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Prevalence of group B streptococcus colonization in Iranian pregnant women: A systematic review and meta-analysis

Abstract Background Group B Streptococcus (GBS) is an important pathogen in newborns and pregnant women. Objective The present study was carried out to estimate the prevalence of GBS colonization in pregnant women in Iran. Materials and Methods This systematic review and meta-analysis was based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline using the national databases including Society for Information Display, Magiran, Irandoc, Iran Medex, and international databases including MEDLINE, Web of Science, Scopus, PubMed, Science-Direct, Cochrane, Embase, Elton Bryson Stephens Company, Centre for Evidence-Based Medicine, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar, published by 01/30/2017. The I2 index was used to measure heterogeneity between the studies. Results In a total of 667 documents, 30 (4.49%) were selected. In this study, the prevalence of GBS colonization in 10090 Iranian pregnant women was calculated as 13.65% [confidence interval (CI): 95%: 10.56–17.45]. Based on geographic region, 24.63% [CI: 95%: 11.52–45.06] in the West and 8.75% [CI: 95%: 6.43–11.8] in the East were the highest and lowest areas in Iran, respectively, and were statistically significant (p = 0.001). Also, with regards to swapping sampling area, Vaginal with 11.96%, Vaginal and Rectal with 13.62%, and Anal and Vaginal with 25.63% were the least to the greatest, respectively, and were statistically significant (p = 0.001). Conclusion Therefore, based on the recommendation of Centers for Disease Control and Prevention as reported by the Ministry of Health and Medical education, early diagnosis, and screening of high-risk women should be done at 35–37 weeks of pregnancy.

Bacterium acquisition by the infant leads to the colonization of the skin or mucous membranes, which is transferred from infected mothers to 15-50% of infants and only progresses in 1-3% of them, leading to the aforementioned diseases (11). The disease early-onset in days before the end of 1 week (0-7 days) emerges as septicemia willing to pneumonia, and in the case of lateonset (after 1 week (days 7-90)) in infants manifests as septicemia willing to meningitis, which despite antibiotic therapy, has accounted for a high mortality (13,14). Colonization of this bacterium can be transient, intermittent, or chronic, and its incidence varies in different geographical areas (15).
Studies have reported GBS colonization to be less in women of over 20 years old and with multiple pregnancies, and more in women with multiple sexual partners, suffering from diabetes mellitus, suffering from cancer, and patients with weakened immune systems (5)(6)(7)(8).
Also, social conditions, microbiology detection methods, different sampling location, and age of the study population could also cause variations in the incidence of GBS colonization in pregnant women (16). According to the guidelines of the  (17)(18)(19)(20)(21)(22)(23).
One of the main objectives of meta-analysis studies is to combine existing studies to increase the sample size because of the increased number of relevant studies. Thus, this can reduce the difference in existing parameters and also the confidence interval; finally, the result can lead to solving the aforementioned problems with the last procedure (24,25). Absolutely, these studies are a vitally important link between research studies and decision-making at the bedside of the patient (26)(27)(28). Studies have reported GBS infection to range from 3 to 75% in Iran (5,6,8,21,23,(28)(29)(30)(31)(32)(33)(34)(35)(36).
Moreover, in Iran, CDC' s prevention orders related to these bacteria are not implemented as a codified

Materials and Methods
The present study is the first systematic and

Inclusion and exclusion criteria
The main inclusion criterion of the study includes colonization rate of GBS in pregnant women in Iran.
The exclusion criteria were: 1. lack of reference to the prevalence of GBS colonization in pregnant women; 2. little information; 3. lack of connection with the subject of the research; 4. non-random sample size; 5. qualitative articles and letters to the editor; 6. duplicate articles; 7. non-Iranian study community.

Search strategy and study selection
The results of this study are based on arti-

Quality assessment
After verifying the relevant studies, STROBE (Strengthening the Reporting of Observational  Figure 2).

Statistical analysis
In each study, after taking into account the prevalence of GBS colonization in pregnant women in Iran as a binomial probability distribution, its variance was calculated by the binomial distribution, and the heterogeneity of the studies was evaluated using the Q sample test and index I 2 .
Due to the heterogeneity of the studies, the random effects model was used to combine the results of the studies. Data analysis was conducted using meta-analysis specialized software -Comprehensive Meta-Analysis Ver.2, and a significance level of tests was considered p < 0.05.

Results
In this systematic study, based on the searches conducted, 667 papers were identified, and after a final review and assessment in accordance with the checklist, 30 cases (4.49%) in a total of 10090 Iranian pregnant women entered the list ( Table I).
The results of the systematic review and meta-           can be ascribed to several factors (6,40,55).

Discussion
Also, in an assessment conducted by Fazeli and colleagues (36), the prevalence of GBS colonization was reported to be more in rural pregnant women, and a significant relationship was reported. More contact with animals, livestock, and its products can be of effective factors in this regard (34).
According to the meta-regression graph, GBS

Limitations
The heterogeneity rate (I2) was calculated as 95.71% in this research, which is in high level (I2 index less than 25% low, 25 to 75% average, and International Journal of Reproductive BioMedicine GBS colonization in Iranian pregnant women more than 75% higher heterogeneity (62)

Conclusion
According to the studied documents, the prevalence of GBS colonization in Iranian pregnant women in the west of Iran is much higher than other regions, and also no research has been done in some provinces in the west. It is therefore suggested that coherent and fresh studies be