Chagas Screening Among Active-Duty Servicewomen with a History of Pregnancy

Approximately 1.0 to 1.7 million women of reproductive age worldwide are estimated to have a Trypanosoma cruzi infection, and fewer than 10% are diagnosed. Chronic Chagas disease (CD) is largely asymptomatic yet can progress to cardiac and gastrointestinal disease, and maternal infection carries a risk of vertical transmission that is highly preventable when identified. Within the U.S. military, foreign-born servicewomen from endemic countries are candidates for risk-based screening, particularly as part of routine prenatal care. The primary aim of this study was to describe the demographic factors associated with CD screening among active-duty servicewomen (ADSW) born in endemic countries, with and without a reported history of pregnancy.

Demographic, testing, and diagnosis data were derived from the Defense Manpower Data Center and Military Health System Data Repository across multiple administrative datasets for fiscal years 2015 through 2023. Categorical and continuous variables were compared using chi-square and independent samples t-tests. Country-specific 2023 Global Burden of Disease prevalence estimates were applied to the cohort to approximate expected screening yield. The protocol was approved by the Uniformed Services University of the Health Sciences Institutional Review Board.

A total of 10,771 ADSW born in Chagas-endemic countries were identified, of whom 2,783 (25.8%) had at least 1 pregnancy encounter. The majority (9,836 or 91.3%) were of childbearing age. All 10,771 women met criteria for CD screening per clinical expert and the CDC recommendations. The mean (SD) age was 32 years (8.8), and most were enlisted (87%). Country of birth served as the operative proxy for exposure risk. Notably, we identified no T. cruzi-related tests, although 2 apparent diagnoses were documented. Applying country-specific prevalence yielded an estimated 104 seropositive women overall, including 26 within the pregnant subcohort, with approximately 1 expected congenital case.

Despite a clearly at-risk population, no documented CD screening occurred, reflecting a gap in implementation of current recommendations. Increased access to CD screening is needed for at-risk pregnant ADSW to enable informed care decisions. Unrecognized CD may adversely impact service member health and readiness and, in women, poses a preventable risk of vertical transmission to the newborn.