Global seroprevalence of anti-HEV antibodies in pregnant women: a systematic meta-analysis

Abstract

Introduction. Hepatitis E virus (HEV) represents a significant public health concern during pregnancy, being associated with severe maternal and fetal complications. This meta-analysis aimed to estimate the global seroprevalence of anti-HEV IgG and IgM antibodies among pregnant women.

Materials and methods. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Observational studies were identified in PubMed, Scopus, and Web of Science. Pooled seroprevalence estimates were calculated using a random-effects model. Heterogeneity was assessed using Cochran’s Q and the I² statistic, while publication bias was evaluated by funnel plots and Egger’s regression test.

Results. Thirty studies from diverse geographic regions were included. The pooled global seroprevalence of anti-HEV IgG was 11.76% (95% CI: 9.45–14.54), indicating widespread prior exposure. Anti-HEV IgM seroprevalence, reflecting recent infection, was 1.07% (95% CI: 0.61–1.86). Substantial heterogeneity was observed for both markers (I² > 95%), reflecting marked regional variability. No statistically significant small-study effects were detected by Egger’s regression (p > 0.05).

Conclusions. HEV exposure among pregnant women is common globally, with pronounced regional differences, whereas recent infection appears relatively rare at the global level. These findings highlight the need for region-specific surveillance, improved diagnostic standardization, and targeted preventive strategies to reduce HEV-related risks during pregnancy.