Publications by authors named "Shayesteh Jahanfar"

71 Publications

The relationship between sexual function and mental health in Iranian pregnant women during the COVID-19 pandemic.

BMC Pregnancy Childbirth 2021 Apr 26;21(1):327. Epub 2021 Apr 26.

Social Determinants of Health Research Center, Department of Midwifery, Tabriz University of Medical Sciences, P.O. Box: 51745-347, Shariati Street, Tabriz, 513897977, Iran.

Background: Sexual function, a significant contributor to quality of life, is affected by various factors, including overall mental health. COVID-19 is a current pandemic that influences the mental health of various populations, especially pregnant women. Despite the importance of sexual health, the specific nature of its relationship to overall mental health during the COVID-19 pandemic is not clearly defined. Thus, this study investigates the relationship between sexual function and mental health during the COVID-19 pandemic in Iranian pregnant women.

Methods: This descriptive-analytical, cross-sectional study was carried out among 437 pregnant women using the sociodemographic and obstetrics characteristics questionnaire, Female Sexual Function Inventory, Stress, Depression, and Anxiety Scales. Random sampling was employed to select pregnant women who had a medical record in Health Centers of Tabriz city, Iran. The questionnaires were sent to the participants' cell phones via WhatsApp or text messages, including links of questionnaires and the participants completed these questionnaires. Spearman correlation test was used to determine the relationship between sexual function and stress, anxiety, and depression. Generalized linear modeling was used to estimate each of the independent variables (sociodemographic characteristics, stress, anxiety, and depression) on the dependent variable (sexual function).

Results: The mean (Standard Deviation) sexual functioning (total) score was 20.0 (8.50) from the available range of 2 to 36. The mean (SD) of depression, stress, and anxiety scale was 4.81 (5.22), 5.13 (4.37), and 7.86 (4.50) (possible score ranging from 0 to 21), respectively. Based on Spearman's correlation test, there was a significant reverse correlation between the total sexual function score and stress, anxiety, and depression, indicating that all three variables negatively impacted sexual functioning. Variables such as mild stress, spouse type of job, sufficient household income, living with parents, higher marital satisfaction, and higher gestational age had a significant, positive impact on sexual function and could predict 35.8% of the variance model.

Conclusions: Sexual functioning was significantly impacted by stress, anxiety, and depression - all of which are heightened during a pandemic. This topic warrants further study, and the general public should be educated on the protective influence of safe sex/intimacy on overall mental health.
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http://dx.doi.org/10.1186/s12884-021-03812-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072090PMC
April 2021

The influence of mode of delivery, anthropometric indices, and infant's sex on the maternal and cord blood orexin-A levels: A cohort study.

J Obstet Gynaecol Res 2021 Apr 18. Epub 2021 Apr 18.

Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.

Background: Orexin as an adipokin hormone plays an important role in appetite regulation, energy metabolism, obesity, diabetes, and cardiovascular disease. The main source of orexin secretion in nonpregnant and pregnant women is adipose tissue and placenta, respectively. This research was conducted to evaluate the association between orexin-A level and the mode of delivery, anthropometric indices, and sex of the infant.

Methods: This prospective cohort study was conducted on 69 normal pregnant women. The samples of umbilical cord blood were obtained at the time of delivery, and maternal blood was taken within 24 h of delivery. Serum orexin-A levels were measured by using enzyme-linked immunosorbent assay. Statistical analyses were performed using SPSS and p < 0.05 was considered as significant.

Results: We found a significant difference between postpartum maternal and umbilical cord orexin-A level both with the mode of delivery (p < 0.001). Also, a significant positive correlation was seen between maternal and umbilical cord serum orexin-A levels (r = -0.61, p < 0.001). There was no relationship between serum orexin-A levels with anthropometric indices and the sex of the neonate (p > 0.05).

Conclusion: Both maternal and umbilical cord serum orexin-A levels were associated with the mode of delivery. Maternal and cord blood orexin-A levels in normal vaginal delivery are higher than cesarean section.
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http://dx.doi.org/10.1111/jog.14758DOI Listing
April 2021

Pharmacological and non-pharmacological strategies for obese women with subfertility.

Cochrane Database Syst Rev 2021 Mar 25;3:CD012650. Epub 2021 Mar 25.

Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.

Background: Clinicians primarily recommend weight loss for obese women seeking pregnancy. The effectiveness of interventions aimed at weight loss in obese women with subfertility is unclear.

Objectives: To assess the effectiveness and safety of pharmacological and non-pharmacological strategies compared with each other, placebo, or no treatment for achieving weight loss in obese women with subfertility.

Search Methods: We searched the CGF Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and AMED from inception to 18 August 2020. We also checked reference lists and contacted experts in the field for additional relevant papers.

Selection Criteria: We included published and unpublished randomised controlled trials in which weight loss was the main goal of the intervention. Our primary effectiveness outcomes were live birth or ongoing pregnancy and primary safety outcomes were miscarriage and adverse events. Secondary outcomes included clinical pregnancy, weight change, quality of life, and mental health outcome.

Data Collection And Analysis: Review authors followed standard Cochrane methodology.

Main Results: This review includes 10 trials. Evidence was of very low to low quality: the main limitations were due to lack of studies and poor reporting of study methods. The main reasons for downgrading evidence were lack of details by which to judge risk of bias (randomisation and allocation concealment), lack of blinding, and imprecision. Non-pharmacological intervention versus no intervention or placebo Evidence is insufficient to determine whether a diet or lifestyle intervention compared to no intervention affects live birth (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.65 to 1.11; 918 women, 3 studies; I² = 78%; low-quality evidence). This suggests that if the chance of live birth following no intervention is assumed to be 43%, the chance following diet or lifestyle changes would be 33% to 46%. We are uncertain if lifestyle change compared with no intervention affects miscarriage rate (OR 1.54, 95% CI 0.99 to 2.39; 917 women, 3 studies; I² = 0%; very low-quality evidence). Evidence is insufficient to determine whether lifestyle change compared with no intervention affects clinical pregnancy (OR 1.06, 95% CI 0.81 to 1.40; 917 women, 3 studies; I² = 73%; low-quality evidence). Lifestyle intervention resulted in a decrease in body mass index (BMI), but data were not pooled due to heterogeneity in effect (mean difference (MD) -3.70, 95% CI -4.10 to -3.30; 305 women, 1 study; low-quality evidence; and MD -1.80, 95% CI -2.67 to -0.93; 43 women, 1 study; very low-quality evidence). Non-pharmacological versus non-pharmacological intervention We are uncertain whether intensive weight loss interventions compared to standard care nutrition counselling affects live birth (OR 11.00, 95% CI 0.43 to 284; 11 women, 1 study; very low-quality evidence), clinical pregnancy (OR 11.00, 95% CI 0.43 to 284; 11 women, 1 study; very low-quality evidence), BMI (MD -3.00, 95% CI -5.37 to -0.63; 11 women, 1 study; very low-quality evidence), weight change (MD -9.00, 95% CI -15.50 to -2.50; 11 women, 1 study; very low-quality evidence), quality of life (MD 0.06, 95% CI -0.03 to 0.15; 11 women, 1 study; very low-quality evidence), or mental health (MD -7.00, 95% CI -13.92 to -0.08; 11 women, 1 study; very low-quality evidence). No study reported on adverse events . Pharmacological versus pharmacological intervention For metformin plus liraglutide compared to metformin we are uncertain of an effect on the adverse events nausea (OR 7.22, 95% CI 0.72 to 72.7; 28 women, 1 study; very low-quality evidence), diarrhoea (OR 0.31, 95% CI 0.01 to 8.3; 28 women, 1 study; very low-quality evidence), and headache (OR 5.80, 95% CI 0.25 to 133; 28 women, 1 study; very low-quality evidence). We are uncertain if a combination of metformin plus liraglutide vs metformin affects BMI (MD 2.1, 95% CI -0.42 to 2.62; 28 women, 1 study; very low-quality evidence) and total body fat (MD -0.50, 95% CI -4.65 to 3.65; 28 women, 1 study; very low-quality evidence). For metformin, clomiphene, and L-carnitine versus metformin, clomiphene, and placebo, we are uncertain of an effect on miscarriage (OR 3.58, 95% CI 0.73 to 17.55; 274 women, 1 study; very low-quality evidence), clinical pregnancy (OR 5.56, 95% CI 2.57 to 12.02; 274 women, 1 study; very low-quality evidence) or BMI (MD -0.3, 95% CI 1.17 to 0.57, 274 women, 1 study, very low-quality evidence). We are uncertain if dexfenfluramine versus placebo affects weight loss in kilograms (MD -0.10, 95% CI -2.77 to 2.57; 21 women, 1 study; very low-quality evidence). No study reported on live birth, quality of life, or mental health outcomes. Pharmacological intervention versus no intervention or placebo We are uncertain if metformin compared with placebo affects live birth (OR 1.57, 95% CI 0.44 to 5.57; 65 women, 1 study; very low-quality evidence). This suggests that if the chance of live birth following placebo is assumed to be 15%, the chance following metformin would be 7% to 50%. We are uncertain if metformin compared with placebo affects gastrointestinal adverse events (OR 0.91, 95% CI 0.32 to 2.57; 65 women, 1 study; very low-quality evidence) or miscarriage (OR 0.50, 95% CI 0.04 to 5.80; 65 women, 1 study; very low-quality evidence) or clinical pregnancy (OR 2.67, 95% CI 0.90 to 7.93; 96 women, 2 studies; I² = 48%; very low-quality evidence). We are also uncertain if diet combined with metformin versus diet and placebo affects BMI (MD -0.30, 95% CI -2.16 to 1.56; 143 women, 1 study; very low-quality evidence) or waist-to-hip ratio (WHR) (MD 2.00, 95% CI -2.21 to 6.21; 143 women, 1 study; very low-quality evidence). Pharmacological versus non-pharmacological intervention No study undertook this comparison.

Authors' Conclusions: Evidence is insufficient to support the use of pharmacological and non-pharmacological strategies for obese women with subfertility. No data are available for the comparison of pharmacological versus non-pharmacological strategies. We are uncertain whether pharmacological or non-pharmacological strategies effect live birth, ongoing pregnancy, adverse events, clinical pregnancy, quality of life, or mental heath outcomes. However, for obese women with subfertility, a lifestyle intervention may reduce BMI. Future studies should compare a combination of pharmacological and lifestyle interventions for obese women with subfertility.
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http://dx.doi.org/10.1002/14651858.CD012650.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094444PMC
March 2021

Association between maternal race and the use of assisted reproductive technology in the USA.

SN Compr Clin Med 2021 Mar 18:1-9. Epub 2021 Mar 18.

MPH Program, Central Michigan University, Health Sciences Building, 2242, Mount Pleasant, MI 48859 USA.

Despite advances in the field of infertility medicine and its availability, disparities affect the accessibility status worldwide. Racial disparities could potentially affect the utilization of assisted reproductive technology (ART). We aimed at studying the association between maternal race and the use of ART treatment in the USA. We analyzed a secondary dataset (2017 Natality) obtained from the Centers for Disease Control and Prevention. This cross-sectional study acquired information on maternal race as well as ART utilization from women living within the reporting States and US territories. We analyzed the data using descriptive, bivariate, and regression analysis. A total of 3,864,754 live births out of 325,719,178 US races and origin populations were reported for the 2017 review year. A total of 42,846 women who had a live birth reported utilization of ART out of 67,554 respondents. The Chi-square test showed a statistically significant association between maternal race and the use of ART treatment, value 0.01. Unadjusted regression odds of the utilization of ART at 95 % confidence interval (CI) was 87% higher among non-Hispanic Asian women as compared to the non-Hispanic White. We also found higher odds for maternal age 35-54 years 2.41 (95% CI 2.34-2.49), maternal education (above college degree) 1.36 (95% CI 1.31-1.42), and non-smoking status 2.44 (95% CI 2.02-2.94). Compared to the non-Hispanic white race, the adjusted regression odds were lower for all other racial/ethnic minorities except for the non-Hispanic Asian 63% (95% CI 1.09-2.44) and non-Hispanic mixed race 59% (95% CI 0.81-3.10) subgroups. The study finds the utilization of ART in the USA to be associated with maternal race.
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http://dx.doi.org/10.1007/s42399-021-00853-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972807PMC
March 2021

Umbilical vein injection for management of retained placenta.

Cochrane Database Syst Rev 2021 03 11;3:CD001337. Epub 2021 Mar 11.

Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK.

Background: Retained placenta is a common complication of pregnancy affecting 1% to 6% of all births. If a retained placenta is left untreated, spontaneous delivery of the placenta may occur, but there is a high risk of bleeding and infection. Manual removal of the placenta (MROP) in an operating theatre under anaesthetic is the usual treatment, but is invasive and may have complications. An effective non-surgical alternative for retained placenta would potentially reduce the physical and psychological trauma of the procedure, and costs. It could also be lifesaving by providing a therapy for settings without easy access to modern operating theatres or anaesthetics. Injection of uterotonics into the uterus via the umbilical vein and placenta is an attractive low-cost option for this. This is an update of a review last published in 2011.

Objectives: To assess the use of umbilical vein injection (UVI) of saline solution with or without uterotonics compared to either expectant management or with an alternative solution or other uterotonic agent for retained placenta.

Search Methods: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (14 June 2020), and reference lists of retrieved studies.

Selection Criteria: Randomised controlled trials (RCTs) comparing UVI of saline or other fluids (with or without uterotonics), either with expectant management or with an alternative solution or other uterotonic agent, in the management of retained placenta. We considered quasi-randomised, cluster-randomised, and trials reported only in abstract form.

Data Collection And Analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach. We calculated pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs), and presented results using 'Summary of findings' tables.

Main Results: We included 24 trials (n = 2348). All included trials were RCTs, one was quasi-randomised, and none were cluster-randomised. Risk of bias was variable across the included studies. We assessed certainty of evidence for four comparisons: saline versus expectant management, oxytocin versus expectant management, oxytocin versus saline, and oxytocin versus plasma expander. Evidence was moderate to very-low certainty and downgraded for risk of bias of included studies, imprecision, and inconsistency of effect estimates. Saline solution versus expectant management There is probably little or no difference in the incidence of MROP between saline and expectant management (RR 0.93, 95% CI 0.80 to 1.10; 5 studies, n = 445; moderate-certainty evidence). Evidence for the following remaining primary outcomes was very-low certainty: severe postpartum haemorrhage 1000 mL or greater, blood transfusion, and infection. There were no events reported for maternal mortality or postpartum anaemia (24 to 48 hours postnatal). No studies reported addition of therapeutic uterotonics. Oxytocin solution versus expectant management UVI of oxytocin solution might slightly reduce in the need for manual removal compared with expectant management (mean RR 0.73, 95% CI 0.56 to 0.95; 7 studies, n = 546; low-certainty evidence). There may be little to no difference between the incidence of blood transfusion between groups (RR 0.81, 95% CI 0.47 to 1.38; 4 studies, n = 339; low-certainty evidence). There were no maternal deaths reported (2 studies, n = 93). Evidence for severe postpartum haemorrhage of 1000 mL or greater, additional uterotonics, and infection was very-low certainty. There were no events for postpartum anaemia (24 to 48 hours postnatal). Oxytocin solution versus saline solution UVI of oxytocin solution may reduce the use of MROP compared with saline solution, but there was high heterogeneity (RR 0.82, 95% CI 0.69 to 0.97; 14 studies, n = 1370; I² = 54%; low-certainty evidence). There were no differences between subgroups according to risk of bias or oxytocin dose for the outcome MROP. There may be little to no difference between groups in severe postpartum haemorrhage of 1000 mL or greater, blood transfusion, use of additional therapeutic uterotonics, and antibiotic use. There were no events for postpartum anaemia (24 to 48 hours postnatal) (very low-certainty evidence) and there was only one event for maternal mortality (low-certainty evidence). Oxytocin solution versus plasma expander One small study reported UVI of oxytocin compared with plasma expander (n = 109). The evidence was very unclear about any effect on MROP or blood transfusion between the two groups (very low-certainty evidence). No other primary outcomes were reported. For other comparisons there were little to no differences for most outcomes examined. However, there was some evidence to suggest that there may be a reduction in MROP with prostaglandins in comparison to oxytocin (4 studies, n = 173) and ergometrine (1 study, n = 52), although further large-scale studies are needed to confirm these findings.

Authors' Conclusions: UVI of oxytocin solution is an inexpensive and simple intervention that can be performed when placental delivery is delayed. This review identified low-certainty evidence that oxytocin solution may slightly reduce the need for manual removal. However, there are little or no differences for other outcomes. Small studies examining injection of prostaglandin (such as dissolved misoprostol) into the umbilical vein show promise and deserve to be studied further.
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http://dx.doi.org/10.1002/14651858.CD001337.pub3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094279PMC
March 2021

Ultrasound for diagnosis of birth weight discordance in twin pregnancies.

Cochrane Database Syst Rev 2021 03 9;3:CD012553. Epub 2021 Mar 9.

Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.

Background: There is a need to standardize monitoring in obstetric research of twin pregnancies. Identification of birth weight discordance (BWD), defined as a difference in the birth weights of twins, is a well-documented phenomenon in twin pregnancies. Ultrasound for the diagnosis of BWD informs complex decision making including whether to intervene medically (via laser photo coagulation) or deliver the twins to avoid fetal morbidities or even death. The question is, how accurate is this measurement?

Objectives: To determine the diagnostic accuracy (sensitivity and specificity) of ultrasound estimated fetal weight discordance (EFWD) of 20% and 25% using different estimated biometric ultrasound measurements compared with the actual BWD as the reference standard in twin pregnancies.

Search Methods: The search for this review was performed on 15 March 2019. We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), seven other databases, conference proceedings, reference lists and contacted experts. There were no language or date restrictions applied to the electronic searches, and no methodological filters to maximize sensitivity.

Selection Criteria: We selected cohort-type studies with delayed verification that evaluated the accuracy of biometric measurements at ultrasound scanning of twin pregnancies that had been proposed for the diagnosis of estimated BWD, compared to BWD measurements after birth as a reference standard. In addition, we only selected studies that considered twin pregnancies and applied a reference standard for EFWD for the target condition of BWD.

Data Collection And Analysis: We screened all titles generated by electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility, and extracted data to create 2 × 2 tables. Two review authors independently performed quality assessment using the QUADAS-2 tool. We excluded studies that did not report data in sufficient detail to construct 2 × 2 tables, and where this information was not available from the primary investigators. We assessed the certainty of the evidence using the GRADE approach.

Main Results: We included 39 eligible studies with a median study sample size of 140. In terms of risk of bias, there were many unclear statements regarding patient selection, index test and use of proper reference standard. Twenty-one studies (53%) were of methodological concern due to flow and timing. In terms of applicability, most studies were of low concern. Ultrasound for diagnosis of BWD in twin pregnancies at 20% cut-off Twenty-two studies provided data for a BWD of 20% and the summary estimate of sensitivity was 0.51 (95% CI 0.42 to 0.60), and the summary estimate of specificity was 0.91 (95% CI 0.89 to 0.93) (8005 twin pregnancies; very low-certainty evidence). Ultrasound for diagnosis of BWD in twin pregnancies at 25% cut-off Eighteen studies provided data using a BWD discordance of 25%. The summary estimate of sensitivity was 0.46 (95% CI 0.26 to 0.66), and the summary estimate of specificity was 0.93 (95% CI 0.89 to 0.96) (6471 twin pregnancies; very low-certainty evidence). Subgroup analyses were possible for both BWD of 20% and 25%. The diagnostic accuracy did not differ substantially between estimation by abdominal circumference and femur length but femur length had a trend towards higher sensitivity and specificity. Subgroup analyses were not possible by sex of twins, chorionicity or gestational age due to insufficient data.

Authors' Conclusions: Very low-certainty evidence suggests that EFWD identified by ultrasound has low sensitivity but good specificity in detecting BWD in twin pregnancies. There is uncertain diagnostic value of EFWD; this review suggests there is insufficient evidence to support this index as the sole measure for clinical decision making to evaluate the prognosis of twins with growth discordance. The diagnostic accuracy of other measures including amniotic fluid index and umbilical artery Doppler resistive indices in combination with ultrasound for clinical intervention requires evaluation. Future well-designed studies could also evaluate the impact of chorionicity, sex and gestational age in the diagnostic accuracy of ultrasound for EFWD.
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http://dx.doi.org/10.1002/14651858.CD012553.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078490PMC
March 2021

The Relationship between the Metabolic Syndrome and the Risk of Obstructive Sleep Apnea Evaluated by STOP-Bang Questionnaire in Professional Drivers in Shahroud, Iran, in 2020: A Case-Control Study.

J Obes Metab Syndr 2021 Mar;30(1):55-62

School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran.

Background: The present study was conducted to investigate the relationship between metabolic syndrome and the risk of respiratory and sleep disorders in professional drivers.

Methods: This case-control study was conducted on professional drivers in Shahroud, Iran. The snoring, tiredness during daytime, observed apnea, high blood pressure, body mass index, age, neck circumference, gender (STOP-Bang) questionnaire was first used to assess obstructive sleep apnea (OSA). Then, based on the questionnaire scores, the participants were divided into two groups: those with and those without OSA. The relationship between this disorder and metabolic syndrome was then studied. Data were analyzed using descriptive and analytical tests (<0.05).

Results: Based on the STOP-Bang questionnaire, 214 drivers with a high risk of OSA and 214 drivers with low risk were recruited for the study. According to the Adult Treatment Panel III criteria, 204 drivers (47.7%) had metabolic syndrome. There was a significant relationship between driver's license class and the risk of OSA. Metabolic syndrome components including fasting blood sugar, triglycerides, and hypertension, but not high-density lipoprotein cholesterol, were able to predict OSA in the professional drivers.

Conclusion: Given the high prevalence of metabolic syndrome and OSA, especially in drivers of high risk who may spend long hours transporting good and operating passenger vehicles, screening and treating these disorders are crucial in this part of the population. The researchers recommend holding regular training sessions about these disorders for professional drivers.
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http://dx.doi.org/10.7570/jomes20105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017324PMC
March 2021

Serum vitamin E level and gestational diabetes mellitus: a systematic review and meta-analysis.

J Diabetes Metab Disord 2020 Dec 4;19(2):1787-1795. Epub 2020 Jul 4.

Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Science, Golestan Ave, Ahvaz, Iran.

Purpose: Gestational diabetes mellitus (GDM) is one of the most common medical complications in pregnancy. This systematic review aimed to evaluate the association between vitamin E and GDM.

Methods: Relevant articles from the Cochrane Library, PubMed, Scopus, Science Direct, Web of Science, and EMBASE databases up to December 2019 were searched. The inclusion criteria were observational full-text articles. The fixed and random effect models were used to analyze the pooled data using Review Manager 5.3.

Results: Thirteen studies, including 596 participants, of whom 285 were diagnosed with GDM were included in the meta-analysis. The vitamin E level was significantly lower in women with GDM (MD: - 0.10; 95% CI: [-0.15, - 0.05]). The level of vitamin E was not different between overweight women with GDM and healthy pregnant women (MD: 0.03; 95% CI: [-0.08, 0.013]). The level of vitamin E was significantly lower in the third trimester of pregnancy in GDM women in comparison to the healthy pregnant women(MD: -0.09; 95% CI: [-0.12, -0.06]).

Conclusion: This study showed that the level of vitamin E is significantly lower in GDM women compared to healthy pregnant women.
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http://dx.doi.org/10.1007/s40200-020-00582-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843911PMC
December 2020

Prevalence of and reasons for women's, family members', and health professionals' preferences for cesarean section in Iran: a mixed-methods systematic review.

Reprod Health 2021 Jan 2;18(1). Epub 2021 Jan 2.

Maternal Health Department, Ministry of Health, Tehran, Iran.

Background: Cesarean section (CS) rates have been increasing globally. Iran has one of the highest CS rates in the world (47.9%). This review was conducted to assess the prevalence of and reasons for women's, family members', and health professionals' preferences for CS in Iran.

Methods And Findings: In this mixed-methods systematic review, we searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, Google scholar; as well as Iranian scientific databases including SID, and Magiran from 1 January 1990 to 8th October 2019. Primary quantitative, qualitative, and mixed-methods studies that had been conducted in Iran with Persian or English languages were included. Meta-analysis of quantitative studies was conducted by extracting data from 65 cross-sectional, longitudinal, and baseline measurements of interventional studies. For meta-synthesis, we used 26 qualitative studies with designs such as ethnography, phenomenology, case studies, and grounded theory. The Review Manager Version 5.3 and the Comprehensive Meta-Analysis (CMA) software were used for meta-analysis and meta-regression analysis. Results showed that 5.46% of nulliparous women (95% CI 5.38-5.50%; χ = 1117.39; df = 28 [p < 0.00001]; I = 97%) preferred a CS mode of delivery. Results of subgroup analysis based on the time of pregnancy showed that proportions of preference for CS reported by women were 5.94% (95% CI 5.86-5.99%) in early and middle pregnancy, and 3.81% (95% CI 3.74-3.83%), in late pregnancy. The heterogeneity was high in this review. Most women were pregnant, regardless of their parity; the risk level of participants were unknown, and some Persian publications were appraised as low in quality. A combined inductive and deductive approach was used to synthesis the qualitative data, and CERQual was used to assess confidence in the findings. Meta-synthesis generated 10 emerging themes and three final themes: 'Women's factors', 'Health professional factors', andex 'Health organization, facility, or system factors'.

Conclusion: Despite low preference for CS among women, CS rates are still so high. This implies the role of factors beyond the individual will. We identified a multiple individual, health facility, and health system factors which affected the preference for CS in Iran. Numerous attempts were made in recent years to design, test and implement interventions to decrease unnecessary CS in Iran, such as mother-friendly hospitals, standard protocols for labor and birth, preparation classes for women, midwives, and gynaecologists, and workshops for specialists and midwives through the "health sector evolution policy". Although these programs were effective, high rates of CS persist and more efforts are needed to optimize the use of CS.
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http://dx.doi.org/10.1186/s12978-020-01047-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778821PMC
January 2021

Maintenance agonist treatments for opiate-dependent pregnant women.

Cochrane Database Syst Rev 2020 11 9;11:CD006318. Epub 2020 Nov 9.

Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.

Background: The prevalence of opiate use among pregnant women can range from 1% to 2% to as high as 21%. Just in the United States alone, among pregnant women with hospital delivery, a fourfold increase in opioid use is reported from 1999 to 2014 (Haight 2018). Heroin crosses the placenta, and pregnant, opiate-dependent women experience a six-fold increase in maternal obstetric complications such as low birth weight, toxaemia, third trimester bleeding, malpresentation, puerperal morbidity, fetal distress and meconium aspiration. Neonatal complications include narcotic withdrawal, postnatal growth deficiency, microcephaly, neuro-behavioural problems, increased neonatal mortality and a 74-fold increase in sudden infant death syndrome. This is an updated version of the original Cochrane Review first published in 2008 and last updated in 2013.

Objectives: To assess the effectiveness of any maintenance treatment alone or in combination with a psychosocial intervention compared to no intervention, other pharmacological intervention or psychosocial interventions alone for child health status, neonatal mortality, retaining pregnant women in treatment, and reducing the use of substances.

Search Methods: We updated our searches of the following databases to February 2020: the Cochrane Drugs and Alcohol Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science. We also searched two trials registers and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs).

Selection Criteria: Randomised controlled trials which assessed the efficacy of any pharmacological maintenance treatment for opiate-dependent pregnant women.

Data Collection And Analysis: We used the standard methodological procedures expected by Cochrane.

Main Results: We found four trials with 271 pregnant women. Three compared methadone with buprenorphine and one methadone with oral slow-release morphine. Three out of four studies had adequate allocation concealment and were double-blind. The major flaw in the included studies was attrition bias: three out of four had a high dropout rate (30% to 40%), and this was unbalanced between groups. Methadone versus buprenorphine: There was probably no evidence of a difference in the dropout rate from treatment (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.37 to 1.20, three studies, 223 participants, moderate-quality evidence). There may be no evidence of a difference in the use of primary substances between methadone and buprenorphine (RR 1.81, 95% CI 0.70 to 4.68, two studies, 151 participants, low-quality evidence). Birth weight may be higher in the buprenorphine group in the two trials that reported data MD;-530.00 g, 95%CI -662.78 to -397.22 (one study, 19 particpants) and MD: -215.00 g, 95%CI -238.93 to -191.07 (one study, 131 participants) although the results could not be pooled due to very high heterogeneity (very low-quality of evidence). The third study reported that there was no evidence of a difference. We found there may be no evidence of a difference in the APGAR score (MD: 0.00, 95% CI -0.03 to 0.03, two studies,163 participants, low-quality evidence). Many measures were used in the studies to assess neonatal abstinence syndrome. The number of newborns treated for neonatal abstinence syndrome, which is the most critical outcome, may not differ between groups (RR 1.19, 95% CI 0.87 to1.63, three studies, 166 participants, low-quality evidence). Only one study which compared methadone with buprenorphine reported side effects. We found there may be no evidence of a difference in the number of mothers with serious adverse events (AEs) (RR 1.69, 95% CI 0.75 to 3.83, 175 participants, low-quality evidence) and we found there may be no difference in the numbers of newborns with serious AEs (RR 4.77, 95% CI 0.59, 38.49,131 participants, low-quality evidence). Methadone versus slow-release morphine: There were no dropouts in either treatment group. Oral slow-release morphine may be superior to methadone for abstinence from heroin use during pregnancy (RR 2.40, 95% CI 1.00 to 5.77, one study, 48 participants, low-quality evidence). In the comparison between methadone and slow-release morphine, no side effects were reported for the mother. In contrast, one child in the methadone group had central apnoea, and one child in the morphine group had obstructive apnoea (low-quality evidence).

Authors' Conclusions: Methadone and buprenorphine may be similar in efficacy and safety for the treatment of opioid-dependent pregnant women and their babies. There is not enough evidence to make conclusions for the comparison between methadone and slow-release morphine. Overall, the body of evidence is too small to make firm conclusions about the equivalence of the treatments compared. There is still a need for randomised controlled trials of adequate sample size comparing different maintenance treatments.
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http://dx.doi.org/10.1002/14651858.CD006318.pub4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094273PMC
November 2020

Effect of dill (Anethum Graveolens Linn) seed on the duration of labor: A systematic review.

Complement Ther Clin Pract 2020 Nov 28;41:101251. Epub 2020 Oct 28.

Reproductive Epidemiologist, School of Health Sciences, MPH Program Health Professions Building 2212, Central Michigan University, USA. Electronic address:

Background: It is well documented that prolonged labor is associated with complications. This systematic review aimed to study the effect of Anethum Graveolens Linn (Dill) on the duration of labor.

Methods: We conducted a search on PubMed, Scopus, Cochrane central, Web of Science, and MEDLINE. All randomized controlled trials and observational studies evaluating the effect of Dill seeds on labor were recruited. The mean differences (MD) with 95% CI were calculated.

Results: Two RCTs showed that using Dill seeds could significantly reduce duration of the first stage (MD = -43.66, 95% CI [-52.99, - 34.33]), second stage (MD = -15.76, 95% CI [-20.06, -11.47]) and third stage of labor (MD = -1.79, 95% CI [-2.62, -0.95]). Two retrospective cohort studies showed a significant reduction in the first, and second stages of labor.

Conclusion: Using Dill seeds could reduce the duration of labor. Using this herb in low-risk pregnant women is recommended. Systematic review registration number: CRD42020145225.
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http://dx.doi.org/10.1016/j.ctcp.2020.101251DOI Listing
November 2020

Exploring the care received by HPV-positive married women at a colposcopy clinic in Tehran, Iran: A qualitative study.

J Family Med Prim Care 2020 Jul 30;9(7):3549-3554. Epub 2020 Jul 30.

Department of Public Health, The Herbert H. & Grace A. Dow College of Health Professions, Central Michigan University, Michigan, USA.

Objectives: Patient experience is the focus of individual care and services to meet patient needs, but this depends on how health care providers deliver their services. The aim of this study was to explore the perceptions of human papilloma virus (HPV)-positive married women from the care they received from health professionals at a colposcopy clinic in Tehran, Iran.

Materials And Methods: Three focus group discussions were conducted between September and December 2016 with 30 women who had recently been referred to the clinic for cervical screening or colposcopy. Samples were collected by a purposeful sampling method in Tehran, the capital of Iran. The focus group discussions were carefully recorded at the same time as data collection. After ensuring the data saturation, interviews were terminated and data were categorized. Data was analyzed by direct conventional content analysis using MAXQDA-10.

Results: Two themes and three sub-themes resulted from the data analysis, including emotional responses (anxiety and fear of women), and appropriate/inappropriate behavior of the healthcare providers.

Conclusion: Healthcare providers, by identifying factors that affect patient's stress, could help reduce the negative outcomes such as patients' emotional responses to HPV positive results.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1243_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567230PMC
July 2020

Predictors of mortality in patients with COVID-19-a systematic review.

Eur J Integr Med 2020 Dec 17;40:101226. Epub 2020 Oct 17.

School of Public Health, Central Michigan University, Mount Pleasant, MI, 48859, United States.

Introduction: In the current COVID-19 pandemic, disease diagnosis is essential for optimal management and timely isolation of infected cases in order to prevent further spread. The aim of this study was to systematically review the assessment of risk and model the predictors of mortality in COVID-19 patients.

Methods: A systematic search was conducted of PubMed, Scopus, Embase, Google Scholar, and Web of Science databases. Variables associated with hospital mortality using bivariate analysis were included as potential independent predictors associated with mortality at the  < 0.05 levels.

Results: We included 114 studies accounting for 310,494 patients from various parts of the world. For the purpose of this analysis, we set a cutoff point of 10% for the mortality percentages. High mortality rates were defined as higher than 10% of confirmed positive cases and were given a score of two, while low mortality (<10%) was assigned the score of one. We then analyzed the associations between 72 variables and the observed mortality rates. These variables included a large range of related variables such as demographics, signs and symptoms and related morbidities, vital signs, laboratory findings, imaging studies, underlying diseases, and the status of countries' income, based on the United Nation's classifications.

Conclusion: Findings suggest that older age, hypertension, and diabetes mellitus conferred a significant increased risk of mortality among patients with COVID-19. In the multivariate analysis, only diabetes mellitus demonstrated an independent relationship with increased mortality. Further studies are needed to ascertain the relationship between possible risk factors with COVID-19 mortality.
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http://dx.doi.org/10.1016/j.eujim.2020.101226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568488PMC
December 2020

Exploring the relationship between health concerns and high-risk behaviours in Medical Sciences' students.

Nurs Open 2020 11 20;7(6):2009-2018. Epub 2020 Aug 20.

Department of Reproductive Health and Midwifery Ph.D in Reproductive Health, Sexual and Reproductive Health Research Center Mazandaran University of Medical Sciences Sari Iran.

Aim: The need to cope with life concerns may drive an individual to resort to high-risk behaviours. This study aimed to determine the relationship between health concerns and high-risk behaviours.

Design: A cross-sectional study.

Methods: We sampled 926 Medical Sciences' students from the North of Iran from September-December 2017 using the stratified sampling method.

Results: The most and less common high-risk behaviour was physical inactivity (97.5%) and high-risk sexual behaviour (15.7%), respectively. In multivariate logistic regression analysis, participants' concerns about human sexuality (AOR: 1.39; CI: 1.22, 1.57), injury prevention and control (AOR: 1.12; CI: 1.01, 1.20), nutrition (AOR: 1.13; CI: 1.02, 1.26) and emotional health (AOR: 1.08; CI: 1.02, 1.15) increased the odds of risky behaviours. Among Medical Sciences' students, health concerns are linked with risky behaviours. The result of this study can be used to develop relevant interventions targeting mental health to reduce risky behaviour among youth.
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http://dx.doi.org/10.1002/nop2.596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544888PMC
November 2020

Evaluation of the effect of vitamin D3 supplementation on quantitative and qualitative parameters of spermograms and hormones in infertile men: A Randomized controlled trial.

Complement Ther Med 2020 Sep 8;53:102529. Epub 2020 Aug 8.

Halal Research Center of IRI, FDA, Tehran, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran; Polish Mother's Memorial Hospital Research Institute (PMMHRI), 93338 Lodz, Poland. Electronic address:

Background: 25-Hydroxy Vitamin D3 is known to have an effect on reproductive system in both genders and may change the semen parameters in men.

Objective: Our study aimed to evaluate the effect of oral vitamin D3 supplementation on spermogram quantitative and qualitative parameters in infertile men.

Materials And Methods: This study was a triple-blind randomized controlled trial involving 62 infertile men with impaired spermatogonial tests. They were randomly divided into placebo and D3-supplemented groups. Spermograms and tests for LH (Luteinizing Hormone), FSH (Follicle Stimulating Hormone), TT (Total Testosterone), FT (Free Testosterone), SHBG (Sex Hormone Bonding Globulin), FAI (Free Androgen Index) and vitamin D3 levels were performed before and after the intervention.

Results: There were no significant differences between the two groups in parameters of the spermograms or serum levels of LH, FSH, TT, and FAI. In the intervention group, SHBG was significantly decreased after intervention (p = 0.01) and there was a significant increase in FT in the placebo group (p = 0.03).

Conclusion: The intake of vitamin D3 did not change the quality and quantity of spermograms and serum levels of LH, FSH, TT, and FAI but affected FT and SHBG. Further studies are still needed to clarify the biological role of vitamin D3 on fertility particularly on male fertility. This study lays a foundation for more extensive studies on male infertility.
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http://dx.doi.org/10.1016/j.ctim.2020.102529DOI Listing
September 2020

The effect of Lavender on pain and healing of episiotomy: A systematic review.

Complement Ther Med 2020 Sep 28;53:102510. Epub 2020 Jul 28.

Librarian of Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran.

Introduction: Some studies have investigated the effect of Lavender on pain and the healing of wounds. The aim of this systematic review was to investigate the effect of Lavender on pain and wound healing of episiotomy.

Methods: The Cochrane Library, MEDLINE (PubMed), Scopus, and Web of Science (all databases from inception until February 2020) were searched. Data were extracted from eligible studies by two review authors individually. Our inclusion criteria were full-text interventional studies published in English or any other languages. All data were analyzed using Review Manager 5.3. The protocol of this systematic review was registered in PROSPERO with the reference number CRD42020140623.

Results: Our search found six trials involving 415 participants. The use of Lavender could significantly reduce pain in women with episiotomy (95 % CI: -1.06 - -0.32). The use of Lavender has significantly improved the healing of episiotomy compared to the placebo (95 % CI: -2.13 - -1.34). In all studies, pain and healing of episiotomy were evaluated with Visual Analog Scale (VAS) and Redness, Edema, Ecchymosis, Discharge, Approximation (REEDA) scale respectively.

Conclusion: This review showed that the use of Lavender (in any form) in postpartum has a significant effect on pain relief and healing of episiotomy wound. All six studies that were included in this systematic review were from developing countries. A high level of heterogeneity was observed in the effect of Lavender on pain but not the healing of the episiotomy. Therefore, the results should be considered with caution. Using Lavender may be considered for wound healing of episiotomy.
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http://dx.doi.org/10.1016/j.ctim.2020.102510DOI Listing
September 2020

The Epigenetic Overlap between Obesity and Mood Disorders: A Systematic Review.

Int J Mol Sci 2020 Sep 15;21(18). Epub 2020 Sep 15.

MPH Program, School of Public Health, Central Michigan University, Mount Pleasant, MI 48859, USA.

(1) Background: Obesity and mood disorders are considered as the most prevalent morbidities in many countries. We suppose that epigenetic mechanisms may induce higher rates of obesity in subjects who suffer from mood disorders. In this systematic review, we focused on the potential roles of DNA methylation on mood disorders and obesity development. (2) Methods: This systematic review was conducted in accordance with the PRISMA statement and registered in Prospero. A systematic search was conducted in MEDLINE, Scopus, Web of Science, Cochrane Central database, EMBASE, and CINHAL. We also conducted a Grey literature search, such as Google Scholar. (3) Results: After deduplication, we identified 198 potentially related citations. Finally, ten unique studies met our inclusion criteria. We have found three overlap genes that show significant DNA methylation changes, both in obesity and depression. Pathway analysis interaction for , and confirmed the relation of these genes in both obesity and mood disorders. (4) Conclusions: While mechanisms linking both obesity and mood disorders to epigenetic response are still unknown, we have already known chronic inflammation induces a novel epigenetic program. As the results of gene enrichment, pathways analysis showed that and linked together by inflammatory pathways. Hypermethylation in these genes might play a crucial rule in the co-occurrence of obesity and mood disorders.
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http://dx.doi.org/10.3390/ijms21186758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7555814PMC
September 2020

Evaluation of the birth plan implementation: a parallel convergent mixed study.

Reprod Health 2020 Sep 7;17(1):138. Epub 2020 Sep 7.

Social determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Pregnancy, birth, and motherhood are among the most important events of every woman's life. Training and participation of mothers in the decision-making process of delivery play an essential role in physical as well as psychosocial preparation of the mother. The healthcare system can improve and enhance the level of care by involving the patient in their self-care process. The aim of the present study is to assess the implementation of the birth plan for the first time in Iran in Tabriz city.

Methods/design: The present study uses a mixed-method with a parallel convergence approach, including both quantitative and qualitative phases. The quantitative phase is a randomized controlled clinical trial performed on 106 pregnant women, 32-36 weeks of pregnancy, referring to Taleghani educational hospital in Tabriz city. The participants will be assigned into intervention and control groups using a randomized block method. A training session will be held about the items of the birth plan checklist at weeks 32-36 of gestation for the participants in the intervention group, whereby a mother-requested birth plan will be developed. It will then be implemented by the researcher after admitting them to the delivery ward. Also, those in the control group will receive routine care. During and after the delivery, the questionnaire of delivery information, neonatal information, and Delivery Fear Scale (DFS) will be completed. Also, a partogram will be completed for all participants by the researcher. The participants in both groups will be followed up until six weeks post-delivery, whereby the instruments of Childbirth Experience Questionnaire (CEQ2.0), Edinburgh's Postpartum Depression Scale and PTSD Symptom Scale 1 (PSS-I) will be completed six weeks 4-6 weeks postpartum by the researcher through an interview with participants in Taleghani educational hospital. The general linear model and multivariate logistic regression model will be used while controlling the possible confounding variables. The qualitative phase will be performed to explore the women's perception of the effect of the birth plan on childbirth experience within 4-6 weeks postpartum. The sampling will be of a purposeful type on the women who would receive the birth plan and will continue until data saturation. In-depth, semi-structured individual interviews would be used for data collection. The data analysis will be done through content analysis with a conventional approach. The results of the quantitative and qualitative phases will be analyzed separately, and then combined in the interpretation stage.

Discussion: By investigating the effect of implementing the birth plan on the childbirth experience of women as well as other maternal and neonatal outcomes, an evidence-based insight can be offered using a culturally sensitive approach. The presentation of the results obtained from this study using the mixed method may be effective in improving the quality of care provided for women during labor.

Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N58. Date of registration: July 7, 2020. URL: https://en.irct.ir/user/trial/47007/view.
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http://dx.doi.org/10.1186/s12978-020-00989-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487561PMC
September 2020

Vaginal Fluid Urea and Creatinine as Indicators of Premature Rupture of Membranes: a Systematic Review.

Reprod Sci 2021 01 27;28(1):1-11. Epub 2020 Jul 27.

Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

The purpose of the present study was to determine the diagnostic accuracy of vaginal urea and creatinine levels in the detection of premature rupture of membrane (PROM). The Cochrane (central), EMBASE, PubMed, Scopus, and Web of Science were searched for studies published from the inception of the databases up to January 2020. We included published observational full-text articles. The mean differences (MD) and 95% confidence intervals (95% CI) were calculated. The significance level was set as 0.05. Eleven studies (n = 1324) were considered for meta-analysis. Using the bivariate model, the summary estimate of sensitivity and specificity for urea was 0.96 (95% CI: 0.86, 0.98) and 0.93 (95% CI: 0.83, 0.97), respectively. The summary estimate of sensitivity and specificity for creatinine was 0.98 (95% CI: 0.92, 0.99) and 0.97 (95% CI: 0.89, 0.99), respectively. The overall mean of urea and creatinine in the case group was significantly higher than that in the control group (MD = 12.63, 95%, CI [12.01, 13.25]) and (MD = 0.31, 95%, CI [0.29, 0.32]), respectively. The results of this systematic review showed that the mean of urea and creatinine in the case group was significantly higher than that in the control group and the sensitivity and specificity of creatinine is higher than urea in the diagnosis of PROM.
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http://dx.doi.org/10.1007/s43032-020-00271-xDOI Listing
January 2021

Temporary changes in clinical guidelines of gestational diabetes screening and management during COVID-19 outbreak: A narrative review.

Diabetes Metab Syndr 2020 Sep - Oct;14(5):939-942. Epub 2020 Jun 18.

Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background And Aims: New clinical approaches are needed to minimize complications of gestational diabetes during the COVID-19 outbreak with timely screening and proper management. The present study aims to highlight changes in the clinical guideline for gestational diabetes during the pandemic.

Methods: In a narrative review, multiple databases were searched. Furthermore, online searches were conducted to identify guidelines or support documents provided by NGOs, local health authorities, and societies and organizations in the field of diabetes and obstetrics.

Results: We included five national guidelines that were published in English from Canada, the United Kingdom, Australia, New Zealand, and Australia health agencies. FBG, A1C, RPG were recommended as alternative tests instead of a 2-h oral glucose tolerance test (OGGT) for GDM screening at 24-28 weeks of gestation. Recommendations also included a deferral of postpartum screening till the end of the pandemic, or postponement of testing to 6-12 months after delivery, use telemedicine and telecare.

Conclusions: Updated temporary changes in clinical guidelines are sensible and accommodates social distancing and minimizes risk of exposure to COVID-19. Despite many unsolved controversies in screening, treatment, and follow-up of gestational diabetes, it seems involvement with novel coronavirus have made a reach to a global agreement simpler.
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http://dx.doi.org/10.1016/j.dsx.2020.06.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299858PMC
September 2020

Cochrane Review Summaries-July 2020.

Obstet Gynecol 2020 07;136(1):187-188

Shayesteh Jahanfar, Matthew Hill, and Diluma Kariyawasam are from the School of Public Health, Central Michigan University, Mount Pleasant, Michigan. Nimisha Kumar and David M. Haas are from the Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana; email:

This feature highlights recently published Cochrane Reviews of interest to the readers of Obstetrics & Gynecology. The brief summaries are published below, and the complete references, along with a hyperlink, are listed in Box 1.
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http://dx.doi.org/10.1097/AOG.0000000000003962DOI Listing
July 2020

Challenges of diabetes care management in developing countries with a high incidence of COVID-19: A brief report.

Diabetes Metab Syndr 2020 Sep - Oct;14(5):731-732. Epub 2020 May 19.

MPH program, Health Sciences Building, 2209 Central Michigan University, Mount Pleasant, MI, 48859, USA. Electronic address:

Background And Aims: Diabetes mellitus (DM) is one of the most critical risk factors for complications and death in COVID-19 patients. The present study aims to highlight challenges in the management of diabetic patients during the COVID-19 outbreak in developing countries.

Methods: We reviewed the literature to obtain information about diabetic care during the Covid-19 crisis. We also seek opinions of clinicians working in undeveloped countries.

Results: Current challenges faced by clinicians in the management of diabetic patients in developing countries are as follows: lack of preventive measures, inadequate number of visits, loss of the traditional method of communication with the patient, shortage of medications, impaired routine diabetic care, and absence of telehealth services.

Conclusions: Developing countries are faced with many challenges in diabetes management due to a lack of resources.
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http://dx.doi.org/10.1016/j.dsx.2020.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235559PMC
September 2020

The effect of hyoscine n- butylbromide on labor progress: A systematic review.

BMC Pregnancy Childbirth 2020 May 13;20(1):291. Epub 2020 May 13.

Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran.

Background: The objective of this systematic review and meta-analysis was to assess the effectiveness of hyoscine n-butylbromide in labor progress.

Methods: The databases including PubMed, the Cochrane Library, Science-Direct, Scopus and Web of Science were searched for studies published up to December 2019. Articles that published as randomized controlled trials (RCTs), and full-text articles published in English or other languages were included and participants were primi or multigravida women who were in active phase of labor. The intervention included HBB compared to placebo (normal saline) that was used during active phase of labor. Pooled estimates were measured using the fixed or random effect model, while the overall effect was reported in a mean difference (MD). All data were analyzed using Review Manager 5.3.

Results: Twenty studies involving 3108 women were included in meta-analysis. Based on subgroup analysis by parity, use of HBB significantly reduced the duration of the first stage of labor in primigravida women (MD = - 57.73; 95% CI: [- 61.48, - 53.60]) and in multigravida women (MD = - 90.74; 95% CI: [- 97.24, - 84.24]). Administering HBB could reduce the second stages of labor in primigravidas and multigravidas about 6 min and 4 min respectively. Also, HBB reduced the duration of the third stage of labor in multigravidas about 3 min. APGAR score at one and 5 min after birth was not affected. The main maternal adverse effect was tachycardia and dry mouth. Labor duration in studies in which the participants were primi-and multigravida was not presented based on separate parities except for four papers, and the route of HBB administration was not the same across all studies.

Conclusions: Although, the effect of HBB was minimal when multigravidas and primigravidas women were considered together, the HBB was clinically effective in primigravida and multigravida women for shortening the first and the second stages of labor. Also, HBB could reduce the length of the third stage of labor in multigravidas.
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http://dx.doi.org/10.1186/s12884-020-2832-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218842PMC
May 2020

The Effect of Twin Sex on Menstrual Characteristics.

Medicina (Kaunas) 2020 Apr 10;56(4). Epub 2020 Apr 10.

Department of Public Health, Central Michigan University, Mt Pleasant MI 48859, USA.

: The purpose of this project is to evaluate the association between twin sex discordance and menstrual characteristics. We hypothesize that sharing the uterus with a male twin can change ovulation programming, hence changing the menstrual cycle characteristics during adulthood. This project could be novel in discovering new physiological mechanisms of hormone exposure and menstrual cycles. : This is a cross-sectional study. We asked females from sex-concordant ( = 1290) and sex-discordant ( = 168) twin pairs in the Washington State Twin Registry about characteristics of menstrual cycles. Generalized Estimating Equation (GEE) analysis was used to compare groups. The main outcome measures included the amount of bleeding, duration of menstruation, the timing of menstruation, length of menstruation, and a number of periods per year. : We found a statistically significant association between the amount of menstrual period bleeding and twin sex discordance (0.42 (95% CI 0.18-0.94)). However, twin sex discordance was not associated with period duration, length of menstrual cycle, cycle regularity, or a number of periods per year. : Twin sex discordance is not a predictor of clinical characteristics of menstruation during adulthood except for the amount of bleeding. Future studies should focus on the impact of male hormones on the amount of bleeding during menstruation.
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http://dx.doi.org/10.3390/medicina56040173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230271PMC
April 2020

Cochrane Review Summaries-January 2020.

Obstet Gynecol 2020 01;135(1):213-214

Dr. Haas and Mr. Kumar are from the Department of Obstetrics and Gynecology at the Indiana University School of Medicine, Indianapolis, Indiana. Dr. Jahanfar is from the School of Public Health at Central Michigan University, Mount Pleasant, Michigan. Dr. Haas is a Contact Editor with the Cochrane Pregnancy and Childbirth Group and the Co-Director of the US Satellite of the Cochrane Pregnancy and Childbirth Group.

With this issue, the journal launches a new feature titled "Cochrane Review Summaries." This feature highlights recently published Cochrane Reviews of interest to the readers of Obstetrics & Gynecology. The brief summaries are published below, and the complete references, with hyperlinks to the full Cochrane Review, are listed in .
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http://dx.doi.org/10.1097/AOG.0000000000003627DOI Listing
January 2020

Sleep Improvement Effect on Sexual Life Quality Among Rotating Female Shift Workers: A Randomized Controlled Trial.

J Sex Med 2020 08 6;17(8):1467-1475. Epub 2020 Apr 6.

Assistant Professor, MPH Program, Health Science Program, Central Michigan University, Mount Pleasant, MI, USA.

Background: Poor sleep quality consequences among shift working nurses are well recognized.

Aim: To investigate the impact of sleep improvement on sexual quality of life.

Methods: The study was a parallel randomized controlled trial, conducted among 120 female nurses in 2 educational hospitals in the Northeast of Iran, Shahroud. Using random blocks of four, 120 eligible participants were randomly assigned to study groups. Data collecting tools included a demographic data questionnaire, Pittsburgh Sleep Quality Index to assess sleep quality, and the survey of sexual quality of life-female and Sexual Self-Efficacy Questionnaire to evaluate level of sexual quality of life and sexual self-efficacy, respectively. The intervention consisted of 3 weekly sleep intervention sessions that lasted from 90 to 120 minutes.

Outcomes: The study's primary and secondary outcomes were sleep quality, and the level of sexual self-efficacy and sexual quality of life, respectively.

Results: By 3-month follow-up, the loss to follow-up rate was 5.9%. The mean sleep quality score was 7.61 ± 2.26 in the recruited participants. Following the intervention, the sleep quality score showed statistically significant differences compared to the control group [mean difference (CI 99.98%), -1.89 (-2.40, -1.38)]. Participants in the intervention group showed modest increases in both measures; sexual self-efficacy [mean difference (CI 99.98%), 8.82 (6.83, 10.81)] and sexual quality of life [mean difference (CI 99.98%), 19.64 (18.08, 21.20)].

Clinical Implications: These findings suggest that sleep improvement could promote the sexual quality of life among shift working nurses.

Strengths & Limitations: Strengths of this study include the use of a validated outcome measure. Focusing the study on female nurses and the small size of the study population are the limitations.

Conclusion: Improved sleep showed an impact on sexual quality of life among rotating female shift workers. Khastar H, Mirrezaie SM, Chashmi NA, et al. Sleep Improvement Effect on Sexual Life Quality Among Rotating Female Shift Workers: A Randomized Controlled Trial. J Sex Med 2020;17:1467-1475.
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http://dx.doi.org/10.1016/j.jsxm.2020.03.003DOI Listing
August 2020

Efficacy of Salvia officinalis extract on the prevention of insulin resistance in euglycemic patients with polycystic ovary syndrome: A double-blinded placebo-controlled clinical trial.

Complement Ther Med 2020 Jan 13;48:102245. Epub 2019 Nov 13.

Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran; Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Objectives: At the present study, we aimed at evaluating the effect of Salvia officinalis (S. officinalis) extract on "anthropometric indices" and "insulin resistance markers" in Polycystic Ovary Syndrome (PCOS) patients.

Design And Setting: This was a randomized, triple-blinded, controlled trial performed in gynecology hospitals affiliated to Iran University of Medical Sciences.

Participants: Sixty PCOS patients diagnosed according to Rotterdam criteria.

Interventions: Consumption of the 330 mg oral S. officinalis extract or placebo capsules daily for eight weeks.

Main Outcome Measures: Body mass index (BMI), waist to hip ratio (WHR), blood pressure, homoeostatic model assessment-insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI).

Results: Results showed a statistically significant decrease in the BMI (P = 0.001) in S. officinalis group, but, there were no significant differences between the two groups for WHR (P = 0.164). Although we failed to find a significant effect of S. officinalis extract on systolic blood pressure (P = 0.283) but using a multivariate model showed a significant difference between two groups regarding diastolic blood pressure (P = 0.025). Also, the consumption of S. officinalis extract, compared to the placebo, resulted in a significant decrease in Insulin levels (P < 0.001), and HOMA-IR (P < 0.001). As well as, S. officinalis extract supplementation resulted in a greater increase in QUICKI (P < 0.001) compared with placebo groups.

Conclusion: S. officinalis extract at a dose of 330 mg/day could decrease BMI and systolic blood pressure, and it could enhance insulin resistance markers in euglycemic PCOS patients.

Trial Registration: Iranian Registry of Clinical Trials (IRCT201504146917N2, 2015-10-03).
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http://dx.doi.org/10.1016/j.ctim.2019.102245DOI Listing
January 2020

Secnidazole for treatment of bacterial vaginosis: a systematic review.

BMC Womens Health 2019 10 21;19(1):121. Epub 2019 Oct 21.

School of Medicine, Atlantic University, Saint Lucia, West Indies, USA.

Background: Bacterial vaginosis (BV) is one of the common vaginal infections among childbearing women. The usual treatment for BV is metronidazole; hence 30% of women have recurrence within 60 to 90 days after treatment. There are some studies which assessed the effect of secnidazole on BV. The aim of this systematic review was to investigate the effectiveness of secnidazole for treatment of BV.

Methods: The Cochrane Library, MEDLINE (PubMed), Scopus, and Web of Science (all databases from inception till October 28, 2018) were searched. Primary outcomes were clinical cure rate and microbiologic cure rate and the secondary outcomes were adverse events. Data was extracted from eligible studies by two review authors individually and analyzed by RevMan 5.3.

Results: Our search found six trials involving 1528 participants. Treatment with 2 g secnidazole could significantly reduce the risk of BV in patients with three or less episodes of BV in the last year by OR: 7.54 (95% CI, 3.89-14.60, p < 0.00001) and in patients with four or more episodes of BV in the last year (OR: 4.74, 95% CI: 1.51-14.84, p = 0.0.008). Secnidazole (2 g) could significantly increase the microbiologic cure rate in women with 3 or less episodes of BV in the last year (OR: 7.63, 95% CI: 2.30-25.33, p = 0.0009) but not in the women with 4 or more episodes of BV in the last year (OR: 20.17, 95% CI: 1.06-382.45, p = 0.05). The clinical cure rate, microbiological effect and the therapeutic cure rate of 2 g secnidazole was significantly more than that of 1 g secnidazole. The results showed that the clinical cure rate of 2 g secnidazole was not different from the following medications: metronidazole (500 mg bid for 5 days), secnidazole plus vaginal metronidazole, 2 g single dose of oral metronidazole and 2 g secnidazole plus vaginal ornidazole.

Conclusion: This review showed that 2 g and 1 g secnidazole were better than placebo, however, 2 g secnidazole was more effective than 1 g. Secnidazole 2 g was not different from metronidazole (500 mg bid for 5 days), or from secnidazole plus vaginal metronidazole, or 2 g single dose of oral metronidazole or from 2 g secnidazole plus vaginal ornidazole.
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http://dx.doi.org/10.1186/s12905-019-0822-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802328PMC
October 2019

Prebiotics for the prevention of hyperbilirubinaemia in neonates.

Cochrane Database Syst Rev 2019 08 13;8:CD012731. Epub 2019 Aug 13.

Division of Neonatology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Hyperbilirubinaemia occurs in approximately two-thirds of all newborns during the first days of life and is frequently treated with phototherapy. Although generally seen as safe, there is rising concern regarding phototherapy and its potentially damaging effects on DNA and increased side effects particularly for preterm infants. Other methods, such as enteral feeding supplementation with prebiotics, may have an effective use in the management of hyperbilirubinaemia in neonates.

Objectives: To determine whether administration of prebiotics reduces the incidence of hyperbilirubinaemia among term and preterm infants compared with enteral supplementation of milk with distilled water/placebo or no supplementation.

Search Methods: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), MEDLINE via PubMed (1966 to 14 June 2018), Embase (1980 to 14 June 2018), and CINAHL (1982 to 14 June 2018). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials.

Selection Criteria: We considered all RCTs that studied neonates comparing enteral feeding supplementation with prebiotics versus distilled water/placebo or no supplementation.

Data Collection And Analysis: Two reviewers screened papers and extracted data from selected papers. We used a fixed-effect method in combining the effects of studies that were sufficiently similar. We then used the GRADE approach to assess the quality of the evidence.

Main Results: Three small studies evaluating 154 infants were included in this review. One study reported a significant reduction in the risk of hyperbilirubinaemia and rate of treatment with phototherapy associated with enteral supplementation with prebiotics (risk ratio (RR) 0.75, 95% confidence interval (95% CI) 0.58 to 0.97; one study, 50 infants; low-quality evidence). Meta-analyses of two studies showed no significant difference in maximum plasma unconjugated bilirubin levels in infants with prebiotic supplementation (mean difference (MD) 0.14 mg/dL, 95% CI -0.91 to 1.20, I² = 81%, P = 0.79; two studies, 78 infants; low-quality evidence). There was no evidence of a significant difference in duration of phototherapy between the prebiotic and control groups, which was only reported by one study (MD 0.10 days, 95% CI -2.00 to 2.20; one study, 50 infants; low-quality evidence). The meta-analyses of two studies demonstrated a significant reduction in the length of hospital stay (MD -10.57 days, 95% CI -17.81 to -3.33; 2 studies, 78 infants; I² = 0%, P = 0.004; low-quality evidence). Meta-analysis of the three studies showed a significant increase in stool frequency in the prebiotic groups (MD 1.18, 95% CI 0.90 to 1.46, I² = 90%; 3 studies, 154 infants; high-quality evidence). No significant difference in mortality during hospital stay after enteral supplementation with prebiotics was reported (typical RR 0.94, 95% CI 0.14 to 6.19; I² = 6%, P = 0.95; 2 studies; 78 infants; low-quality evidence). There were no reports of the need for exchange transfusion and incidence of acute bilirubin encephalopathy, chronic bilirubin encephalopathy, and major neurodevelopmental disability in the included studies. None of the included studies reported any side effects.

Authors' Conclusions: Current studies are unable to provide reliable evidence about the effectiveness of prebiotics on hyperbilirubinaemia. Additional large, well-designed RCTs should be undertaken in neonates that compare effects of enteral supplementation with prebiotics on neonatal hyperbilirubinaemia with supplementation of milk with any other placebo (particularly distilled water) or no supplementation.
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http://dx.doi.org/10.1002/14651858.CD012731.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699678PMC
August 2019

Assessment of the relationship between metabolic syndrome and obstructive sleep apnea in male drivers of Shahroud city in 2018: a cross sectional study.

BMC Public Health 2019 Aug 6;19(1):1058. Epub 2019 Aug 6.

Environmental and Occupational Health Research centre, Shahroud University of Medical Sciences, Shahroud, Iran.

Background: Metabolic syndrome involves a set of metabolic risk factors that directly increases the risk of atherosclerotic cardiovascular disease. Physical inactivity due to driving can increase the risk of metabolic syndrome. It is also known that sleep disorders (sleep apnea) can result in MetS. Driving in Iran is considered a very popular but risky occupation, so paying attention to this profession is of special importance. Therefore, the researchers aimed to investigate the association between sleep disorders and metabolic syndrome in drivers in Shahroud city in 2018.

Methods: This cross-sectional study was carried out on 948 drivers from Shahroud city in 2018. After obtaining consent from participants, 3 questionnaires including demographic, Epworth Sleepiness Scale and STOP-BANG were completed. Clinical and anthropometric measurements were assessed, including blood pressure, waist circumference, hip circumference, weight, height, and body mass index. In addition, blood was drawn to measure High Density Lipoprotein, Low Density Lipoprotein, Triglyceride, cholesterol, and Fasting Blood Sugar levels. The relationship between metabolic syndrome and sleep disorders was then studied. In this study, statistical analyses were performed using SPSS software version 23 at a significance level of 0.05.

Results: Mean age of drivers was 44.15 ± 11.66 (years). The mean waist circumference and mean hip circumference in subjects with a Class 1 Driver's License (a certificate for trucks and buses) were higher than those with a Class 2 Driver's License (a certificate for motorcars, minibuses, vans, etc. (seating< 20)) (P = 0.01 and P = 0.003, respectively). Moreover, the BMI in subjects with a Class 1 Driver's License was higher compared to subjects with a Class 2 Driver's License. The correlation between metabolic syndrome with sleep apnea based on STOP-BANG questionnaire was significant (p < 0.001) irrespective of definition (ATP and IDF).

Conclusions: According to the results of this study, there was a bi-directional association between sleep disorders and Mets, so this group should pass periodic medical examinations and training courses. Moreover, their families should be informed of prevention and treatment of this syndrome.
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http://dx.doi.org/10.1186/s12889-019-7361-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685249PMC
August 2019