Publications by authors named "Masoumeh Simbar"

117 Publications

The prevalence of depression symptoms among infertile women: a systematic review and meta-analysis.

Fertil Res Pract 2021 Mar 4;7(1). Epub 2021 Mar 4.

Proteomics Research Center and Department of Biostatistics, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Infertile women's mental health problems, including depression, are key fertility health issues that affect infertile women more severely than infertile men. Depression may threaten the health of individuals and reduce the quality of their lives. Considering the role and impact of depression on responses to infertility treatments, a systematic review and meta-analysis were conducted to investigate the prevalence of depression symptoms among infertile women.

Methods: International databases (PubMed, Cochrane Library, Web of Sciences, Scopus, Embase, and PsycINFO), national databases (SID and Magiran), and Google Scholar were searched by two independent reviewers for articles published from 2000 to April 5, 2020. The search procedure was performed in both Persian and English using keywords such as "depression," "disorders," "infertility," "prevalence," and "epidemiology." The articles were evaluated in terms of their titles, abstracts, and full texts. The reviewers evaluated the quality of the articles using the Newcastle-Ottawa Scale, after which they analyzed the findings using STATA version 14. The I and Egger's tests were performed to examine heterogeneity and publication bias, respectively.

Results: Thirty-two articles were subjected to the meta-analysis, and a random effects model was used in the examination given the heterogeneity of the articles. The samples in the reviewed studies encompassed a total of 9679 infertile women. The lowest and highest pooled prevalence rates were 21.01% (95% confidence interval [CI]: 15.61-34.42), as determined using the Hospital Anxiety and Depression Scale, and 52.21% (95% CI: 43.51-60.91), as ascertained using the Beck Depression Inventory, respectively. The pooled prevalence values of depression among infertile women were 44.32% (95% CI: 35.65-52.99) in low- and middle-income countries and 28.03% (95% CI: 19.61-36.44) in high-income countries.

Conclusion: The prevalence of depression among infertile women was higher than that among the general population of a given country. Especially in low- and middle-income countries, appropriate measures, planning, and policy that target the negative effects of depression on infertile women's lives should be established to reduce related problems.
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http://dx.doi.org/10.1186/s40738-021-00098-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931512PMC
March 2021

Needs for a gender-based perimarital couples' counselling services in Iran.

Nurs Open 2021 03 20;8(2):850-857. Epub 2020 Nov 20.

Department of Biostatistics, Faculty of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aim: To assess needs for a gender-sensitive perimarital counselling services in Iran.

Design: A descriptive cross-sectional study.

Methods: This was a study on all 236 premarital counselling providers in 37 health centres in Shiraz-Iran. The tools for data collection included the following: (a) a demographic information questionnaire and; (b) a valid and reliable Needs Assessment questionnaire for Gender-Sensitive Perimarital Counseling Services (GSPCS) in 3 sections of needs for process, structure and policy making of the perimarital counselling services. Data were analysed using SPSS 21.

Results: All health providers with average working experience of 8.63 (SD 5.35) years participated in the study. Results demonstrated highest scores for needs related to facilities as the structure of the services (90.09 SD 13.70 per cent) and community empowerment (89.50 SD 16.67 per cent) as the necessary policy for the gender-sensitive services. We concluded that providing gender-sensitive perimarital counselling healthcare services needs to reform the process, structure and policies of the services.
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http://dx.doi.org/10.1002/nop2.692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877227PMC
March 2021

The Viewpoint of Iranian Gynecologists and Midwives on the Expectations of Pregnant Women: A Content Analysis Study.

Iran J Nurs Midwifery Res 2020 Sep-Oct;25(5):419-425. Epub 2020 Sep 1.

Assistant Professor, Department of Basic sciences, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Prenatal care providers play an important role during pregnancy. Because healthcare providers provide comprehensive support to pregnant women, they must pay attention to pregnant women's expectations and efforts to meet their expectations. Understanding of pregnant women's expectations is associated with continuation of care and improving the health of the community. The present study is carried out to investigate the viewpoints of Iranian gynecologists and midwives on the expectations of pregnant women.

Materials And Methods: This qualitative study was carried out on 10 prenatal care providers in Shiraz in 2018. Sampling method was purposive. Sampling continued until data saturation. Structured, face to face and in-depth interviews were used for data collection. Implementation and coding of interviews were performed simultaneously with data collection. The data were analyzed using conventional content analysis approach. The Lincoln and Guba criteria were used to increase the trustworthiness of the data.

Results: Two main categories were emerged after analyzing of the data. The main category of "competent prenatal care providers" consisted of three subcategories: professional skills, communication skills, and individual characteristics. Another main category was the "appropriate pregnancy and childbirth centers" that included two subcategories of personnel-facilities and management system.

Conclusions: According to the results, prenatal care providers have been aware that women during pregnancy period expect to have competent providers. Also, they tend that receive pregnancy care and delivery from appropriate pregnancy and childbirth centers.
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http://dx.doi.org/10.4103/ijnmr.IJNMR_182_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737829PMC
September 2020

Quality of life among infertile women living in a paradox of concerns and dealing strategies: A qualitative study.

Nurs Open 2021 01 13;8(1):251-261. Epub 2020 Sep 13.

Proteomics Research Center and Department of Biostatistics Faculty of Allied Medical Sciences Shahid Beheshti University of Medical Sciences Tehran Iran.

Aim: The current work investigated the issues that cause apprehension in infertile women, the effects of this disquiet on their quality of life and the strategies that they adopt in dealing with their concerns.

Design: The qualitative research.

Method: This qualitative research sampled participants from a training centre in Mazandaran University of Medical Sciences and a privately owned infertility centre in Mazandaran Province, north of Iran. Purposive sampling continued until data saturation was reached. We conducted a conventional content analysis of the responses of 30 individuals (15 women with female infertility and 15 key informants) to in-depth and semi-structured in-person interviews on May to November 2019 .

Results: The results uncovered two themes subsuming four categories of issues: The first theme revolves around "infertility concerns," under which "concerns" and "the difficulty and vagueness of treatment" belonged. The second theme was "dealing with infertility," which covered "adaptive strategies" and "inhibitors of reconciliation with perceived infertility."
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http://dx.doi.org/10.1002/nop2.624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729776PMC
January 2021

Exploring Infertile Couples' Decisions to Disclose Donor Conception to The Future Child.

Int J Fertil Steril 2020 Oct 12;14(3):240-246. Epub 2020 Oct 12.

Nursing and Midwifery Care Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Despite significant advances in reproductive technology, using donor assisted reproductive technology is a double-edged sword that has numerous challenges. One of the most challenging issues for couples is whether or not to disclose this information to donor offspring. This study, therefore, explored infertile couples' decision to disclose donor conception to their future child.

Materials And Methods: This qualitative study was conducted using content analysis approach in 2012 in the Milad Infertility Centre, Mashhad, Iran. Data were collected through semi-structured interviews with 32 infertile persons including nine couples and 14 women who were selected by purposive sampling. Data were analysed by conventional qualitative content analysis adopted by Graneheim and Lundman using MAXQDA 2010 software.

Results: Two categories were emerged: 'not to disclose information to the child' and 'to disclose information to the child'. The first category consisted of three subcategories: 1. child support from probable harms; 2.to maintain healthy family relationships; and 3. lack of a compelling reason to disclose this information. The second category embraced four subcategories: 1. awareness of the others; 2. emergence of new living conditions; 3. appreciation for the donor; and 4. honesty among family members. The main reason for not disclosing information was to protect the child from probable harm.

Conclusion: Although protecting children from possible harms was a major reason for infertile couples' secrecy, keeping this secret would not be always easy. Therefore, increasing public awareness about the donation process in order to change the beliefs of community and eliminate the infertile couples' concerns would help them to overcome this problem. Additionally, long-term psychological counselling during and after the donation process is highly recommended.
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http://dx.doi.org/10.22074/ijfs.2020.44408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604704PMC
October 2020

The optimal cut-off point of vitamin D for pregnancy outcomes using a generalized additive model.

Clin Nutr 2021 Apr 2;40(4):2145-2153. Epub 2020 Oct 2.

Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Background & Aim: Several studies consider vitamin D deficiency as a modifiable risk factor for adverse pregnancy outcomes. However, there is no specific cut-off point for the serum level of this prohormone to identify high-risk pregnant women. This study aimed to determine the thresholds for the circulating levels of 25-hydroxyvitamin D (25(OH)D), associated with adverse pregnancy outcomes, including preterm labor, preeclampsia (PE), and gestational diabetes mellitus (GDM), using a generalized additive model.

Methods: This is a descriptive and analytical cross-sectional study carried out on the data collected from the Khuzestan Vitamin D Deficiency Screening Program in Pregnancy. Of 1800 pregnant women, referred to the health centers of Masjed-Soleyman and Shushtar (Khuzestan Province, Iran), we used the data of 1763 pregnant women, whose serum vitamin D status during the third trimester of pregnancy was available. The datasets were randomly divided into training (70%) and validation (30%) subsets. The cut-off levels of 25(OH)D were identified for the low, moderate, and high risk of adverse pregnancy outcomes, according to generalized additive models (GAM) with smooth functions in the training data set. Then Generalized Linear Model (GLM), with logit link function was applied in the validation dataset to explore the relationships between the optimal vitamin D classification and adverse pregnancy outcomes after adjusting for the potential confounders.

Results: The optimal cut-off levels of 25(OH)D for the high, moderate, and low risk of GDM were ≤16, 16-26, and >26 ng/mL, respectively. Also, the optimal cut-off points of 25(OH)D for the high, moderate, and low risk of preterm delivery were ≤15, 15-21, and >21 ng/mL, respectively. Finally, the corresponding values for the high, moderate, and low risk of PE were ≤15, 15-23, and >23 ng/mL, respectively. The models were well-calibrated, based on the Hosmer-Lemeshow test. Results of the adjusted generalized linear model showed a significant increasing trend in the risk of pregnancy outcomes by decreasing 25(OH)D levels.

Conclusion: In the preconception period, a 25(OH)D cut-off level of >15 ng/mL is recommended for the prevention of adverse pregnancy outcomes.
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http://dx.doi.org/10.1016/j.clnu.2020.09.039DOI Listing
April 2021

Effects of training based on the health belief model on Iranian women's performance about cervical screening: A systematic review and meta-analysis.

J Educ Health Promot 2020 28;9:179. Epub 2020 Jul 28.

Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Context: Pap smear test is one of the most important actions in preventing cervical cancer. This study aimed to perform a meta-analysis on all related literature about the effects of health belief model (HBM)-based training on Pap smear screening test performance of Iranian women.

Methods: The search was performed in Scopus, PubMed, and Web of Science. Eligibility criteria were limited to English and Persian language articles with experimental or semi-experimental methods until October 2019 that evaluated the effect of HBM-based training on Iranian women's performance of Pap smear test. We excluded studies that used both cervical and breast cancer screening together.

Results: Twelve studies were performed on totally 1605 participants. This meta-analysis showed that all of Health Belief Model (HBM) constructs improved significantly among HBM-based trained women, perceived susceptibility (standard mean division [SMD] =0.785; = 0.002; confidence interval [CI] = 0.005 to 1.56; Heterogeneity; = 0.013; = 97%)., perceived severity (SMD = 1.14; = 0.001; CI = 0.66-1.62; heterogeneity; < 0.001; = 92%), perceived benefits (SMD = 1.25; = 0.001; CI = 0.545-0.135 heterogeneity; = 0.003; = 97%), perceived barrier (SMD = 0.20; = 0.001; CI = 0.44-1.24; heterogeneity; < 0.001; = 92%) and perceived self-efficacy (SMD = 0.638; < 0.001; CI =1.76-0.426; heterogeneity; < 0.001; = 97%).

Conclusion: Cervical screening education program based on the HBM can be effective on Iranian women's performance in their perceived susceptibility, perceived severity, perceived barrier, and perceived self-efficacy about Pap smear test.
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http://dx.doi.org/10.4103/jehp.jehp_684_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482640PMC
July 2020

Development and psychometric evaluation of a quality of life questionnaire for infertile women: a mixed method study.

Reprod Health 2020 Sep 10;17(1):140. Epub 2020 Sep 10.

Proteomics Research Center and Department of Biostatistics, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Infertility is one of the most important issues that negatively influences women's quality of life, especially when the cause is associated with females. Given that no instruments have been designed to assess quality of life among infertile women with focus on female factors, this study was conducted to develop and evaluate the psychometric properties of a female-centric quality of life questionnaire for infertile women.

Method: This sequential exploratory study was conducted in two stages. First, the concept of quality of life and its dimensions as they relate to infertile women were elucidated through a qualitative inquiry accompanied with a content analysis. Accordingly, infertile women and key informants from a teaching hospital affiliated with the Mazandaran University of Medical Sciences and a private center for infertility treatment in Sari (north of Iran) were screened through purposive sampling until data saturation. Those who satisfied the inclusion criteria and exhibited maximum variance in terms of age, educational level, employment status, infertility duration, treatment type, and social class were recruited. The conventional content analysis was carried out in accordance with the steps proposed by Graneheim and Lundman, and the accuracy and robustness of the data were verified using Lincoln and Guba's criteria (credibility, transferability, dependability, confirmability and authenticity). Second, the psychometric properties of the instrument developed in the qualitative stage were evaluated using a quantitative method and on the basis of the results of a literature review. The content, face, and construct validity of the instrument was determined, and its test-retest reliability and stability were ascertained using internal correlation and Cronbach's alpha. The collected data were entered into the Statistical Package for the Social Sciences (version 22) for analysis, and descriptive statistics were calculated.

Discussion: Developing and evaluating the psychometric properties of a valid and reliable female factor-centric instrument that measures quality of life among infertile women will be very useful in the assessment of their future status.
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http://dx.doi.org/10.1186/s12978-020-00988-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488261PMC
September 2020

A Review of Pharmacological Treatments for Vaginal Atrophy in Postmenopausal Women in Iran.

J Menopausal Med 2020 Aug;26(2):104-111

Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Vaginal atrophy is one of the most common menopausal complications and is often overlooked. There are various pharmacological and non-pharmacological treatment approaches to reduce vaginal atrophy; however, no comprehensive study on a convenient, affordable, inexpensive, and noninvasive treatment with fewer complications has been conducted so far. Thus, the current study aimed to provide a systematic review of pharmacological treatment for vaginal atrophy in postmenopausal women in Iran. In this systematic review, all Iranian articles published in Persian or English during 2009 to 2019 were collected and analyzed by searching the Scopus, PubMed, Web of Science, Magiran, Iranian Registry of Clinical Trials (IRCT), and Cochrane Library databases. The inclusion criteria were clinical trials for vaginal atrophy and menopause. Based on the selection criteria, articles with a Jadad scale score of 3 and above were included in the study and qualitatively analyzed. Overall, 15 clinical trials met the inclusion criteria. In total, 12 articles examined the efficacy of pharmacological treatments (including three herbal medicines, three vitamins and dietary supplements, and two chemical drugs) in treating vaginal atrophy in postmenopausal women. Various types of medication have been used to improve vaginal atrophy, and effective treatments include licorice, chamomile, royal jelly, vitamin E, vitamin D, hyaluronic acid, and Vagifem; however, the results of studies on fennel have been inconsistent. However, considering the small number of studies reviewed, further studies with a stronger methodology are needed to confirm the efficacy of these medications.
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http://dx.doi.org/10.6118/jmm.19021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475289PMC
August 2020

Spouse's participation in perinatal care: a qualitative study.

BMC Pregnancy Childbirth 2020 Aug 26;20(1):489. Epub 2020 Aug 26.

Department of Biostatistic, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Pregnancy is one of the most important periods of any woman's life, wherein the support of her relatives, especially her spouse, enables her to tolerate the difficulties with good memories. However, in Iran, there are very few studies on the participation of spouses in the perinatal period. Therefore, the present study aimed to explain the concept of spouse participation in perinatal care.

Methods: This is a qualitative study that was carried out in 2018 on spouse participation in perinatal care in Qom, Iran. Purposive sampling from pregnant or postpartum women, spouses, midwifery care providers, and key informants was performed according to study inclusion criteria. Semi-structured in-depth interviews were carried out until the data saturation was met. Also, the data analysis was performed based on a conventional content analysis approach according to Graneheim & Lundman steps using MAXQDA software (v.10). Five Guba and Lincoln criteria were applied to ensure the trustworthiness of data.

Results: Fifty-three final codes were classified into 18 sub-categories, 7 categories, and 3 themes including empathy (emotional and cognitive understanding), accountability (supporting, position management, compassion), and consequences (help improvement of family function, improvement of maternal-neonatal health).

Conclusions: Based on the findings of this study, the concept of men's participation in this period has been defined as a set of empathic and responsive behaviors that can lead to improvement of the family function and mother and baby health.
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http://dx.doi.org/10.1186/s12884-020-03111-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448314PMC
August 2020

Sexual Compatibility with Spouse Questionnaire: Development and Psychometric Property Evaluation.

Int J Community Based Nurs Midwifery 2020 Jul;8(3):220-233

Physiotherapy Research Center,Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Sexual compatibility between husband and wife is an effective factor in both sexual and marital satisfaction. However, there is limited valid and reliable questionnaire to measure the degree of sexual compatibility between the couples.

Methods: In this exploratory mixed method study, 54 individuals were interviewed in the qualitative phase and 448 persons participated in the quantitative phase. Totally 502 participants (261 woman, 241 men) took part in this study. According to 205 final codes derived from the qualitative phase, 102 initial items were developed, the number of which reached 69 items after deletion and merging performed by the research team. After face validity, content validity and construct validity, 68 items were introduced into the construct validity phase.

Results: Following exploratory factor analysis and promax rotation, the items were reduced to 35 in 4 factors: "Requirements of a sexual relationship", "Sexual agreement", "Contextual obstacles" and "Outcomes of sexual compatibility". The questionnaire Cronbach alpha and correlation coefficient of the test-retest method were 0.90 and 0.91, respectively.

Conclusion: Final Questionnaire included 35 items in 4 point-Likert scale with total score of between 35-140. This valid and reliable questionnaire is brief, easily interpreted and can measure the main factors affecting sexual compatibility with the spouse in clinics and research fields.
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http://dx.doi.org/10.30476/ijcbnm.2020.82160.1039.DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334741PMC
July 2020

Design and psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services: a sequential exploratory study.

BMC Public Health 2020 Jul 6;20(1):1063. Epub 2020 Jul 6.

Department of Biostatistics, Faculty of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Providing gender sensitive reproductive health service is recently emphasized by health organizations. This study aims to develop and assess psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services (GS-PNCS) to be used by managers of perinatal services.

Methods: This study is a mixed sequential (Qualitative-Quantitative) exploratory study. In the qualitative phase, 34 participants were interviewed and the items were generated. To evaluate the validity; face, content and construct validity were assessed. The reliability was assessed by internal consistency and stability calculation.

Results: The content validity and reliability were demonstrated by S-CVR = 0.92 and S-CVI = 0.98, Cronbach's α = 0.880 and the ICC = 0.980 to 0.947. Exploratory factor analysis showed 8 factors which explained more than 52.53% of the variance.

Conclusion: GS-PNCS is a valid and reliable questionnaire, with 49 items to assess gender sensitivity of perinatal care services and helps health care managers and planners to improve the quality of the services.
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http://dx.doi.org/10.1186/s12889-020-08913-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336432PMC
July 2020

Explaining challenges of obstetric triage structure: A qualitative study.

Nurs Open 2020 07 18;7(4):1074-1080. Epub 2020 Mar 18.

Midwifery and Reproductive Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran.

Aim: The purpose of this study was to explain the challenges of the obstetric triage structure.

Design: The present qualitative research was conducted with directed content analysis approach on 21 members of the triage team and the key informant using purposeful sampling in 2018.

Methods: The method of data collection was semi-structured interviews. Then, the accuracy and rigour of the qualitative data were examined.

Results: In this study, the most important challenges in the structure of obstetric triage were identified as pattern and standard, equipment, physical space, human resource and triage procedure and process. Correction and revision in the obstetric triage structure is important to provide high-quality services. Therefore, the quality of the structure can be developed and maintained accounting for the corresponding challenges.
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http://dx.doi.org/10.1002/nop2.478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308674PMC
July 2020

The necessity of education about reproductive health of female adolescents to mothers in Iran: a qualitative study.

Int J Adolesc Med Health 2020 Jun 7. Epub 2020 Jun 7.

Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives Parents are challenged to provide the required information about reproductive issues for their adolescents. The study aims to explain women's perception of the necessity of education about adolescent girls, reproductive health to mothers. Methods This research is a qualitative content analysis. Sampling was performed using purposeful sampling to saturation of data. The study sample included 26 mothers and 14 key informants. To collect data, semi-structured interviewing was used. Data trustworthiness was verified based on Lincoln and Guba's criteria and the data was analyzed using conventional content analysis with MAXQDA10 software. Results Four themes and 13 main categories each with some subcategories were extracted in this research. The themes and categories included: "risky social-environmental factors (existence of inappropriate educational resources, a challenge between tradition and modernity in the society, social harms, and educational barriers)", weakness in awareness, attitude, and family relationships (mother's limited awareness, mother's negative attitude, improper interaction between the parents and the adolescent in the family, and lack of discussion about sexual and reproductive matters in the family), problems associated with sexual and reproductive health of adolescent girls (puberty changes, insufficient perception, and understanding of the process of puberty and harms arising from early education), and high-risk behaviors of adolescents and their consequences (the adolescent's maladaptive behaviors and their outcomes). Conclusion The results of this research necessitate education of adolescent girls' reproductive health to mothers.
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http://dx.doi.org/10.1515/ijamh-2018-0197DOI Listing
June 2020

Correction to: Is body image a predictor of women's depression and anxiety in postmenopausal women?

BMC Psychiatry 2020 Jun 4;20(1):278. Epub 2020 Jun 4.

Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s12888-020-02685-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271525PMC
June 2020

Iranian mothers' needs for reproductive health education of their adolescent daughters: a qualitative study.

Int J Adolesc Med Health 2020 Jun 1. Epub 2020 Jun 1.

Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction In order to be effective in discussing high-risk sexual behaviors with adolescents, mothers need to be educated about their adolescent daughters' sexual issues. As no detailed and exact knowledge on mothers' educational needs concerning adolescent girls' reproductive health is available, the current study was intended to investigate mothers' educational needs concerning their adolescent daughters' reproductive health. Materials and methods This research was a qualitative content analysis. Purposive sampling was performed to the saturation point. The samples included 26 mothers and 14 key informants. Semi-structured interviews were used for data collection. Data authenticity was verified based on Lincoln and Guba's criteria and data analysis was conducted using conventional content analysis with MAXQDA10 software. Findings In this study, three themes and 13 main categories, each with a number of subcategories were extracted. The themes and main categories included: "appropriate educational content (reproductive health, sexual health, general health, psychological health, family health, social health and spiritual health)", "characteristics of the educator (communicative skill, cognitive skill and moral competence)", and "effective factors in learning (teaching method, learning conditions and environment, and the learner's readiness)". Conclusions The results demonstrated that mothers need to be informed about sexual, reproductive, general, psychological, family, social and spiritual health in adolescent girls. Consequently, the results can help the healthcare authorities to implement need-based programs and boost the effectiveness of education about adolescent girls' reproductive health for mothers.
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http://dx.doi.org/10.1515/ijamh-2018-0144DOI Listing
June 2020

The Association Between Air Pollution and Low Birth Weight and Preterm Labor in Ahvaz, Iran.

Int J Womens Health 2020 4;12:313-325. Epub 2020 May 4.

Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Science, Tehran, Iran.

Purpose: Pregnant women and fetuses are sensitive to air pollution due to physiological changes in pregnancy. The aim of this study was to determine the relationship between exposure to air pollution, low birth weight and preterm labor in Ahvaz.

Methods: This research was a time-series study. The research sample consisted of all data about low birth weight and preterm labor pregnant women from Imam Khomeini Hospital and Razi Hospital in Ahvaz city. Air pollutant data including O, NO, NO, SO, CO, PM and PM and climate data were collected from the Environmental Protection Agency and the Khuzestan Province during a 10-year period from 2008 to 2018. The generalized additive models (GAMs) with different air pollutant lags up to 6 days were used.

Results: The results of multiple GAM model have shown that there is a direct and significant relationship between exposure to PM at 0-6-day lag, SO at 2- and 3-day lag and low birth weight. In addition, there was a direct and significant correlation between exposure to NO, NO, CO and PM at 0-6-day lag and preterm labor.

Conclusion: The results indicate the effect of air pollutants on low birth weight and preterm labor. Therefore, pregnant women should be informed about the negative consequences of air pollution and avoid exposure to polluted air during pregnancy.
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http://dx.doi.org/10.2147/IJWH.S227049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211085PMC
May 2020

Factors associated with quality of life of postmenopausal women living in Iran.

BMC Womens Health 2020 05 14;20(1):104. Epub 2020 May 14.

Department of Biostatistics, School of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Quality of life (QoL) after menopause could be influenced by a host of personal and social factors. This study aimed to determine the factors associated with quality of life among postmenopausal women.

Methods: This cross-sectional study was conducted among 405 postmenopausal women selected using a multi-stage randomized sampling. The data-collection tools were the WHO Quality of Life-BREF (WHOQOL-BREF), the Menopause Rating Scale (MRS), and a researcher-designed questionnaire. The relationship between QoL and its potentially correlated factors was examined using t-test, ANOVA, Pearson's correlation, Spearman's correlation coefficient, and multiple linear regression.

Results: A negative correlation was found between the scores of QoL (total and all subscales) and the MRS total scores. The total scores of QoL were negatively correlated with duration of menopause (r = - 0.127, P = 0.010), gravida (r = - 0.177, P < 0.001), parity (r = - 0.165, P = 0.001), frequency of stillbirth (r = - 0.104, P = 0.037), vaginal delivery (r = - 0.161, P = 0.001), and waist-to-hip ratio (r = - 0.195, P < 0.001). The QoL total scores were positively correlated with the educational level of the participants (r = 0.207, P < 0.001) and that of their spouses (r = 0.160, P = 0.001) along with their level of monthly family income (r = 0.218, P < 0.001). Multiple-linear-regression analysis showed that the total score of QoL decreased with inadequate income, waist-to-hip ratio, and the total score of MRS.

Conclusions: Personal and social factors along with the severity of menopausal symptoms affect QoL post-menopause. These factors need to have a bearing on any effort to improve QoL among postmenopausal women.
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http://dx.doi.org/10.1186/s12905-020-00960-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227259PMC
May 2020

Is body image a predictor of women's depression and anxiety in postmenopausal women?

BMC Psychiatry 2020 05 6;20(1):202. Epub 2020 May 6.

Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Women in perimenopausal and postmenopausal period are at increased risk of depression and anxiety. Physiologic changes in menopause can change body's appearance and function that may disturb body and then lead to anxiety and depression. This study aims to assess the relationship between body image with anxiety and depression among postmenopausal women.

Methods: This descriptive study was performed on 307 women attending to the health centers in Tehran- Iran. Sampling was performed by a multi-staged randomized method. Data were collected by using Beck Depression questionnaire, Spielberger Anxiety Questionnaire, Fisher Body Image Questionnaire and Socio-demographic questionnaires. Data were analyzed by SPSS 21 and using t-test, Pearson and Spearman correlation tests and multiple linear regression methods.

Results: The average age of the participants was 55.19 ± 4.034 years. Mean scores for body image, anxiety and depression were 163.26 ± 20.38, 12.00 ± 7.71 and 42.70 ± 8.40 respectively. Fifty five percent of women had mild to severe depression and 83.7% of them had mild to severe anxiety. Total score and all domains of body image had a negative correlation with depression and anxiety scores (P < 0.001). Multiple linear correlation showed that body image is a predictor for depression and anxiety (P < 0.001).

Conclusions: Body image of women can be effective on occurrence of depression and anxiety in menopause. Therefore, women's health policies should consider body image to control cognitive problems including depression and anxiety in menopause.
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http://dx.doi.org/10.1186/s12888-020-02617-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201601PMC
May 2020

The prevalence of anxiety symptoms in infertile women: a systematic review and meta-analysis.

Fertil Res Pract 2020 15;6. Epub 2020 Apr 15.

1Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Infertile women are exposed more frequently to anxiety risk than are infertile men, thereby adversely affecting the procedures with which they are treated and the quality of their lives. Yet, this problem is often disregarded. This study accordingly determined the prevalence of anxiety symptoms among infertile women.

Methods: All Persian and English studies published from the early 2000s to May 2019 were searched in international (i.e., PubMed, the Cochrane Library, Web of Science, Scopus, Embase, and PsycINFO) and national (i.e., SID, Magiran) databases as well as through Google Scholar. After the titles and abstracts of the articles were reviewed, their quality was evaluated, and relevant works for examination were selected in consideration of established inclusion and exclusion criteria. The risk of biases of individual studies according to Newcastle - Ottawa Scale was assessed. The heterogeneity of the studies was assessed using the I statistic, and indicators of publication bias were ascertained using Egger's test. Stata (version 14) was employed in analyzing the findings.

Results: Thirteen studies having a collective sample size of 5055 infertile women were subjected to meta-analysis, with study heterogeneity incorporated into a random effects model. The findings indicated that 36% of the infertile women involved in the evaluated studies self-reported their experience with anxiety. The pooled prevalence of the condition among the subjects was 36.17% [95% confidence interval (CI): 22.47-49.87]. The pooled prevalence levels in low- and middle-income countries and high-income countries were 54.24% (95% CI: 31.86-78.62) and 25.05% (95% CI: 15.76-34.34), respectively. The results revealed no evidence of publication bias (P  = 0.406).

Conclusion: Considering the prevalence of anxiety in infertile women and its effects on health processes and quality of life, this problem requires serious consideration and planning for effective intervention, especially in low- and middle-income nations.
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http://dx.doi.org/10.1186/s40738-020-00076-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7157980PMC
April 2020

Coronavirus Pandemic and Worries during Pregnancy; a Letter to Editor.

Arch Acad Emerg Med 2020 16;8(1):e21. Epub 2020 Mar 16.

Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075675PMC
March 2020

Structural equation modeling of psychosocial determinants of health for the empowerment of Iranian women in reproductive decision making.

BMC Womens Health 2020 02 3;20(1):19. Epub 2020 Feb 3.

Proteomics Research Center and Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Women's empowerment is a process wherein females are afforded power over their own lives as well as their participation in the communities and larger societies to which they belong. An important aspect of such empowerment is the right to make decisions regarding fertility-an entitlement affected by the social health determinants that contribute to the social conditions under which humans live and work throughout their lives. As one such determinant, psychosocial factors play an essential role in the development of women's empowerment. Correspondingly, this study conducted a structural equation modeling of these determinants to examine the empowerment of Iranian women in reproductive decision making.

Methods: This cross-sectional study involved 400 women who were referred to clinical centers of the Shahid Beheshti University of Medical Sciences in Tehran, Iran. Data were collected using six questionnaires, namely, demographic, socioeconomic, and social support questionnaires, the Rosenberg self-esteem scale, a marital satisfaction questionnaire, and an empowerment survey. The data were analyzed using SPSS software version 17, and the structural equation modeling was carried out using EQS software version 6.1.

Results: The Iranian women had an average level of empowerment with respect to reproductive decision making, and such empowerment was related to all the psychosocial factors examined (p = 0.001). The final model appropriately fit the data (comparative fit index = 0.92, root mean square error of approximation = 0.06). The psychosocial factors served as intermediate social determinants of the women's empowerment in reproductive decision making (β = 0.78, p = 0.001). This empowerment was indirectly affected by socioeconomic situation as a structural factor (β = 0.44, p = 0.001).

Conclusions: Socioeconomic factors, through the mechanism of psychosocial determinants, may significantly affect women's empowerment in making decisions regarding reproductive health. Conditions associated with these factors should be improved to ensure that women claim and exercise their right to have mastery over their reproductive health.
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http://dx.doi.org/10.1186/s12905-020-0893-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6998239PMC
February 2020

Needs assessment for gender sensitive reproductive health services for adolescents.

Int J Adolesc Med Health 2020 Jan 23;32(5). Epub 2020 Jan 23.

Department of Biostatistics, Faculty of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background A dimension of reproductive health services that should be gender sensitive is reproductive health services for adolescents. Objective This study aims to assess needs for gender sensitive reproductive health care services for adolescents. Methods This was a descriptive cross-sectional study on 341 of health care providers for adolescents in health centers and hospitals affiliated to Shiraz University of Medical Sciences in Iran in 2016. The subjects of the study were recruited using a convenience sampling method. The tools for data collection were: (1) a demographic information questionnaire and; (2) a valid and reliable questionnaire to Assess the Needs of Gender-Sensitive Adolescents Reproductive Health Care Services (ANQ-GSARHS) including three sections; process, structure and policy making for the services. Data were analyzed using SPSS 21. Results Three hundred and forty-one health providers with an average working experience of 8.77 ± 5.39 [mean ± standard deviation (SD)] years participated in the study. The results demonstrated the highest scores for educational needs (92.96% ± 11.49%), supportive policies (92.71% ± 11.70%) and then care needs (92.37% ± 14.34%) of the services. Conclusions Providing gender sensitive reproductive health care services for adolescents needs to be reformed as regards processes, structure and policies of the services. However, the gender appropriate educational and care needs as well as supportive policies are the priorities for reform of the services.
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http://dx.doi.org/10.1515/ijamh-2017-0201DOI Listing
January 2020

The Quality of the Maternity Triage Process: a Qualitative Study.

Adv J Emerg Med 2020 3;4(1):e6. Epub 2019 Oct 3.

Department of Biostatics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: There is no consensus on what the bases and criteria are for the dynamic process of maternity triage. Properly performing the maternity triage process requires reliable data to ensure the correct implementation of this process and the identification of existing deficiencies, and find strategies to modify, improve and enhance the quality of this process.

Objective: The present study was conducted to explain the quality of the maternity triage process.

Methods: The present qualitative study performed a directed content analysis on 19 maternity triage service providers and key informants selected through purposive sampling. The data were collected through semi-structured interviews in 2018 and analyzed using directed content analysis based on the Donabedian's model. The accuracy and rigor of the qualitative data were then investigated and confirmed.

Results: The participants identified the most important factors affecting the quality of the services provided in maternity triage as two categories of measures and care, and interactions and communication. The category of measures and care included two subcategories of examinations and obtaining a medical history.

Conclusion: The present study comprehensively identified different dimensions of the quality of maternity triage services at different levels. The participants identified the quality of the maternity triage process as a multi-dimensional and important concept. Different dimensions of the maternity triage process are recommended that be addressed when designing and implementing maternity triage guidelines and instructions so as to maintain the quality of this process and satisfy their needs.
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http://dx.doi.org/10.22114/ajem.v0i0.242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955035PMC
October 2019

Prevalence, dimensions, and predictor factors of sexual dysfunction in women of Iran Multiple Sclerosis Society: a cross-sectional study.

Neurol Sci 2020 May 2;41(5):1105-1113. Epub 2020 Jan 2.

Department of Biostatics, School of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Sexual dysfunction (SD) is a stressful and common symptom in women with multiple sclerosis (MS) and affects different aspects of their life, seriously. The purpose of this study was to determine the prevalence, dimensions, and predictor factors of SD in Iranian women with MS.

Methods: This cross-sectional study was conducted in Iran MS Society. Participants were 260 married women who had definite MS. Data were collected using self-report questionnaires, including Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19); Fatigue Severity Scale (FSS); Depression, Anxiety, and Stress Scale-21 (DASS-21); Questionnaire for Urinary Incontinence Diagnosis (QUID); ENRICH Marital Satisfaction Scale (EMS); Sexual Self-Efficacy Questionnaire; and socio-demographic and disease information questionnaire. Pearson correlation coefficients, independent sample t-test, one-way analysis of variance (ANOVA), and multiple linear regression model were used for data analysis.

Results: Majority (76.2%) of the participants had SD, and according to the dimensions of SD in MS, primary SD was found in 176 (67.7%), secondary SD in 158 (60.7%), and tertiary SD in 126 (48.5%) of the participants. The most important and common problem was delayed orgasm (60%). According to the results of multiple linear regression model, the predictor factors of SD were sexual self-efficacy (B = -0.721, P < 0.001), disability status (B = 2.714, P < 0.001), urge incontinence (B = 0.367, P = 0.029), depression (B = 0.446, P = 0.007), anxiety (B = 0.332, P = 0.037), fatigue (B = 0.177, P = 0.002), duration of disease (B = -0.463, P = 0.014), and duration of DMT use (B = 0.662, P = 0.002).

Conclusion: According to the results of this cross-sectional study, SD was a very common and complex problem in women of Iran MS Society, and a number of physical, neurological, and psychological factors, such as sexual self-efficacy, disability status, urge incontinence, depression, anxiety, fatigue, duration of DMT use, and duration of disease, play a role in SD of these patients. So, in the treatment procedure of SD in MS women, adopting a multidisciplinary approach, as well as considering all contributory factors and their impact on sexual function, is recommended.
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http://dx.doi.org/10.1007/s10072-019-04222-6DOI Listing
May 2020

Social health needs of Iranian male adolescents.

Int J Adolesc Med Health 2019 Nov 21;33(1). Epub 2019 Nov 21.

Department of Midwifery, Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran.

Background: Adequate attention to adolescents' health is considered an investment for the future of any country. Adolescents face many social and cultural challenges when they enter a new stage of social life. The advancement of adolescent social health depends on the recognition of their needs. This study aimed to explain the concept of social health needs from the perspectives of male adolescents to improve the health of both adolescents and the society.

Method: In this qualitative study with a content analysis approach, 52 male adolescents aged 13-18 years participated in 10 semi-structured individual interviews and seven focus group discussions. They expressed their experiences and opinions regarding social health needs. Purposive sampling was performed to recruit the adolescents in different areas of Tehran in 2017. Collected data was analyzed using the conventional content analysis method.

Results: The findings were divided into four main themes and eight sub-themes including "need to have a healthy family (healthy family relationships and family responsibility)", "need to have a healthy society (favorable social status and favorable economic situation)", "need to have educational facilities (promoting productivity in schools and public education facilities)", "need to have communication with peers (healthy communication with peers and setting up for communication with peers of the opposite gender)".

Conclusion: To promote social health in adolescents, it is necessary to plan for the empowerment of community, family, schools and mass media by health authorities and devise appropriate health policies.
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http://dx.doi.org/10.1515/ijamh-2018-0055DOI Listing
November 2019

A questionnaire to assess women's perception of respectful maternity care (WP-RMC): Development and psychometric properties.

Midwifery 2020 Jan 5;80:102573. Epub 2019 Nov 5.

Independent scholar, Rotterdam, the Netherlands.

Objective: To develop and assess the psychometric properties of Women's Perspection-Respectful Maternity Care (WP-RMC) Questionnaire.

Design: An exploratory sequential mixed method study was carried out from March to August 2018 in Tehran, Iran. The questionaire items were generated from the literature review and qualitatatve study. The revised items of questionnaire were assessed for validity via testing for face, content and construct validity and relibility.

Setting: Public and semi-public hospitals, and public primary health care centers.

Participants: Postpartum women who had a low risk pregnancy, normal vaginal childbirth and gave birth to a healthy baby with normal birth weight.

Findings: The WP-RMC has 19 items that loaded in three factors: Providing comfort, Participatory care and Mistreatment. Exploratory factor analysis jointly accounted for 53.05% of observed variance. The CVI was 0.97 and the CVR in all items was more than 0.79. Cronbach's alpha for all items was 0.91 and ICC was 0.9.

Key Conclusions: 'The WP-RMCquestionnaire is a valid and reliable tool to measure women's experiences of Respectful Maternity Care. This questionnaire could assess subjective features of quality of childbirth care. It can be used in maternity services trying to evaluate and improve women's care experiences during labour and childbirth. The use of the translation of WP-RMC questionnaire in other countries is recommended.
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http://dx.doi.org/10.1016/j.midw.2019.102573DOI Listing
January 2020

Adolescent's psychological health in Iran.

Int J Adolesc Med Health 2019 Oct 30. Epub 2019 Oct 30.

Sexual and Reproductive Health Research Center, Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.

Aim Adolescence is characterized by dynamic brain development in which the interaction with the social environment shapes the capabilities an individual takes forward into adult life. Improvement of adolescent psychological health depends on the recognition of their needs during this critical transition period. This study aimed to explain the concept of psychological health needs from the perspectives of male adolescents to improve the health of both adolescents and society. Method In this qualitative study with a content analysis approach, 52 male adolescents aged 13-18 years participated in 10 semi-structured individual interviews and seven focus group discussions. They expressed their experiences and opinions regarding psychological health needs. Purposive sampling was performed to recruit the adolescents in different areas of Tehran in 2017. Collected data was analyzed using the conventional content analysis method. Results The findings were divided into two main themes and five sub-themes including 'self-esteem (self-cognition and Suitable relationship between teen and family)', 'Well-being and calmness (Intellectual affinity, Rich leisure time, Religious beliefs)'. Conclusion To promote emotional health in adolescents, it is necessary to plan for the empowerment of community, family, schools by health authorities and devise appropriate health policies.
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http://dx.doi.org/10.1515/ijamh-2018-0221DOI Listing
October 2019

The Social Construction of Infertility Among Iranian Infertile Women: A Qualitative Study.

J Reprod Infertil 2019 Jul-Sep;20(3):178-190

Department of Reproductive Health and Midwifery, Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran.

Background: Infertility is considered an important phenomenon in couples' life. Infertility and its treatment process influence all aspects of the individual's life. This study aimed to explain the psycho-social process of social construction of infertility among Iranian infertile women.

Methods: This was a qualitative study using a grounded theory approach. The study setting was the Vali-e-Asr Fertility Health Research Center and Avicenna Fertility clinic in Tehran. The sampling started purposefully and it was continued theoretically. The data collection was performed by using 36 semi-structured interviews, observation and field notes with 27 women who suffered from primary and secondary infertility having no living child. The method suggested by Strauss and Corbin was used for data analysis.

Results: Results indicate that "Concerns over life instability" and "being judged by others" were the participants' most important preoccupation. Attempts to stabilize life and get rid of being judged by others were key aspects of the social construction of infertility and the main strategies for resolving their preoccupation. This core concept explained the basic psychological-social process of infertility in relation to axial codes.

Conclusion: The results of the study show that various interactive factors affect the social construction of infertility among infertile women who focus on the central concept of attempts to stabilize life and get rid of being judged by others. Therefore, in order to achieve this goal, infertile women should be empowered by effective coping strategies.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6670265PMC
August 2019

The effectiveness of low trans-fatty acids dietary pattern in pregnancy and the risk of gestational diabetes mellitus.

Caspian J Intern Med 2019 ;10(2):197-204

Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.

Background: Gestational diabetes mellitus (GDM) is a common disorder in pregnancy. The association of trans fatty acids (TFA) intake and risk of GDM have been reported; It remains unclear whether dietary TFA can influence GDM risk. We examined the effect of low TFA dietary intakes during pregnancy on risk of GDM.

Methods: This randomized controlled trial was performed on 800 pregnant women who were randomly divided into 393 intervention and 407 comparison groups with gestational age ≥7 weeks. In the intervention group, the diet of pregnant women was designed in such a way that their daily intake of TFA content was less than1% but in control group, the daily intake of TFA content was not changed. The dietary intake was assessed using a 24-hour dietary recall questionnaire for three non-consecutive days at the beginning of the pregnancy before week 7, and at 13, 25 and 35 weeks. Diagnosis of GDM was performed using a 3-hour glucose tolerance test with 100 g glucose at 24-28 weeks of gestation.

Results: 14 women in the intervention group (5%) and 31 women in the control group (8%) were diagnosed with GDM. Chi-square test did not show any significant difference between two groups (P=0.08). Cox model was used and the variables were examined in four multivariate models that none of the modals showed a statistically significant difference between the two groups regarding the incidence of GDM.

Conclusion: It seems that the diet with low trans-fatty acid content has no effect on the incidence of GDM.
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http://dx.doi.org/10.22088/cjim.10.2.197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619474PMC
January 2019