Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-26T03:44:44.018Z Has data issue: false hasContentIssue false
  • English
  • Français

Pregnancy Outcomes of Wives of Chemical and Non-Chemical Weapons Exposed Veterans in Ahvaz, Iran: A Retrospective Cohort Study

Published online by Cambridge University Press:  25 June 2020

Leila Karimi Open the ORCID record for Leila Karimi [Opens in a new window] ,
Andrew C. Miller Open the ORCID record for Andrew C. Miller [Opens in a new window] ,
Alberto A. Castro Bigalli Open the ORCID record for Alberto A. Castro Bigalli [Opens in a new window] ,
Somaye Makvandi ,
Hossein Amini Open the ORCID record for Hossein Amini [Opens in a new window]  and
Amir Vahedian-Azimi Open the ORCID record for Amir Vahedian-Azimi [Opens in a new window]
Leila Karimi
Affiliation:
Behavioral Sciences Research Center, Lifestyle Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
Andrew C. Miller
Affiliation:
Department of Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA Department of Emergency Medicine, Nazareth Hospital, Philadelphia, Pennsylvania, USA
Alberto A. Castro Bigalli
Affiliation:
East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
Somaye Makvandi
Affiliation:
Department of Midwifery, Faculty of Nursing and Midwifery, Ahvaz branch, Islamic Azad University, Ahvaz, Iran
Hossein Amini
Affiliation:
Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
Amir Vahedian-Azimi*
Affiliation:
Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
*
Correspondence: Amir Vahedian-Azimi, PhD, RN, Trauma Research Center, Baqiyatallah University of Medical Sciences, P.O. Box19575-174, Sheykh bahayi Stress Vanak Square, Tehran, Iran, E-mail: Amirvahedian63@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Sulphur mustard (HD) is a lipophilic caustic alkylating vesicant (blister agent) that has mutagenic and carcinogenic effects. Among the studied perturbations are long-term genitourinary (GU) and fertility effects. Approximately 50,000 Iranian soldiers and civilians were exposed to HD during the Iraq-Iran war (1980-1989). This study questioned the wives of Iraq-Iran war veterans to determine the effects of male HD-exposure on pregnancy complications, adverse pregnancy outcomes, and secondary infertility.

Methods:

A retrospective, survey-based cohort study was conducted of wives of Iranian military veterans that survived HD-associated injuries while serving in Ahvaz, Iran during the Iraq-Iran war (1980-1989), as compared to non-exposed veterans serving concomitantly. Patients were identified from a database of injured veterans maintained by the Foundation of Martyrs and Veterans Affairs (Iran) via a systematic random sampling method utilizing a random number table. Using a validated questionnaire, collected data included: demographics; type and severity of chemical injury; spouse’s obstetric history (pregnancy number, duration, complications, and outcomes before and after spouse’s chemical injury); and secondary infertility.

Results:

An increase in spontaneous abortion (P = .03), congenital anomalies (P < .0001), and secondary infertility (P = .003) were observed. These findings were greatest amongst those with HD injuries affecting >50% body surface area. No difference in stillbirth, premature birth, or low birth weight was observed.

Conclusion:

Exposure to HD in combat may have long-lasting fertility effects on soldiers and their spouses, including spontaneous abortion, congenital anomalies, and secondary infertility. Further investigation is needed into the long-term effects of HD exposure as well as methods to better protect soldiers.

Keywords

chemical warfaredisasterinfertilitymustard gaspregnancy outcome
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 5 , October 2020 , pp. 477 - 481
Copyright
© World Association for Disaster and Emergency Medicine 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amirzargar, MA, Yavangi, M, Rahnavardi, M, Jafari, M, Mohseni, M. Chronic mustard toxicity on the testis: a historical cohort study two decades after exposure. Int J Androl. 2009;32(4):411–416.Google ScholarPubMed
Iyriboz, Y. A recent exposure to mustard gas in the United States: clinical findings of a cohort (n = 247) 6 years after exposure. Medscape Gen Med. 2004;6(4):4.Google ScholarPubMed
Safarinejad, M. Testicular effect of mustard gas. Urology. 2001;58(1):90–94.CrossRefGoogle ScholarPubMed
Shakeri, S, Yazdani, M, Kheradpezhouh, E. Long-term effect of exposure to mustard gas on male infertility. Iran Red Crescent Med J. 2007;9(2):59–62.Google Scholar
Center for Health Security, Johns Hopkins Bloomberg School of Public Health. Sulfur Mustard (blister agent) fact sheet; 2013. http://www.centerforhealthsecurity.org/our-work/publications/blister-agent-fact-sheet. Accessed December 12, 2019.Google Scholar
Ghanei, M, Rajaee, M, Khateri, S, Alaeddini, F, Haines, D. Assessment of fertility among mustard-exposed residents of Sardasht, Iran: a historical cohort study. Reprod Toxicol. 2004;18(5):635–639.CrossRefGoogle ScholarPubMed
Dacre, JC, Goldman, M. Toxicology and pharmacology of the chemical warfare agent sulfur mustard. Pharmacol Rev. 1996;48(2):289–326.Google ScholarPubMed
National Institute for Occupational Safety and Health, US Centers for Disease Control and Prevention. Sulfur Mustard: Blister Agent; 2011. https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750008.html. Accessed December 12, 2019.Google Scholar
Panahi, Y, Ghanei, M, Ghabili, K, et al. Acute and chronic pathological effects of sulfur mustard on genitourinary system and male fertility. Urol J. 2013;10(2):837–846.Google ScholarPubMed
Malekyari, B, Karimian, N, Farahbakh, K, Esmaeili, M. Qualitative analysis of emotional and familial situations of injured victims of Sardasht chemical air attack. Clin Psychol Stud. 2013;4(13):107–120.Google Scholar
von Elm, E, Altman, DG, Egger, M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–1499.Google ScholarPubMed
Amanpoor, A, Ahmadi, R, Monfared, S, Torabi, Z. Investigating and analyzing the process of first urban formation in Khuzestan province during 2011-2012. J Soc Econ Hist. 2013;2(1):19–50.Google Scholar
Director General of the Martyrs Foundation of Khuzestan. A specialized chemical warfare clinic is set up in Ahwaz. Iran Student’s News Agency; 2019. https://www.isna.ir/news/khouzestan-70515/. Accessed December 10, 2019.Google Scholar
Ketabchi, A. Urogenital and fertility complications in victims of chemical war residing in Kerman province. J Kerman Univ Med Sci. 1998;5(2):72–77.Google Scholar
Amirzargar, MA, Yavangi, M, Rahnavardi, M, Jafari, M, Mohseni, M. Chronic mustard toxicity on the testis: a historical cohort study two decades after exposure. Int J Androl. 2009;32(4):411–416.CrossRefGoogle ScholarPubMed
Marzony, ET, Ghanei, M, Panahi, Y. Relationship of oxidative stress with male infertility in sulfur mustard-exposed injuries. Asian Pacific J Reprod. 2016;5(1):1–9.Google Scholar
Azizi, F, Keshavarz, A, Roshanzamir, F, Nafarabadi, M. Reproductive function in men following exposure to chemical warfare with Sulphur mustard. Med War. 1995;11(1):34–44.CrossRefGoogle ScholarPubMed
Agin, K, Sarvaghadi, F. Serum free testosterone levels among sulfur mustard induced asthma in Iran war veterans 15 years postwar: a case control study. Int J Endocrinol Metab. 2006;4(3):130–135.Google Scholar
Safarinejad, MR. Sperm chromatin structure assay analysis of Iranian mustard gas casualties: a long-term outlook. Curr Urol. 2010;4(2):71–80.CrossRefGoogle Scholar
Hadavi, M, Alidalaki, S, Abedininejad, M, Akhavan, S. Etiologies and contributing factors of perinatal mortality: a report from southeast of Iran. Taiwan J Obstet Gynecol. 2011;50(2):145–148.CrossRefGoogle ScholarPubMed
Ghorat, F, Ghafarzadeh, R, Esfehani, RJ. Perinatal mortality and its associated risk factors: a study in the North-East of Iran. Iran J Neonatol. 2016;7(1):47–51.Google Scholar
Bahmanjanbeh, F, Kohan, S, Yarmohammadian, MH, Haghshenas, A. Evaluation of reproductive health indicators in women affected by East Azerbaijan earthquake on August 2012. Iran J Nurs Midwifery Res. 2016;21(5):504–509.Google Scholar
Roudbari, M, Yaghmaei, M, Soheili, M. Prevalence and risk factors of low-birth-weight infants in Zahedan, Islamic Republic of Iran. East Mediterr Heal J. 2007;13(4):838–845.Google ScholarPubMed
Alijahan, R, Hazrati, S, Mirzarahimi, M, Pourfarzi, F, Ahmadi Hadi, P. Prevalence and risk factors associated with preterm birth in Ardabil, Iran. Iran J Reprod Med. 2014;12(1):47–56.Google ScholarPubMed
Derakhshi, B, Esmailnasab, N, Ghaderi, E, Hemmatpour, S. Risk factor of preterm labor in the west of Iran: a case-control study. Iran J Public Health. 2014;43(4):499–506.Google ScholarPubMed
Vakilian, K, Ranjbaran, M, Khorsandi, M, Sharafkhani, N, Khodadost, M. Prevalence of preterm labor in Iran: a systematic review and meta-analysis. Int J Reprod Biomed. 2015;13(12):743–748.Google ScholarPubMed
Alijahan, R, Hazrati, S, Mirzarahimi, M, Pourfarzi, F, Ahmadi Hadi, P. Associated risk factors and prevalence of congenital malformations in Ardabil, Iran. Iran J Neonatol. 2014;5(3):3–4.Google Scholar
Abdi-Rad, I, Khoshkalam, M, Farrokh-Islamlou, H-R. The prevalence at birth of overt congenital anomalies in Urmia, Northwestern Iran. Arch Iran Med. 2008;11(2):148–151.Google ScholarPubMed
Golalipour, MJ, Ahmadpour-Kacho, M, Vakili, MA. Congenital malformations at a referral hospital in Gorgan, Islamic Republic of Iran. East Mediterr Health J. 2005;11(4):707–715.Google Scholar
Mosayebi, Z, Movahedian, AH. Pattern of congenital malformations in consanguineous versus nonconsanguineous marriages in Kashan, Islamic Republic of Iran. East Mediterr Health J. 2007;13(4):868–875.Google ScholarPubMed
Abolghasemi, H, Radfar, MH, Rambod, M, et al. Childhood physical abnormalities following paternal exposure to sulfur mustard gas in Iran: a case-control study. Confl Health. 2010;4(1):13.CrossRefGoogle ScholarPubMed
Mirzaei, M, Namiranian, N, Dehghani Firouzabadi, R, Gholami, S. The prevalence of infertility in 20-49 years women in Yazd, 2014-2015: a cross-sectional study. Int J Reprod Biomed. 2018;16(11):683–688.Google ScholarPubMed
Ahmadi Asr Badr, Y, Madaen, K, Haj Ebrahimi, S, Ehsan Nejad, AH, Koushavar, H. Prevalence of infertility in Tabriz in 2004. Urol J. 2006;3(2):87–91.Google ScholarPubMed
Aflatounian, A, Seyed Hasani, SM, Tabibnezhad, N. The epidemiological and etiological aspects of infertility in Yazd province of Iran. Int J Reprod Biomed. 2009;7(3):117–122.Google Scholar
Hosseini, J, Emadeddin, M, Mokhtarpour, H, Sorani, M. Prevalence of primary and secondary infertility in four selected provinces in Iran, 2010-2011. Iran J Obstet Gynecol Infertil. 2012;15(29):1–7.Google Scholar
Moghaddam, AD, Delpisheh, A, Sayehmiri, K. The prevalence of infertility in Iran, a systematic review. Iran J Obstet Gynecol Infertil. 2013;16(81):1–7.Google Scholar