 1.72-1.89%) and 3.29% (3.01-3.57%) in overall and sensitivity analyses, respectively. The seroprevalence was highest in the Eastern Mediterranean region (6.21%, 4.39-8.29%) and lowest in the Western Pacific region (0.75%, 0.38-1.22%). Subgroup analysis indicated that the seroprevalence of HCV Ab among pregnant women was significantly higher for those with opioid use disorder (51.94%, 95% CI: 37.32-66.39) and HIV infection (4.34%, 95% CI: 2.21-7.06%) than for the general population of pregnant women (1.08%, 95% CI: 1.02-1.15%), as confirmed by multivariable meta-regression (p < 0.001). A significant decreasing trend was observed with increasing human development index levels. Other important risk factors for HCV seropositivity included older age, lower educational levels, poly sexual activity, history of blood transfusion, hospitalization, surgery, abortion and sexual transmitted diseases, having scarification/tattoo or piercing, and testing hepatitis B positive.
UNASSIGNED: This meta-analysis showed relatively high burden of exposure to HCV infection (2.2-5.3 million) in pregnant women globally. However, due to substantial heterogeneity between studies, our estimates might be different than the true seroprevalence. Our findings highlighted the need to expand HCV screening for women of reproductive age or during pregnancy, particularly in countries with high prevalence; as well as for more studies that assess safety of existing therapeutic drugs during pregnancy or potentially support development of drugs for pregnant women.
UNASSIGNED: There was no funding source for this study.