Rubella Immunity in Pregnant Iranian Women: A Systematic Review and Meta-Analysis

Rubella infection with in the first trimester of pregnancy may lead to adverse pregnancy outcomes. The present study was conducted to evaluate the immunity against rubella among pregnant Iranian women. The steps of meta-analyses were conducted based on the PRISMA guidelines. To review the associated English and Persian literature, a comprehensive search was conducted among international databases such as Scopus, PubMed/Medline, Science Direct, Cochrane library, Web of Science, and Google Scholar search engine as well as Iranian databases until October 1, 2017 using the following MeSH keywords: ‘Pregnant’, ‘Gestational’, ‘Prenatal care’, ‘Complications of pregnancy’, ‘Pregnancy’, ‘Rubella infection’, ‘Prevalence, ‘Epidemiology’, ‘Immunity’, ‘Immunization’, ‘Antibody’, ‘Iran’, and ‘Immunogenicity’. Random effects model and fixed effects model were respectively used to estimate the rate of rubella immunity and the effect of different variables on the immunity against rubella. The obtained data were analyzed using Comprehensive Meta-Analysis Ver.2. Sixteen studies constituting 8,411 pregnant Iranian women met the inclusion criteria. The overall pooled rubella immunity was 89.8% (95%CI: 86.1-92.6). Rubella immunity rates were 88.6% (95%CI: 80.6-93.6), and 90.4% (95%CI: 87.5-92.8) before and after national vaccine program, respectively. Rubella immunity rates were 90.7% (95% CI: 87.6-93.1) and 87.2% (95% CI: 74.3-94.1) based on the ELISA method and HIA method, respectively. There was no significant association between rubella immunity and vaccination program (P=0.593), diagnostic methods (P = 0.435), geographic regions (P=0.286), quality of the studies (P=0.603), occupation (P = 0.639), residence (P=0.801), and year of the studies (P=0.164), but it was significantly associated with age (P<0.001). Despite a high rubella immunity among pregnant Iranian women, anti-rubella antibody screening is recommended for all women of childbearing age.