Cytomegalovirus Seroprevalence in Pregnant Women and Turkey’s Seroepidemiological Status in the World: A Meta-Analysis Reseach

Abstract

Introduction: Human cytomegalovirus (HCMV) may lead to intrauterine infection during pregnancy and may cause various fetal anomalies. Therefore, HCMV is serologically tested during pregnancy. With this meta-analysis for HCMV IgG, IgM and IgG-avidity results in pregnancy in our country is going to be revealed for the first time and the seroprevalence status of our country is going to be compared with other countries. Materials and Methods: Systematic literature search was conducted in Google Scholar, PubMed, Web of Science and Turkish Medline and Higher Educational Institute (YOK) thesis central databases. Studies published in Turkey between 2007 and 2017 were separated in PRISMA flow diagram according to the inclusion criteria. A total of 22 studies were included in the systematic review and meta-analysis. Data were analyzed by Medcalc© software version 18.9. Begg's Funnel Plot was used to reveal possible bias. Test for Heterogeneity value analyzed to demonstrate heterogeneity in studies. Results: As a result of the meta-analysis of the studies including serological tests of 55.034 pregnant women in a total of 22 studies, HCMV IgM positivity seroprevalence rate in Turkey was 1.30% (95% CI: 0859-1823). The Cochrane Q test for study heterogeneity and I2 were found as 470.4713 and 95.54, respectively (p< 0.0001). In terms of HCMV IgG, there were 43.506 pregnant women in the same 22 studies, and seropositivity was found to be 97.98% (95% CI: 96.991-98.771) in the meta-analysis. The Cochrane Q test for study heterogeneity and I2 were found as 834.6153 and 97.48, respectively (p< 0.0001). Meta-analysis of HCMV in pregnancy in terms of low, middle and high values of IgG-avidity revealed that low avidity was 5.9% in 251 pregnant women (95% CI: 0.0078-23.095, p< 0.0001), middle avidity was 19.5% in 101 pregnant women (95% CI: 12.429-28.488, p= 0.6736), and high avidity was 83.1% in 252 pregnant women (95% CI: 50.029-99.621, p< 0.0001). Conclusion: According to the meta-analysis results, our country is in the high-prevalence countries with 97.7% seropositivity rate in HCMV IgG. Studies about HCMV in our country are just related to IgG and IgM serology in pregnancy, and congenital HCMV infections are only presented as case reports. Comprehensive randomized prospective studies should be conducted to reveal the relationship between IgM and IgG results and congenital HCMV infections.