Introduction: Every year, 100,000 infants worldwide are born with CRS. Routine vaccination of pregnant women can prevent this complication. In the Democratic Republic of the Congo, this vaccine was not yet available at the time of the study. This research aims to determine the seroprevalence and analyze the factors associated with rubella immunity in pregnant women in Kinshasa. Methods: A cross-sectional study was conducted from January to February 2025 among 376 pregnant women recruited from two centers (urban-rural and urban). Serological analyses were used to detect specific IgG and IgM antibodies. Multivariate logistic regression was performed to identify factors associated with seropositivity. Results: The anti-rubella IgG seroprevalence was 79.0% (n = 297), with no cases of IgM detected. Factors associated with immunity included age ≥ 25 years (aOR = 4.3; 95% CI = 1.98 - 9.8), marital status (married) (aOR = 2.35; 95% CI = 1.24 - 4.53), and late first pregnancy. Multiparity (aOR = 0.22) and consultation in the third trimester (aOR = 0.11) were inversely associated with seropositivity. Conclusion: Despite high overall immunity, 21% of pregnant women remain exposed to rubella, putting their fetuses at severe risk. These results reinforce the call for routine vaccination of women of childbearing age and targeted prenatal screening in the DRC, in the context of the recent introduction of the vaccine.
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