Document Type : Systematic Review
Authors
1 Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran;Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Pediatrics, Behbahan Faculty of Medical Sciences, Behbahan, Iran
3 4School of Nursing and Midwifery, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran
4 Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran;5Student Research Committee, School of Nursing, Midwifery, and Paramedicine, Guilan University of Medical Sciences, Rasht, Iran
5 6Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
6 Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
7 7Dezful University of Medical Sciences, Dezful, Iran
8 Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
Keywords
Pregnancy is a serious period in women´s lives, which
is related to physiological changes, such as weakening the
immune system (
The level of immunity in the body decreases during
pregnancy (
These microorganisms have an important role in infections and potential complications during pregnancy. Therefore, it is necessary to be aware of prevalence patterns to plan and screen pregnant women for these microorganisms. Several studies have been conducted in Iran to determine the prevalence of
We conducted the present study based on systematic review and meta-analysis studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (
We searched national online databases such as MagIran, IranMedex, SID, MedLib, and IranDoc, in addition to the international databases Scopus, PubMed, ISI Web of Knowledge, and Google Scholar search engine till June 16, 2017. To maximize the comprehensiveness of the search, we used MeSH keywords with all possible combinations with “OR” and “AND” in the English databases: 'Epidemiology', 'Prevalence', 'Chlamydia', 'Ureaplasma', 'Mycoplasma', 'Sexually transmitted diseases', 'Reproductive tract infections', 'Pregnant women', 'Pregnancy', 'Gestational', and 'Iran'. At the end of the search, the titles of the collected articles were entered into EndNote™ software to find similar articles.
The studied population included pregnant Iranian women. The positive result for
Inclusion criteria of this study consisted of a reference to the prevalence of
In the next step, researchers assessed the quality of articles according to the modified Newcastle Ottawa Scale (NOS) for cross-sectional studies (
All included articles were prepared for data extraction by a pre-prepared checklist. The checklist included the author’s name, year of the study, the location of the study, study design, sample volume, mean age, quality score and the prevalence of
The variance of each study was estimated according to the binomial distribution. We used the Q test and I2 index to assess the heterogeneity of the studies (
We located 240 relevant studies in the systematic review. There were 229 studies omitted due to the following reasons: duplicate studies [120]; irrelevance [68]; lack of epidemiological data in the article [10]; non-Iranian sample size [17]; failure to report disease prevalence [2]; controlled sample size [8]; and review articles, case reports and editorials [4] (
Study flow diagram.
Characteristics of 13 studies on
Reference | First author | Place | Year | Sample size | Prevalence (%) | Test | ||
---|---|---|---|---|---|---|---|---|
(9) | Sohrabi et al. | Ahwaz | 2005 | 79 | 10.1 | ELISA | ||
(10) | Rashidi et al. | Tehran | 2008 | 225 | 11.1 | PCR | ||
(11) | Khezerdoust et al. | Tehran | 2006 | 667 | 3.3 | ELISA | ||
(11) | Khezerdoust et al. | Tehran | 2006 | 447 | 2.2 | ELISA | ||
(12) | Chamani Tabriz et al. | Tehran | 2003 | 340 | 11.2 | PCR | ||
(13) | Behrozi and Badamee | Tehran | 1994 | 400 | 2.75 | ELISA | ||
(14) | Ahmadi et al. | Sanandaj | 2012 | 218 | 17.43 | PCR | ||
(15) | Mobasheri et al. | Ardal | 2010 | 85 | 4.7 | 19.8 | ELISA | |
(16) | Rohi et al. | Ardabil | 2010 | 100 | 28.6 | 15 | PCR | |
(17) | Sobouti et al. | Tehran | 2010 | 165 | 15 | 9.1 | PCR | |
(18) | Azizmohammadi et al. | Tehran | 2015 | 350 | 2.8 | PCR | ||
(19) | Mohseni et al. | Tonekabon | 2012 | 44 | 22.7 | PCR | ||
(20) | Haghighi Hasanabad et al. | Sabzevar | 2010 | 196 | 14.8 | 2.04 | PCR | |
(21) | Sisakht et al. | Yasuj | 2010 | 107 | 14.02 | PCR | ||
We assessed 11 surveyed articles that had a sample size of 2864 pregnant Iranian women and determined the prevalence to be 8.74% (95% CI: 5.40-13.84), and high heterogeneity was estimated between studies (P<0.001, I2 = 92.32%) for
Forest plot. Prevalence of
The prevalence of
Meta-regression for the prevalence of
Meta-regression of prevalence of
Prevalence of
Variable | Studies (n) | Sample size (n) | Prevalence (%) | 95% CI | I2 (%) | P value (heterogeneity) | |
---|---|---|---|---|---|---|---|
Diagnostic test | ELISA | 6 | 1778 | 5.73 | 2.09-14.73 | 94.81 | <0.001 |
PCR | 5 | 1086 | 13.55 | 11.23-16.25 | 31.11 | 0.214 | |
Subgroup differences: Q value=3.029, df=1, P=0.082 | |||||||
Year of studies | 2005-2009 | 4 | 1418 | 5.41 | 2.40-11.73 | 90.25 | <0.001 |
2010-2014 | 5 | 706 | 15.67 | 10.47-22.78 | 78.05 | 0.001 | |
Subgroup differences: : Q value=5.76, df=1, P=0.016 | |||||||
Province | Khuzestan | 1 | 79 | 10.10 | 5.13-18.93 | - | - |
Tehran | 5 | 2079 | 4.96 | 2.45-9.81 | 92.19 | <0.001 | |
Ardebil | 1 | 100 | 28.60 | 20.61-38.20 | - | - | |
Razavi Khorasan | 1 | 196 | 14.8 | 10.48-20.49 | - | - | |
Kurdistan | 1 | 218 | 17.43 | 12.95-23.05 | - | - | |
Chaharmahal and Bakhtiari | 1 | 85 | 4.7 | 1.77-11.87 | - | - | |
Kohgiloyeh and Boyerahmad | 1 | 107 | 14.02 | 8.63-21.96 | - | - | |
Subgroup differences: : Q value=32.88, df=6, P<0.001 | |||||||
CI; Confidence interval, I2; Heterogeneity in Meta-analysis, ELISA; Enzyme-linked immunosorbent assay, and PCR; Polymerase chain reaction.
Publication bias in the studies for the prevalence of
The systematic review results of
Funnel plot for the prevalence of
Awareness of the prevalence pattern and screening for diseases that affect the health of the mother and fetus is necessary during pregnancy. The present study is the first systematic review to assess the prevalence of
We have determined the prevalence of
The prevalence of
Age (particularly 18-27 years) and socioeconomic conditions such as an urban residence or low income (
Recent studies report a significant relationship between
These bacteria can be easily detected by cell culture and serological methods that use micro-immunofluorescence techniques, ELISA, the complement fixation test (CFT), antigen detection methods, molecular methods (DNA hybridization, nucleic acid amplification techniques), and direct cytological methods (Giemsa, Gimenez, and hematoxylin stains) (
The prevalence of
Factors that increase the prevalence of prenatal infections in women include young age (adolescents and young adults); use of an intrauterine device (IUD); low level of education, unemployment, and low income; multiple sex partners; not using a condom, diaphragm or spermicide; lack of attention to individual health care for both men; and women and smoking, alcohol consumption, and drugs (
Several meta-analysis studies in Iran have focused on other infections in pregnant women and reported the following results: prevalence of urinary tract infection (11.2%) (
The limitations of the study included the failure to search using a combination of words in internal databases due to low sensitivity and the inability to perform further subgroup analysis because of the limited number of studies.
Future case-control studies to determine the role of various risk factors in Iranian societies seems necessary.
The high prevalence of reproductive tract infections among pregnant Iranian women necessitates screening these women as a preventive measure. Therefore, timely recognition and treatment of this disease can prevent maternal and fetal complications.