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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: Amirvahedian63@gmail.com
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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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