Tsantila A, Gourounti K, Nanou C, Metallinou D, Georgakopoulou VE, Bolou A, Diamanti A. Human metapneumovirus infection in pregnancy: A systematic review of cohort studies and case reports. World J Virol 2026; 15(2): 118445 [DOI: 10.5501/wjv.v15.i2.118445]
Corresponding Author of This Article
Vasiliki E Georgakopoulou, Department of Pathophysiology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, 17 Agiou Toma Street, Athens 11527, Greece. vaso_georgakopoulou@hotmail.com
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Respiratory System
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Tsantila A, Gourounti K, Nanou C, Metallinou D, Georgakopoulou VE, Bolou A, Diamanti A. Human metapneumovirus infection in pregnancy: A systematic review of cohort studies and case reports. World J Virol 2026; 15(2): 118445 [DOI: 10.5501/wjv.v15.i2.118445]
World J Virol. Jun 25, 2026; 15(2): 118445 Published online Jun 25, 2026. doi: 10.5501/wjv.v15.i2.118445
Human metapneumovirus infection in pregnancy: A systematic review of cohort studies and case reports
Aikaterini Tsantila, Kleanthi Gourounti, Christina Nanou, Dimitra Metallinou, Vasiliki E Georgakopoulou, Angeliki Bolou, Athina Diamanti
Aikaterini Tsantila, Kleanthi Gourounti, Christina Nanou, Dimitra Metallinou, Angeliki Bolou, Athina Diamanti, Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens 12243, Greece
Vasiliki E Georgakopoulou, Department of Pathophysiology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
Author contributions: Tsantila A, Gourounti K contributed to study conception and design, overall coordination, and critical revision of the manuscript; Nanou C, Metallinou D conducted data collection, data curation, and preliminary analyses; Bolou A, Diamanti A performed the literature search, contributed to interpretation of findings, and drafted the initial manuscript; Georgakopoulou VE provided expert pathophysiology input, supervised the analytical approach, and critically reviewed the manuscript for important intellectual content; all authors revised the manuscript, approved the final version, and agree to be accountable for all aspects of the work.
Conflict-of-interest statement: The authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Vasiliki E Georgakopoulou, Department of Pathophysiology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, 17 Agiou Toma Street, Athens 11527, Greece. vaso_georgakopoulou@hotmail.com
Received: January 4, 2026 Revised: February 14, 2026 Accepted: March 17, 2026 Published online: June 25, 2026 Processing time: 168 Days and 12.2 Hours
Abstract
BACKGROUND
Human metapneumovirus (hMPV) is an important cause of acute respiratory tract infection worldwide, but its impact during pregnancy has not been systematically characterized.
AIM
To synthesize available evidence on maternal, obstetric and neonatal outcomes of hMPV infection in pregnancy.
METHODS
Following PRISMA 2020 guidelines, a comprehensive search of PubMed/MEDLINE, EMBASE, Scopus, Web of Science and Google Scholar from inception to November 2025 identified studies reporting laboratory-confirmed hMPV infection in pregnant women. Eligible designs included case reports, case series and observational studies; however, the available evidence consisted predominantly of case reports and small case series, with only two prospective cohort studies contributing population-level data. Given anticipated heterogeneity, findings were synthesized narratively.
RESULTS
Seven studies met inclusion criteria, comprising two prospective community-based cohorts and five case reports/series. Across studies, approximately 50-60 women had laboratory-confirmed antenatal hMPV infection after exclusion of postpartum-only cases and accounting for non-overlapping cohorts. In community cohorts from Nepal and Thailand, hMPV accounted for a modest but non-trivial proportion of symptomatic antenatal respiratory illnesses, most of which were mild to moderate, self-limited, and did not require hospitalization or intensive care. In contrast, case-based reports described severe pneumonia and acute respiratory distress syndrome (ARDS) in women—typically in the second or third trimester-with underlying comorbidities such as asthma, morbid obesity, diabetes, chronic kidney disease or hypertensive disorders; no maternal deaths were reported. Obstetric outcomes were generally reassuring, although one cohort demonstrated an increased risk of small-for-gestational-age infants after antenatal hMPV infection, while evidence for preterm birth and other major complications remained limited and inconsistent. Neonatal outcomes were mostly favorable, with live births, gestational age and birthweight distributions comparable to uninfected pregnancies, and no confirmed congenital hMPV infections.
CONCLUSION
hMPV is an under-recognized cause of respiratory illness in pregnancy, usually resulting in mild disease but occasionally associated with severe pneumonia and ARDS in women with comorbidities. A possible association with fetal growth restriction has been reported; however, given the predominance of case reports and small cohort data, causality cannot be inferred for obstetric outcomes. Evidence for other adverse maternal and neonatal outcomes remains limited and inconsistent.
Core Tip: Human metapneumovirus (hMPV) is an under-recognized cause of respiratory illness during pregnancy. This systematic review synthesizes all available evidence on laboratory-confirmed hMPV infection in pregnant women, integrating data from community-based cohorts and hospital-based case reports. Most antenatal hMPV infections are mild and self-limited; however, severe pneumonia and acute respiratory distress syndrome can occur, particularly in women with underlying comorbidities. Obstetric and neonatal outcomes are generally reassuring, although a possible association with fetal growth restriction warrants further investigation. These findings highlight the need for greater clinical awareness of hMPV in pregnancy and for prospective studies to better define maternal and perinatal risks.
