Congenital Chagas disease in Mexico: a systematic review of gaps in diagnosis and clinical follow-up.

Congenital Chagas disease is a public health priority in Latin America, yet its status in Mexico remains poorly characterized. This systematic review aims to analyse the available evidence on Trypanosoma cruzi maternal infection, vertical transmission rates and diagnostic challenges in Mexico. A systematic search was conducted in PubMed, Scopus and Web of Science following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Original observational studies and case reports on maternal-foetal T. cruzi infection in Mexico were included. Seventeen studies met the inclusion criteria, covering 63 373 analysed samples between 1998 and 2021. While 82.4% of studies reported maternal seroprevalence (estimated at 2.21% nationally), only 41.2% documented confirmed congenital transmission. A critical gap in clinical follow-up was identified: only 29.4% of studies reported neonatal monitoring and only 5.9% explicitly documented antiparasitic treatment. Geographic evidence is highly concentrated in Yucatan (41.2%), Chiapas and Veracruz. High diagnostic heterogeneity persists, with 88.2% of studies using enzyme-linked immunosorbent assay, while molecular methods (polymerase chain reaction) were used in 52.9%. Evidence on congenital Chagas in Mexico is fragmented and geographically biased. The disconnect between maternal detection and neonatal treatment highlights a fractured care chain. Implementing universal prenatal screening and standardized molecular diagnostics at birth is urgently needed to close the gap in maternal-infant care and fulfil the regional commitments established under the Pan American Health Organization Elimination Initiative.