شیوع و عوامل خطر عفونت هپاتیت B در زنان باردار ایران: یک مطالعه مرور سیستماتیک و متاآنالیز

نوع مقاله: مروری

نویسندگان

1 دانشجوی پزشکی، کمیته تحقیقات دانشجویی، دانشکده پزشکی، دانشگاه علوم پزشکی ایلام، ایلام، ایران.

2 کارشناس ارشد پرستاری داخلی جراحی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی دزفول، دزفول، ایران.

3 دانشیار گروه زنان و مامایی، مرکز تحقیقات سلامت باروری زنان، دانشکده پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران.

4 دانشجوی کارشناسی ارشد اپیدمیولوژی، کمیته تحقیقات دانشجویی، دانشکده بهداشت، دانشگاه علوم پزشکی ایلام، ایلام، ایران

5 دانشجوی دکترای پژوهشی، مرکز تحقیقات پیشگیری از آسیب های روانی- اجتماعی، دانشکده بهداشت، دانشگاه علوم پزشکی ایلام، ایلام، ایران.

6 استاد گروه اپیدمیولوژی بالینی، دانشکده بهداشت، دانشگاه علوم پزشکی ایلام، ایلام، ایران.

7 دانشجوی کارشناسی پرستاری، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی دزفول، دزفول، ایران.

چکیده

مقدمه: انتقال پری‌ناتال یکی از رایج‌ترین مسیرهای انتقال هپاتیت  B(HBV ) در سراسر جهان است. در ایران بیش از 50% حاملین HBV، عفونت را از این طریق دریافت کرده‌اند. لذا این مطالعه مروری با هدف بررسی شیوع و عوامل خطر HBV در زنان باردار ایران انجام شد.
روش‌کار: مطالعه حاضر بر اساس چک لیست PRISMA برای مطالعات مرور سیستماتیک و متاآنالیز انجام شد. جهت دستیابی به مستندات فارسی و انگلیسی مرتبط، پایگاه‌های الکترونیکی Scopus، PubMed، Science-Direct، Cochrane، Web of Science (ISI)، Springer، Online Library Wiley،Magiran ، Iranmedex، SID، Medlib، IranDoc و موتور جستجوی Google Scholar با استفاده از کلیدواژه‌های استاندارد شامل: شیوع، هپاتیت B، زنان باردار، بارداری، عوامل خطر، HBsAg و ایران بدون محدودیت زمانی تا بهمن ماه 1394 توسط دو پژوهشگر جستجو شدند. داده‌های شیوع HBV با استفاده از مدل اثرات تصادفی و عوامل خطر HBV براساس مدل اثرات ثابت توسط نرم افزار STATA (نسخه 2/11) مورد تجزیه و تحلیل آماری قرار گرفتند.
یافته‌ها: در بررسی 36 مطالعه واجد شرایط با حجم نمونه 64195 زن باردار در ایران،شیوع HBV 5/0%(CI 95%: 6/0-5/0) محاسبه شد. کمترین و بیشترین شیوع HBV مرتبط با شمال (4/0%) و شرق ایران (6/1%) بود. شیوع HBV در زنان باردار شهری و روستایی به ترتیب 1/1 و 2/1% برآورد شد. شیوع HBV در زنان باردار خانه‌دار 7/1% و در زنان باردار شاغل 1/0% بدست آمد. فراوانی HBsAb(AntiHBS>10 mIU/ml) در زنان باردار ایرانی 40% محاسبه شد. از میان عوامل خطر، بی‌سوادی، شغل، سقط جنین، سابقه تزریق خون و اعتیاد همسر با ابتلاء به HBV از نظر آماری معنی‌دار بود (05/0>p)، اما این ارتباط با شهرنشینی، سابقه جراحی و خالکوبی معنی‌دار نبود (05/0<p).
نتیجه‌گیری: کمترین شیوع هپاتیت B در ایران، در گروه زنان باردار می‌باشد و کمتر از جمعیت عمومی ایران است. تزریق خون، شغل، اعتیاد همسر، بی‌سوادی و سقط جنین با ابتلاء به HBV در زنان باردار ایران در ارتباط است.

کلیدواژه‌ها


عنوان مقاله [English]

Prevalence and Risk Factors of Hepatitis B Infection in Pregnant Women of Iran: A Systematic Review and Meta-Analysis

نویسندگان [English]

  • Milad Azami 1
  • Marzieh Khataee 1
  • Marzieh Beigom Bigdeli Shamloo 2
  • Fatemeh Abbasalizadeh 3
  • Shoboo Rahmati 4
  • Shamsi Abbasalizadeh 3
  • Yousef Veisani 5
  • Ali Delpisheh 6
  • Yaeghoob Madmoli 7
1 Medical Student, Student Research Committee, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
2 M.Sc. student of Surgery Internal Nursing, School of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran.
3 Associate professor, Department of Obstetrics & Gynecology, Women’s Reproductive Health Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
4 M.Sc. student of Epidemiology, Student Research Committee, School of Health, Ilam University of Medical Sciences, Ilam, Iran.
5 PhD student of Research, Psychosocial Injuries Prevention Research Center, Ilam University of Medical Sciences, Ilam, Iran.
6 Professor, Department of Clinical Epidemiology, School of Health, Ilam University of Medical Sciences, Ilam-Iran.
7 Nursing student, Student Research Committee, School of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran.
چکیده [English]

Introduction: Perinatal transmission is one of the most common routes of hepatitis B virus (HBV) transmission in the worldwide. In Iran, more than 50% of HBV carriers have received the infection in this route. Therefore, this review study was performed with aim to determine the prevalence and risk factors of HBV infection in pregnant women of Iran.
Methods: Current study was conducted based on PRISMA checklist for systematic review and meta-analysis studies. To access to the English and Persian documents, two independent authors searched Scopus, PubMed, ScienceDirect, Cochrane, Web of Science (ISI), Springer, Online Library Wiley, Magiran, Iranmedex, SID, Medlib, IranDoc and Google Scholar search engine up to January 2016 by using Mesh keywords including: Prevalence, Hepatitis B, Pregnant women, Pregnancy, Risk Factors, HBsAg and Iran. Data was analyzed using the random-effects model for HBV prevalence and fixed-effects model for risk factors of HBV via Stata software (Version 11.2).
Results: A total of 36 eligible studies with sample size of 64,195 pregnant women in Iran, HBV prevalence was estimated 0.5%. Minimum and maximum of this range were related to the North (0.4%) and East (1.6%) of the Iran. HBV prevalence in urban and rural pregnant women was estimated 1.1 and 1.2%, respectively. HBV prevalence among housewife pregnant women was 1.7% and employee pregnant women was 0.1%. The frequency of HBsAb>10 mIU/ml in Iranian pregnant women were calculated 40%. Among the risk factors, illiteracy, occupation, blood transfusion, abortion and husband addiction were significant related with prevalence of HBV (P<0.05), but this relationship was not statistically significant with urbanization, history of surgery and tattooing (P>0.05).
Conclusion: The lowest prevalence of HBV in Iran was related to pregnant women and less than the general population. History of blood transfusions, husband addiction, illiteracy, occupation and abortion are associated with HBV in Iranian pregnant women.

کلیدواژه‌ها [English]

  • Hepatitis B
  • Meta-analysis
  • Pregnant Women
  • Prevalence
  • Risk factors
  1. World Health Organization. Geographic pattern of hepatitis B prevalence, 1997. The World Health Organizations pages on vaccines and immunizations. Available at: URL: http: //www.who.int/vaccines/surveillance/ graphics/ htmls/hepbrev.htm; 2007.
  2. Hepatitis B Vaccines. Weekly epidemiological record. Switzerland: World Health Organization; 2009. P. 405-20.
  3. Alavian SM, Fallahian F, Lankarani KB. The changing epidemiology of viral hepatitis B in Iran. J Gastrointestin Liver Dis 2007; 16(4):403-6.
  4. Kolawole OM, Wahab AA, Adekanle DA, Sibanda T, Okoh AI. Seroprevalence of hepatitis B surface antigenemia and its effects on hematological parameters in pregnant women in Osogbo, Nigeria. Virol J 2012; 9:317.
  5. Merat Sh, Malekzadeh R, Rezvan H, Khatibian M. Hepatitis B in Iran. Archives of Iranian Medicine 2000; 3(4): 192-201.
  6. Jonas MM. Hepatitis B and pregnancy: an underestimated issue. Liver Int 2009; 29(Suppl 1):133–9.
  7. Batayneh N, Bdour S. Risk of perinatal transmission of hepatitis B virus in Jordan. Infect Dis Obstet Gynecol 2002; 10(3):127-32.
  8. Yadegari D, Doaee SH. A study of prevalence and epidemiological factors at the Hepatitis B in the pregnancy women referral at to Zanjan hospitals. J Zanjan Univ Med Sci 1999; 25(6):64-71. (Persian).
  9. Aminzadeh Z, Gachkar L, Sayyadi Anari AR. Frequency of HBsAg positive in pregnant women Rafsanjan in the year 2003. J Rafsanjan Univ Med Sci 2004; 3(2):126-33. (Persian).
  10. Moradi B, Ghazizade S. Prevalence of HBsAg in pregnant women referred to prenatal clinic of Imam Khomeini in 1999. [Dissertation Thesis]. Tehran, Iran: Tehran University of Medical Sciences; 2003. (Persian).
  11. Ghalenoee M, Aali S. Evaluation of serum HBsAg positive in pregnant women referred to laboratory in Kerman. [Dissertation Thesis]. Kerman, Iran: Kerman University of Medical Sciences; 2003. (Persian).
  12. Sharifi M, Assefzade M, Lalouha F, Eshtiagh B. Detecting carriers of HBsAg among pregnant women in Qazvin Blood Transfusion Center from 2000 to 2001. Proceeding of the 1th Iranian Congress Virology, Tehran, Iran; 2000.
  13. Aali BS. The prevalence of HBsAg among pregnant women referred to Kerman maternity hospitals in 1997. J Kerman Univ Med Sci 1999; 6(2):89-96.
  14. Mirghaforvand M, Montazam SH, Rafie A. Study of prevalence and contributing factors of hepatitis B among pregnant women referred to laboratory of health center of Bonab. J Urmia Nurs Midwifery Facul 2007; 5(3):120-31.
  15. Salimi S, Alijahan R, Nakhostin B, Hazrati S. Prevalence of HbsAg+ cases and its associated factors in pregnant women referred to health centers of Ardabil district in 2009. J Health 2014; 5(3):248-58.
  16. Sarifimoud B, Kaikha F, Sanei MS, Salehi M, Alavi NR, Metanat M, et al. Epidemiological study of Hepatitis B surface antigen in pregnant women in Zahedan. Zahedan J Res Med Sci 2005; 7(2):119-24. (Persian).
  17. Tabasi Z, Mir Hosseini F, Mousavi SG, Ghafouri L. HBsAg in parturients referring to gynecologic clinics in Kashan, 2002 . J Feyz 2003; 7(3):35-41. (Persian).
  18. Motazakker M, Shokat Nagadeh M, Khalili F, Shayeri B. Hepatitis B virus infection among pregnant women attending health care centers of Urmia. J Guilan Univ Med Sci 2014; 23(89):45-50. (Persian).
  19. Cheraghali F, Yazarloo S, Behnampour N, Azarhoush R. Frequency of HBsAg in pregnant women in Gorgan, Iran. J Gorgan Univ Med Sci 2011; 12(4):84-90. (Persian).
  20. Kavosi A, Vizvari P, Mohammadi G, Jouybari L, Sanagu A. Seroprevalence of positive HbsAg and its associated factors in pregnant women referred to health centers of Agh-Ghala city in 2010-2012. Iran J Obstet Gynecol Infertil 2015; 18(149):8-16. (Persian).
  21. Mohammad JR, Vaziri ES, Soorani YC, Saadati N. A survey of the frequency of HBsAg+ status in pregnant women attending health centers in Ahwaz. Payesh 2004; 3(3):237-43. (Persian).
  22. Mohammadian F, Mazloomzadeh S, Esmaeilzadeh A, Sorouri Zanjani R, Savabi S, Soleimanipor S, et al. Seroprevalence of Hepatitis B virus among pregnant women referred to healthcare centers of Zanjan. ZUMS J 2014; 22(93):96-104. (Persian).
  23. Behjati Ardekani R, Sharifi N, Mjibiban M. The prevalence of HBsAg-positive in 1904 pregnant women attending obstetrics and gynecology clinics in Yazd. [Dissertation Thesis]. Yazd, Iran: Shahid Sadoughi Yazd University of Medical Sciences; 2000. (Persian).
  24. Mohebbi SR, Sanati A, Cheraghipour K, Rostami Nejad M, Shalmani HM, Zali M. Hepatitis C and Hepatitis B virus infection: epidemiology and risk factors in a large cohort of pregnant women in Lorestan, West of Iran. Hepat Mon 2011; 11(9):736-9.
  25. Motamedifar M, Amini E, Shirazi PT, Sarvari J. The prevalence of HBsAg and HBsAb among pregnant women referring to Zeinabiyeh Hospital, Shiraz Iran. Shiraz E Med J 2012; 13(4):187-96.
  26. Ahmadi M, Toghyani R, Shahidi S, Izadi M, Merasi MR, Agdak P, et al. Prevalence of HBsAg and high-risk behaviors in pregnant women referring to urban health centers in Isfahan province. Iran J Nurs Midwifery Res 2011; 16(1):47-54.
  27. Jalali P, Rabie S, Falah M. Frequency of HbsAg+ among pregnant women in Hamadan in 1998. [Dissertation Thesis]. Hamadan, Iran: Hamadan University of Medical Sciences; 1999. (Persian).
  28. Hassanjan Roshan M. Rate hepatitis B in Babol pregnant women in 1994. Nabz 1994; 9(6):28-31. (Persian).
  29. Ebrahim Pour S, Khoshnejad F, Naziri S. Study of HBsAg at the time of delivery in pregnant women in Gynecology Hospital of Tabriz, 1987-89. Med J Tabriz Univ Med Sci 1993; 27(19):3-15. (Persian).
  30. Ghafoor L, Tabassi M, Mousavi G. Frequency of HbsAg+ in 2000 pregnant women referred to gynecology clinic in Kashan in 2002. [Dissertation Thesis]. Kashan, Iran: Kashan University of Medical Sciences; 2000. (Persian).
  31. Ahansaz MB. Evaluation of HBsAg positive in pregnant women referring to prenatal ward Dezyani hospital in Gorgan in the first half of 1999. [Dissertation Thesis]. Tehran, Iran: Iran University of Medical Sciences; 2000. (Persian).
  32. Nassri Razin B, Famili A. Prevalence of hepatitis B virus surface antigen and facilitating factors for the creation thousands of pregnant women referring to hospital in Mirza Koochak Khan and Iranian Blood Transfusion Organization. Proceeding of the 9th Congress of Infectious Diseases, Tehran, Iran; 2000.
  33. Aghighi M, Aghighi Z. Study of HBsAg positive cases in pregnant women referring to gynecology clinic during 1995-2000. Proceeding of the 9th Congress of Infectious Diseases, Tehran, Iran; 2000.
  34. Ryazi Z, Mahmoud Yaghoobi M. Prevalence of hepatitis B in referring to the maternity ward of nohome dei hospital Torbat-Heidaryeh in the first half of 2004. Proceeding of the 9th Congress of Infectious Diseases, Tehran, Iran; 2000.
  35. Moradi HR, Razin B, Khataee A, Talebia A. Frequency of hepatitis B surface antigen (HBsAg) and facilitating factors studied 1,000 pregnant referred to Blood Transfusion Organization. [Dissertation Thesis]. Tehran, Iran: Shahid Beheshti University of Medical Sciences; 2000.
  36. Sahaf F, Tanomand A, Montazam H, Sany AA. Seroprevalence of hepatitis C, hepatitis B and HIV and co-infections among pregnant women: a retrospective study in 2006 at Malekan City, Iran. Res J Med Sci 2007; 1:138-41.
  37. Shoghli A, Nabavi SM, Alavian SM, Kolifarhood G, Goya MM, Namazi R, et al. Hepatitis B surface antigen prevalence in pregnant women: a cross-sectional survey in Iran. Int J Prev Med 2014; 5(Suppl 3):213-8.
  38. Afzali H, Momen Heravi M, Moravveji SA, Poorrahnama M. Prevalence of hepatitis B surface antigen in pregnant women in Beheshti hospital of Kashan, Isfahan. Iran Red Crescent Med J 2015; 17(7):e20598.
  39. Yahyapour Y, Karimi M, Molaei HR, Khoddami E, Mahmoudi M. Active-passive Immunization effectiveness against hepatitis B virus in children born to HBsAg positive mothers in Amol, North of Iran. Oman Med J 2011; 26(6):399-403.
  40. Sayehmiri K, Darvishi Z, Azami M, Qavam S. The prevalence of anemia in first, second and third trimester of pregnancy in iran: a systematic review and meta- analysis. IJOGI 2015;18:7-15.
  41. Azami M, Darvishi Z, Sayehmiri K. Systematic Review and Meta-Analysis of the Prevalence of Anemia Among Pregnant Iranian Women (2005 - 2015). Shiraz E-Med J. 2016;17(4-5):e38462. Epub 2016-05-28.
  42. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8(5):336-41.
  43. Mast EE, Margolis HS, Fiore AE, Brink EW, Goldstein ST, Wang SA, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep 2005; 54(RR-16):1-31.
  44. Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States-recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: Immunization of adults. MMWR Recomm Rep 2006; 55(RR-16):1-33.
  45. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370(9596):1453-7.
  46. Ades AE, Lu G, Higgins JP. The interpretation of random-effects meta-analysis in decision models. Med Decis Making 2005; 25(6):646-54.
  47. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods 2010; 1(2):97-111.
  48. Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 2001; 54(10):1046–55.
  49. Poorolajal J, Majdzadeh R. Prevalence of chronic hepatitis B infection in Iran: a review. J Res Med Sci 2009; 14(4):249-58.
  50. Sayehmiri K, Azami M, Darvishi Z, Nikpay S, Borji M. The prevalence of hepatitis B infection in health care workers in Iran- a Systematic Review and Meta-analysis. Iran J Public Health 2016; 45(2): 7.
  51. Sayehmiri K,AzamiM, Borji M, Nikpay S, Chamani M. Seroprevalence of Hepatitis B Virus Surface Antigen (HBsAg) in Iranian Health Care Workers: Systematic Review and Meta-Analysis Study. Journal of Occupational and Environmental Health 2016; 2(1): 1-11.
  52. Mohammadi Z, Keshtkar A, Eghtesad S, Jeddian A, Pourfatholah AA, Maghsudlu M, et al.. Epidemiological profile of hepatitis B virus infection in Iran in the past 25 years; a systematic review and meta-analysis of general population studies. Middle East J Dig Dis 2016; 8(1):5–18.
  53. Molijn MH, Van der Linden JM, Ko LK, Gorgels J, Hop W, Van Rhenen DJ. Risk factors and anti-HBc reactivity among first-time blood donors. Vox Sang 1997; 72(4):207-10.
  54. Utoo BT. Hepatitis B surface antigenemia (HBsAg) among pregnant women in southern Nigeria. Afr Health Sci 2013; 13(4):1139–43.
  55. Furuncuoglu Y, Bolukbas FF, Bolukbas C, Torun P, Ozturk R. Changes in the prevalence of HBV infection in pregnant women in Turkey between 1995 and 2015: a 20-year evaluation. Postgrad Med J 2016; 3:133876.
  56. Yohanes T, Zerdo Z, Chufamo N. Seroprevalence and predictors of hepatitis B virus infection among pregnant women attending routine antenatal care in Arba Minch Hospital, South Ethiopia. Hepat Res Treat 2016; 2016:9290163.
  57. Bayo P, Ochola E, Oleo C, Mwaka AD. High prevalence of hepatitis B virus infection among pregnant women attending antenatal care: a cross-sectional study in two hospitals in northern Uganda. BMJ Open 2014; 4(11):e005889.
  58. Souza MT, Pinho TL, Santos MD, Santos Ad, Monteiro VL, Fonsêca LM, et al. Prevalence of hepatitis B among pregnant women assisted at the public maternity hospitals of São Luís, Maranhão, Brazil. Braz J Infect Dis 2012; 16(6):517-20.
  59. Fouquet A, Jambon AC, Canva V, Bocket-Mouton L, Gottrand F, Subtil D. Hepatitis B and pregnancy. Part 1. Thirteen practical issues in antenatal period. J Gynecol Obstet Biol Reprod 2016; 45(6):531-9.
  60. Ayatollahi J, Taghipour Zahir S, Owlia MB, Sajjadi SM. Viral hepatitis in pregnancy. Iran J Obstet Gynecol Infertil 2009; 12(2):57-62. (Persian).
  61. Sayehmiri K, Azami M, Nikpey S, Borji M, Sayehmiri F. Hepatitis B vaccination coverage in health personnel of Iran: a systematic review and meta-analysis study. Iran J Epidemiol 2015; 11(3):1-10. (Persian).
  62. Azami M, Borji M, Ghanbari F, Nikpay S, Sayehmiri K. Hepatitis B vaccination coverage of physicians and nurses in Iran: a systematic review and meta-analysis study. J Birjand Univ Med Sci 2015; 22(4):304-15. (Persian).
  63. Azami M, Sayehmiri K, Darvishi Z, Sayehmiri F. Hepatitis B vaccination coverage among dentists in Iran: a systematic review and meta-analysis study. Hepatitis Mont 2015; 15(83):37.
  64. Azami M, Nikpey S, Pakzad I, Sayehmiri K. Effects of immunization to hepatitis B vaccine in Iranian health staff: a systematic review and meta-analysis study. Koomesh 2016; 17(4):789-95. (Persian).
  65. AzamiM, HafeziAhmadi MR, Sayehmiri K. The Efficacy of Hepatitis B Vaccine Among Healthcare Workers: A Meta-Analysis Study. Hepatitis Mont 2016; In Press.
  66. Ephraim R, Donko I, Sakyi SA, Ampong J, Agbodjakey H. Seroprevalence and risk factors of Hepatitis B and Hepatitis C infections among pregnant women in the Asante Akim North Municipality of the Ashanti region, Ghana; a cross sectional study. Afr Health Sci 2015; 15(3):709–13.
  67. Akani CI, Ojule AC, Opurum HC, Ejilemele AA. Sero-prevalence of hepatitis B surface antigen (HBsAg) in pregnant women in Port Harcourt, Nigeria. Niger Postgrad Med J 2005; 12(4):266-70.