Past Issue

Volume 13, Number 3, Oct-Dec 2019 Pages: 169-177

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

Milad Azami, M.D, 1, 2, Zahra Jaafari, M.Sc, 3, Ali Soleymani, M.Sc, 4, Gholamreza Badfar, M.D, 5, Shamsi Abbasalizadeh, M.D, 2, *,
Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Dezful University of Medical Sciences, Dezful, Iran
Department of Pediatrics, Behbahan Faculty of Medical Sciences, Behbahan, Iran
*Corresponding Address: P.O.Box: 5138665793 Women’s Reproductive Health Research Center Tabriz University of Medical Sciences Tabriz Iran


Rubella infection within the first trimester of pregnancy may lead to adverse pregnancy outcomes. The present study was conducted to evaluate the immunity against rubella among the pregnant Iranian women. The steps of meta-analyses were conducted based on the MOOSE protocol and results were reported according to the PRISMA guideline. To review the associated English and Persian literature, a comprehensive search was conducted among the international databases such as Scopus, PubMed/Medline, Science Direct, Embase, Cochrane library, Web of Science and Google Scholar search engine as well as Iranian databases, until April 1, 2018 using the following medical subject headings (MeSH) keywords: ‘Pregnant’, ‘Gestational’, ‘Prenatal care’, ‘Complications of pregnancy’, ‘Pregnancy’, ‘Rubella infection’, ‘Prevalence, ‘Epidemiology’, ‘Immunity’, ‘Immunization’, ‘Antibody’, ‘Immunogenicity’ and ‘Iran’. Cochran’s Q test and I2 index were used to investigate heterogeneity in the studies. Random effects model was used to estimate the rate of rubella immunity. The obtained data were analyzed using Comprehensive Meta-Analysis Ver.2. Fifteen studies constituting 7,601 pregnant Iranian women met the inclusion criteria. The overall pooled rubella immunity rate was 90.1% [95% confidence interval (CI): 86.1-93.1]. Rubella immunity rates were respectively 88.6% (95% CI: 80.6-93.6) and 91.5% (95% CI: 88.1-93.9) before and after national vaccine program. Rubella immunity rates were 91.4% (95% CI: 87.8-94.0) and 87.2% (95% CI: 74.3-94.1) based on the enzyme-linked immunosorbent assay (ELISA) and haemagglutination-inhibition (HAI) methods, respectively. There was no significant association between rubella immunity and vaccination program (P=0.398), diagnostic methods (P=0.355), geographic regions (P=0.286), quality of the studies (P=0.751), 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 high rubella immunity among the pregnant Iranian women, anti-rubella antibody screening is recommended for all women of childbearing age.