INTRODUCTION Leptospirosis is a leading zoonotic disease worldwide with more than 1 million cases in the general population per year. With leptospirosis being an emerging infectious disease and as the world's environment changes with more floods and environmental disasters, the burden of leptospirosis is expected to increase. The objectives of the systematic review were to explore how leptospirosis affects pregnancy, its burden in this population, its effects on maternal and fetal outcomes and the evidence base surrounding treatment options. METHODS We performed a systematic review of published and unpublished literature using automated and manual methods to screen nine electronic databases since inception, with no language restriction. Two reviewers independently screened articles, completed the data extraction and assessment of risk of bias. Due to significant heterogeneity and paucity of data, we were unable to carry out a meta-analysis, but we conducted a pooled analysis of individual patient data from the case reports and case series to examine the patient and disease characteristics, diagnostic methods, differential diagnoses, antibiotic treatments, and outcomes of leptospirosis in pregnancy. The protocol for this review was registered on the International Prospective Register of Systematic Reviews, PROSPERO: CRD42020151501. RESULTS We identified 419 records, of which we included eight observational studies, 21 case reports, three case series and identified four relevant ongoing studies. Overall the studies were with moderate bias and of 'fair' quality. We estimated the incidence of leptospirosis in pregnancy to be 1.3 per 10,000 in women presenting with fever or with jaundice, but this is likely to be higher in endemic areas. Adverse fetal outcomes were found to be more common in pregnant patients who presented in the second trimester compared with patients who presented in the third trimester. There is overlap between how leptospirosis presents in pregnancy and in the general population. There is also overlap between the signs, symptoms and biochemical disturbances associated with leptospirosis in pregnancy and the presentation of pregnancy associated conditions, such as Pre-Eclampsia (PET), Acute Fatty Liver of Pregnancy (AFLP) and HELLP Syndrome (Haemolysis Elevated Liver enzymes Low Platelets). In 94% of identified cases with available data, there was an indicator in the patient history regarding exposure that could have helped include leptospirosis in the clinician's differential diagnosis. We also identified a range of suitable antibiotic therapies for treating leptospirosis in pregnancy, most commonly used were penicillins. CONCLUSION This is the first systematic review of leptospirosis in pregnancy and it clearly shows the need to improve early diagnosis and treatment by asking early, treating early, and reporting well. Ask early-broaden differential diagnoses and ask early for potential leptospirosis exposures and risk factors. Treat early-increase index of suspicion in pregnant patients with fever in endemic areas and combine with rapid field diagnosis and early treatment. Report well-need for more good quality epidemiological studies on leptospirosis in pregnancy and better quality reporting of cases in literature.

中文翻译：

---

妊娠钩端螺旋体病：系统评价。

引言 钩端螺旋体病是世界范围内主要的人畜共患疾病，在普通人群中每年有超过 100 万例病例。由于钩端螺旋体病是一种新出现的传染病，随着世界环境发生更多的洪水和环境灾害，预计钩端螺旋体病的负担会增加。系统评价的目的是探讨钩端螺旋体病如何影响怀孕、它在该人群中的负担、它对母婴结局的影响以及围绕治疗方案的证据基础。方法我们使用自动和手动方法对已发表和未发表的文献进行了系统审查，以筛选自成立以来的九个电子数据库，没有语言限制。两名审稿人独立筛选文章，完成数据提取和偏倚风险评估。由于显着异质性和数据缺乏，我们无法进行荟萃分析，但我们对病例报告和病例系列中的个体患者数据进行了汇总分析，以检查患者和疾病特征、诊断方法、鉴别诊断、抗生素治疗和妊娠期钩端螺旋体病的结果。本次审查的方案已在国际前瞻性系统评价注册中心 PROSPERO 上注册：CRD42020151501。结果 我们确定了 419 条记录，其中包括八项观察性研究、21 份病例报告、三个病例系列，并确定了四项相关的正在进行的研究。总体而言，这些研究具有中等偏倚和“一般”质量。我们估计怀孕期间钩端螺旋体病的发病率为 1.3/10，000 在出现发烧或黄疸的女性中为 000，但在流行地区可能更高。与在妊娠晚期就诊的患者相比，在妊娠中期就诊的孕妇中，不良胎儿结局更为常见。钩端螺旋体病在妊娠期和一般人群中的表现存在重叠。与妊娠期钩端螺旋体病相关的体征、症状和生化紊乱与妊娠相关疾病的表现之间也存在重叠，例如先兆子痫 (PET)、妊娠期急性脂肪肝 (AFLP) 和 HELLP 综合征（溶血性肝酶升高）低血小板）。在 94% 有可用数据的已识别病例中，患者病史中有一项有关暴露的指标可能有助于临床医生的鉴别诊断中包括钩端螺旋体病。我们还确定了一系列适用于治疗妊娠期钩端螺旋体病的抗生素疗法，最常用的是青霉素。结论 这是对妊娠期钩端螺旋体病的第一次系统评价，它清楚地表明需要通过早问、早治疗和好报告来改善早期诊断和治疗。询问早期扩大鉴别诊断，并尽早询问潜在的钩端螺旋体病暴露和危险因素。结合快速现场诊断和早期治疗，对流行区发热孕妇早期增加疑似指数进行治疗。