# Seroprevalence of Strongyloides stercoralis Infection and Its Risk Factors in Pregnant Women Referred to Al‐Zahra Hospital in Guilan Province, North Part of Iran: A Cross‐Sectional Study From 2024 to 2025

## TL;DR

This study found a 2.6% seroprevalence of Strongyloides stercoralis infection in pregnant women in Iran, with gestational diabetes being a significant risk factor.

## Contribution

The study is the first to report seroprevalence and risk factors of Strongyloides stercoralis in pregnant women in Guilan Province, Iran.

## Key findings

- Seroprevalence of Strongyloides stercoralis was 2.6% in pregnant women.
- Six of the seropositive women also tested positive via parasitological examination.
- Gestational diabetes was significantly associated with infection (30% of cases).

## Abstract

In immunocompromised individuals, strongyloidiasis may progress to hyperinfection syndrome or disseminated disease. To date, the death of a pregnant woman infected with Strongyloides stercoralis has been reported. Chronic cases carry a risk of malnutrition, especially among vulnerable populations like pregnant women and children. Pregnancy‐related immunosuppression increases susceptibility to severe strongyloidiasis. This study assesses strongyloidiasis seroprevalence in pregnant women at Al‐Zahra Hospital, Guilan Province.

This cross‐sectional study (September 2024 to February 2025) randomly selected 384 pregnant women referred to Al‐Zahra Hospital, Rasht. After consent, blood (all) and permitted stool samples plus symptom questionnaires were collected. Serum was tested for anti–S. stercoralis IgG antibodies using ELISA (NovaLisa). Stool underwent parasitological examination (direct smear, formalin–ethyl acetate concentration method, and nutrient agar plate culture [APC]). SPSS v25 analyzed data using Fisher′s exact test.

The study enrolled pregnant women (gestational age: 1–8 months) aged 15–48 years. The seroprevalence of strongyloidiasis (anti–S. stercoralis IgG antibodies) was 2.6%. Six of these individuals, who provided stool samples, also tested positive by parasitological examination. No significant associations (p > 0.05) were observed between infection and factors including vegetable washing practices, residential location (urban/rural), education level, occupational exposure, soil contact, clinical symptoms, animal contact, or hypereosinophilia. However, a significant association (p < 0.05) was identified between strongyloidiasis and underlying conditions, with gestational diabetes present in 30% of patients.

The overlap of gastrointestinal, respiratory, and hematological symptoms with pregnancy contributes to the underdiagnosis of strongyloidiasis. Early respiratory symptoms are hormonally driven, whereas persistent later symptoms suggest infection (50% strongyloidiasis cases here). Preconception S. stercoralis serology and hygiene/animal‐contact education are recommended.