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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: [email protected]
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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

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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