We systematically reviewed the associations between H. pylori (HP), cytomegalovirus (CMV) and C. pneumoniae (CP) infection in pregnancy and preeclampsia (PE), a disorder found in 5-8% of pregnancies and a leading cause of maternal and perinatal mortality. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines and searched PubMed, EMBASE and Web of Science. We also assessed the studies for risk of bias by utilizing a modified version of A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies of Interventions (ACROBAT-NRSI). After exclusions based on criteria from these tools, 16 studies were reviewed in detail, of 1,031 initially identified by our search algorithm. Evidence of infection was based on serology (12 studies), Polymerase Chain Reaction (2) or both (2). All four studies of the association between HP and PE found significant odds ratios ranging from 2.7 – 9.2. Two of four studies of CMV and PE found significantly elevated odds ratios (1.9 and 2.7), while only three of ten studies of CP found significant odds ratios, ranging from 3.1 to 4.1. Not all studies controlled fully for confounding, and ten studies were at serious risk of bias.The available literature provides partial support for the association between these infectious agents and PE, especially for HP, but more rigorous studies are needed in this area, because more than half of the studies examined were at high risk of bias.
Read
