Supplementary Material for: Helicobacter pylori infection as a high risk factor for preeclampsia: a systematic review and meta-analysis

Objective: This systematic review and meta-analysis aimed to evaluate the potential association between H. pylori infection and an increased risk of preeclampsia. Methods: PubMed, Embase, Medline, Ovid, Clinical Trails, Cochrane Library, ISI Web of Science databases were searched, and observational studies were identified from the database established up to September 2022. All included studies compared the association between H. pylori infection and preeclampsia, and the incidence of anti-H. pylori immunoglobulin G (IgG), IgA antibody, anti-CagA antibodies and H. pylori stool antigen (HPSA) were assessed in patients with preeclampsia. Review Manager and SATA software were conducted for statistical analysis and forest plots. Dichotomous variables were measured by odds ratio (OR) with corresponding 95% confidence interval (CI). Results: Finally, a total of 15 studies were included with 10,029 perinatal women. Compared to healthy controls, patients with preeclampsia had significantly higher serum anti-H. pylori IgG antibody positivity (OR 2.91, P< 0.00001), serum anti-CagA antibody positivity (OR 4.74, P< 0.00001), and HPSA positivity (OR 5.42, P< 0.00001). In addition, the rate of positive serum anti-H. pylori IgG antibodies was also significantly higher in patients with intrauterine growth restriction in preeclampsia (OR 3.14, P< 0.00001). Conclusion: H. pylori infection is a high risk factor for the development of preeclampsia. It is unclear whether the association between the severity of disease and H. pylori infection. More high quality clinical epidemiological studies are needed to provide evidence regarding the benefit of H. pylori eradication in pregnant women.