Global Prevalence and Predictors of Intestinal Parasitic Infections Among Pregnant Women: An Updated Systematic Review and Meta-Analysis

Intestinal parasitic infections (IPIs) remain a major public health burden, particularly affecting women of reproductive age in low-resource settings. Untreated IPIs during pregnancy contribute to adverse maternal, fetal, and neonatal outcomes, including anemia, low birth weight, and preterm delivery. Contemporary global data on IPI burden during pregnancy remain limited, with existing reviews heavily focused on helminths while neglecting protozoan pathogens. This systematic review and meta-analysis aimed to provide updated global prevalence estimates of IPIs among pregnant women, including species-specific estimates for both helminths and protozoa. This systematic review and meta-analysis was conducted following PRISMA 2020 guidelines and registered with PROSPERO (CRD420261290660). We systematically searched MEDLINE/PubMed, African Journals Online, CrossRef, EMBASE, Google Scholar, CINAHL, Cochrane Library, and Science Direct for studies published between January 2020 and December 2025. Explicit search terms included population terms (e.g., “pregnant women,” “antenatal”), parasite terms (e.g., “intestinal parasite,” “helminth,” “ Ascaris lumbricoides ,” “ Entamoeba histolytica ,” “ Giardia lamblia ”), and prevalence terms (e.g., “prevalence,” “epidemiology”), combined using Boolean operators. Study quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Prevalence Studies. A random-effects meta-analysis model (DerSimonian and Laird method) was used to compute pooled prevalence estimates with 95% confidence intervals (CIs), as this approach accounts for the anticipated substantial heterogeneity across studies. Subgroup analyses were conducted by continent, country, diagnostic method, sample size, study design, and sampling technique. Heterogeneity was assessed using the I² statistic and Cochran’s Q test. Publication bias was assessed using funnel plots, Egger’s linear regression test, and Begg’s rank correlation test. A total of 45 studies encompassing 22,013 pregnant women from 15 countries across Africa, Asia, and Europe met the inclusion criteria. This review provides an updated global synthesis of IPI prevalence among pregnant women, incorporating more recent studies (2020–2025) and providing species-specific estimates for both helminths and protozoa—a critical gap in previous reviews that focused predominantly on helminths. However, geographic representation was highly uneven, with Africa contributing approximately 80% of studies (36/45), while Latin America, the Middle East, and Eastern Europe were minimally represented or absent. The overall pooled prevalence of IPIs was 31.76% (95% CI: 26.86–36.67), with substantial heterogeneity (I² = 98.98%, p < 0.001). Among helminths, Ascaris lumbricoides showed the highest prevalence (13.50%; 95% CI: 23.29–24.40), followed by hookworm (5.55%; 95% CI: 4.39–6.71) and Schistosoma mansoni (5.43%; 95% CI: 1.67–9.20). Among protozoa, Entamoeba histolytica/dispar was most common (10.89%; 95% CI: 7.50–14.26), followed by Cryptosporidium parvum (7.41%; 95% CI: 3.30–11.52) and Giardia lamblia (6.11%; 95% CI: 5.04–7.17). Subgroup analysis by continent revealed the highest prevalence in Europe (42.50%; 95% CI: 11.95–73.06), followed by Africa (31.89%; 95% CI: 25.61–38.16) and Asia (28.07%; 95% CI: 16.54–39.60). Country-level estimates varied substantially, from 13.46% (95% CI: 8.10–18.82) in Cameroon to 60.90% (95% CI: 55.50–66.29) in Burkina Faso. Studies using multi-method diagnostic approaches reported higher prevalence compared to wet mount alone. Sensitivity analyses confirmed the robustness of the pooled estimates. This updated systematic review and meta-analysis reveals that approximately one in three pregnant women globally are affected by intestinal parasitic infections, with substantial geographic and diagnostic method-related variation. The high prevalence of protozoan infections highlights the need for species-specific diagnostic and treatment approaches beyond traditional helminth-focused programs. However, the substantial heterogeneity (I² = 98.98%) and uneven geographic representation with Africa contributing approximately 80% of studies while Latin America, the Middle East, and Eastern Europe remain understudied caution against overgeneralization of the global estimate and highlight critical evidence gaps requiring urgent research attention.