title: Prevalence of Chagas disease in pregnant women and congenital transmission of Trypanosoma cruzi in Brazil: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To estimate the prevalence of Chagas disease in pregnant women and the risk of congenital transmission of Trypanosoma cruzi infection in Brazil, through a systematic review and meta-analysis.
  
  
  METHODS
  We searched electronic databases, grey literature and reference lists of included publications to identify epidemiological studies on the prevalence of Chagas disease in pregnant women and on the congenital transmission rate of T. cruzi infection in Brazil published between January 1980 and June 2013. Pooled estimates and 95% confidence intervals (95% CIs) were calculated using fixed- and random-effects models.
  
  
  RESULTS
  Sixteen articles were included - 12 studies on the prevalence of Chagas disease in pregnant women (549,359 pregnant women) and nine on congenital transmission rates (1687 children born to infected mothers). Prevalence of Chagas disease in pregnant women ranged from 0.1% to 8.5%, and congenital transmission rates from 0% to 5.2%. The pooled prevalence of Chagas disease among pregnant women across studies was 1.1% (95% CI: 0.6-2.0); the pooled congenital transmission rate was 1.7% (95% CI: 0.9-3.1). In 2010, 34,629 pregnant women were estimated to be infected with T. cruzi, and 312-1073 children born (mean: 589 cases) with congenital infection.
  
  
  CONCLUSIONS
  Congenital Chagas disease is a neglected public health problem in Brazil. Systematic congenital Chagas disease control programs through routine prenatal screening for T. cruzi should be widely implemented in Brazil's endemic areas, to identify infected pregnant women and newborns at risk of congenital infection.
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
authors.forename: Francisco Rogerlândio
authors.initials: FR
authors.lastname: Martins-Melo
authors.forename: Mauricélia da Silveira
authors.initials: Mda S
authors.lastname: Lima
authors.forename: Alberto Novaes
authors.initials: AN
authors.lastname: Ramos
authors.forename: Carlos Henrique
authors.initials: CH
authors.lastname: Alencar
authors.forename: Jörg
authors.initials: J
authors.lastname: Heukelbach
mesh_terms: D001938:Brazil / Q000453:epidemiology; D014355:Chagas Disease / Q000151:congenital / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology* / Q000209:etiology / Q000469:parasitology; D014349:Trypanosoma cruzi
keywords: Brasil; Brazil; Brésil; Chagas disease; Trypanosoma cruzi; congenital infection; enfermedad de Chagas; femmes enceintes; infección congénita; infection congénitale; maladie de Chagas; mujeres embarazadas; pregnant women; revisión sistemática; revue systématique; systematic review