Pregnancy and hantavirus infection: maternal, fetal, and neonatal outcomes - a systematic review

Hantavirus infection is a rare zoonotic disease caused by rodent-borne RNA viruses and may present as hemorrhagic fever with renal syndrome or hantavirus cardiopulmonary syndrome. Evidence regarding its impact during pregnancy remains limited. This systematic review synthesized available data on maternal manifestations, maternal and fetal outcomes, and vertical transmission.

A systematic literature search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar was conducted from database inception through May 2026 in accordance with PRISMA 2020 guidelines. Studies reporting pregnant women with confirmed or suspected hantavirus infection and relevant maternal or fetal outcomes were included.

Nineteen studies comprising 24 unique pregnancies were included. Fever (22/24, 91.7%), myalgia (20/24, 83.3%), thrombocytopenia (21/24, 87.5%), respiratory compromise (11/24, 45.8%), and renal dysfunction (10/24, 41.7%) were the most frequently reported maternal manifestations. Intensive care unit admission occurred in 10 cases (41.7%), mechanical ventilation in 7 (29.2%), and maternal mortality in 2 (8.3%). Live birth occurred in 18 pregnancies (75.0%), preterm delivery in 8 (33.3%), fetal distress in 7 (29.2%), miscarriage in 2 (8.3%), and intrauterine fetal demise or stillbirth in 4 (16.7%). No confirmed cases of vertical transmission were identified.

The currently available evidence suggests that hantavirus infection during pregnancy may be associated with substantial maternal morbidity and adverse fetal outcomes; however, the limited number of reported cases precludes definitive conclusions. Current evidence does not support confirmed vertical transmission. Early recognition, prompt supportive management, and multidisciplinary care remain essential to optimize maternal and neonatal outcomes.