Infectious diseases in pregnancy in Sri Lanka: gaps in surveillance, diagnosis, and policy: a scoping review

Infectious diseases during pregnancy are often overlooked in the Global South. Country-level mapping of infectious diseases and their effects on pregnancy would provide possible intervention strategies for diagnosis, prevention, and management. This scoping review aims to map the evidence from 2000–2024 on pathogens, mortality, morbidity, and adverse outcomes caused by infectious diseases in pregnancy among pregnant women in Sri Lanka. We conducted a PRISMA-ScR-based systematic search on PubMed, Scopus, EBSCO, and the Web of Science using key terms related to infectious diseases, pregnancy, and Sri Lanka. We hand-searched 32 local-indexed journals, library catalogs, and grey literature on Ministry of Health websites. Publications in English from January 2000 to March 2024 were included for title/abstract and full-text screening. We performed a narrative synthesis in reporting infectious diseases in pregnancy. We synthesized data from 117 records, including 70 scholarly sources and 47 grey literature records, to map infectious diseases impacting pregnant women over the past two decades. The analysis identified 33 pathogens associated with 26 infectious diseases, with 19 conditions linked to maternal deaths. Dengue was the most frequently reported (15 of 70 studies reporting outcomes). Respiratory viruses accounted for nearly half (104/214) of reported maternal fatalities, while malaria, hepatitis B, HIV, and hepatitis E were less frequently documented. Most evidence came from tertiary-care centres, with limited representation of rural areas. This review highlights a decline in dengue-related maternal mortality following the introduction of national management guidelines. However, bacterial infections such as leptospirosis and tuberculosis remain significant contributors to maternal mortality. We identify key gaps, including deficiencies in diagnostics and screening for maternal conditions; research disparities; limited data availability; the absence of pregnancy-specific infectious disease surveillance in Sri Lanka; and shortcomings in classifying infectious diseases in morbidity and mortality surveillance. The data on infectious diseases in pregnant women in Sri Lanka show significant gaps, with available data systematically underrepresenting rural areas. Addressing research gaps, enhancing disease surveillance, and strengthening policy implementation is essential for ending preventable maternal mortality.