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Background <p>Herpes simplex virus (HSV) infection in pregnancy poses important risks for mothers and newborns. We synthesised global evidence on HSV prevalence in pregnant women, stratified by virus type (HSV‑1, HSV‑2), immunoglobulin class (IgG, IgM), diagnostic method, and biological specimen Herpes simplex virus (HSV) infection during pregnancy poses risks for neonatal transmission, particularly when primary infection occurs near delivery. We synthesized global evidence on HSV markers among pregnant women to inform clinical risk stratification and evidence-based management.</p> Methods <p>We systematically searched PubMed, Embase, Web of Science, and Scopus from January 2000 to June 2024 for observational studies reporting HSV prevalence in pregnant women. Two reviewers independently screened studies, extracted data, and assessed quality using standardized tools. Random-effects meta-analysis was performed on logit-transformed proportions using Python-based statistical tools (due to logistical constraints, Python libraries including pandas, numpy, and scipy were utilized for all meta-analytical computations), with heterogeneity quantified using I² statistics and prediction intervals. Temporal trends were explored via meta-regression. This review was registered on PROSPERO (CRD42023395041).</p> Results <p>We identified 200 studies comprising 120,536 pregnant women from 56 countries. HSV-1 IgG seroprevalence was 79.1% (95% CI: 73.3–83.9%; I² = 97.0%) across 48 studies, indicating widespread prior exposure. HSV-2 IgG seroprevalence was 28.6% (95% CI: 25.6–31.9%; I² = 97.7%) across 150 studies, with marked geographic variation (6–55%). Acute infection markers were uncommon: HSV-1 IgM 1.9% (95% CI: 1.0–3.6%) and HSV-2 IgM 4.7% (95% CI: 2.8–7.9%). PCR detected HSV DNA in 9.4% of cervico-vaginal specimens but 0% of amniotic fluid samples (4,383 tests). Meta-regression revealed declining HSV-1 (− 14 points/decade, <i>p</i> = 0.034) and rising HSV-2 (+ 7.7 points/decade, <i>p</i> = 0.016).</p> Conclusions <p>Low IgM seroprevalence suggests primary HSV infection during pregnancy is likely uncommon and High HSV IgG seroprevalence reflects widespread prior exposure and indicates protective maternal immunity, more than an infection risk. based on our findings Management should remained focused on: (1) suppressive antivirals from 36 weeks for women with known recurrent genital herpes; (2) recognizing primary infection during pregnancy; and (3) clinical assessment at delivery. Our findings are not consistent with Universal screening and do not support the routine use of PCR testing for amniotic fluid.</p>

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Global prevalence of herpes simplex virus among pregnant women: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月9日

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  • Amin Shehni Nezhadpour,
  • Emadeddin Hemadi,
  • Arash Shehni Nezhadpour,
  • Sara Ansarian

摘要

Background

Herpes simplex virus (HSV) infection in pregnancy poses important risks for mothers and newborns. We synthesised global evidence on HSV prevalence in pregnant women, stratified by virus type (HSV‑1, HSV‑2), immunoglobulin class (IgG, IgM), diagnostic method, and biological specimen Herpes simplex virus (HSV) infection during pregnancy poses risks for neonatal transmission, particularly when primary infection occurs near delivery. We synthesized global evidence on HSV markers among pregnant women to inform clinical risk stratification and evidence-based management.

Methods

We systematically searched PubMed, Embase, Web of Science, and Scopus from January 2000 to June 2024 for observational studies reporting HSV prevalence in pregnant women. Two reviewers independently screened studies, extracted data, and assessed quality using standardized tools. Random-effects meta-analysis was performed on logit-transformed proportions using Python-based statistical tools (due to logistical constraints, Python libraries including pandas, numpy, and scipy were utilized for all meta-analytical computations), with heterogeneity quantified using I² statistics and prediction intervals. Temporal trends were explored via meta-regression. This review was registered on PROSPERO (CRD42023395041).

Results

We identified 200 studies comprising 120,536 pregnant women from 56 countries. HSV-1 IgG seroprevalence was 79.1% (95% CI: 73.3–83.9%; I² = 97.0%) across 48 studies, indicating widespread prior exposure. HSV-2 IgG seroprevalence was 28.6% (95% CI: 25.6–31.9%; I² = 97.7%) across 150 studies, with marked geographic variation (6–55%). Acute infection markers were uncommon: HSV-1 IgM 1.9% (95% CI: 1.0–3.6%) and HSV-2 IgM 4.7% (95% CI: 2.8–7.9%). PCR detected HSV DNA in 9.4% of cervico-vaginal specimens but 0% of amniotic fluid samples (4,383 tests). Meta-regression revealed declining HSV-1 (− 14 points/decade, p = 0.034) and rising HSV-2 (+ 7.7 points/decade, p = 0.016).

Conclusions

Low IgM seroprevalence suggests primary HSV infection during pregnancy is likely uncommon and High HSV IgG seroprevalence reflects widespread prior exposure and indicates protective maternal immunity, more than an infection risk. based on our findings Management should remained focused on: (1) suppressive antivirals from 36 weeks for women with known recurrent genital herpes; (2) recognizing primary infection during pregnancy; and (3) clinical assessment at delivery. Our findings are not consistent with Universal screening and do not support the routine use of PCR testing for amniotic fluid.