Evidence of Coxiella burnetii infection among pregnant and aborted women: A systematic review and meta-analysis.

Background: Q fever infection in pregnant women and its complications have been neglected in the world and little attention has been paid to it by health systems. Therefore, this study aimed to provide evidence regarding the association between Q fever infection and its effects on human abortion. Methods: English electronic data sources were searched including PubMed and Web of Science from 1993 to December 2024; the search strategy was implemented using these keywords (in the title/abstract) were used: "Coxiella burnetii" OR "Q fever" and "pregnancy" OR "pregnant" OR "women" OR "miscarriage" OR "humans" OR "abortion". Results: In this review, 30 papers of 705 candidate articles obtained from two databases, were considered for meta-analysis. The overall seroprevalence of Coxiella burnetii in pregnant women was 11 %, higher in low-income countries and high-risk women. Molecular detection was low (0.1 %), slightly higher in high-risk and abortion-history groups. Past infection prevalence was 62.6 %, more common in high-risk individuals. Conclusions: According to the results, the seroprevalence of Q fever among pregnant women, especially women who have a history of abortion, is significant and requires more investigations by the health providers. Active surveillance and further studies are recommended to more clearly define the epidemiology and significance of C. burnetii infections in pregnant women. Prospero registration number: CRD42023402863.