Women's worries about prenatal screening tests suspected of fetal anomalies: a qualitative study.

BACKGROUND: Pregnant women with suspected fetal anomalies experience a great deal of stress following prenatal screening tests. The present study aimed to investigate women's worries about prenatal screening tests suspected of fetal anomalies. METHODS: Through the use of qualitative content analysis, the reports of women whose prenatal screening tests were suspected of fetal anomalies were analyzed and the results were interpreted. The participants were selected from four public and private maternity care clinics of Babol, Iran, from December 2021 to January 2022, using targeted convenience sampling. Data were collected from 20 women aged 24 to 41 years old, who underwent prenatal screening tests and were suspected of fetal anomalies, using semi-structured face-to-face interviews. RESULTS: The four main themes included the "causes of worries" (with sub-themes of challenge with spouse and relatives, medical diagnosis processes, previous unpleasant experiences, physical and mental problems, financial worries, and misinformation), "anxiety-coping styles" (with cognitive emotion-oriented, behavioral emotion-oriented, and problem-oriented sub-themes), "reactions to a possible diagnosis of anomaly" (with three sub-themes, namely concealment, extreme fear and worry, and denial), and "attribution of the cause of the anomaly" (with sub-themes of consanguine marriage, evil eyes, tendency to have a baby of a particular gender, a history of anomalies in the previous child, the spouse's medical illness, unplanned pregnancy, and high maternal anxiety). CONCLUSION: Women with suspected fetal anomalies experience a great deal of stress, the most important reason for which is the "physician's uncertainty". "Sharing worries with relatives" was the most common style of coping with worries. Establishing emotional support and empathetic communication between midwives and physicians with pregnant women suspected of fetal anomalies were important ways to reduce their worries.

The effects of synbiotic supplementation on hormonal status, biomarkers of inflammation and oxidative stress in subjects with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: To our knowledge, no reports are available indicating the effects of synbiotic supplementation on hormonal status, biomarkers of inflammation and oxidative stress in subjects with polycystic ovary syndrome (PCOS). This research was done to assess the effects of synbiotic supplementation on hormonal status, biomarkers of inflammation and oxidative stress in subjects with PCOS. METHODS: This randomized double-blind, placebo-controlled trial was conducted on 60 subjects diagnosed with PCOS according to the Rotterdam criteria. Subjects were randomly assigned into two groups to take either synbiotic (n = 30) or placebo (n = 30) for 12 weeks. Endocrine, inflammation and oxidative stress biomarkers were quantified at baseline and after the 12-week intervention. RESULTS: After the 12-week intervention, compared with the placebo, synbiotic supplementation significantly increased serum sex hormone-binding globulin (SHBG) (changes from baseline in synbiotic group: + 19.8 ± 47.3 vs. in placebo group: + 0.5 ± 5.4 nmol/L, p = 0.01), plasma nitric oxide (NO) (changes from baseline in synbiotic group: + 5.5 ± 4.8 vs. in placebo group: + 0.3 ± 9.1 µmol/L, p = 0.006), and decreased modified Ferriman Gallwey (mF-G) scores (changes from baseline in synbiotic group: - 1.3 ± 2.5 vs. in placebo group: - 0.1 ± 0.5, p = 0.01) and serum high-sensitivity C-reactive protein (hs-CRP) (changes from baseline in synbiotic group: - 950.0 ± 2246.6 vs. in placebo group: + 335.3 ± 2466.9 ng/mL, p = 0.02). We did not observe any significant effect of synbiotic supplementation on other hormonal status and biomarkers of oxidative stress. CONCLUSIONS: Overall, synbiotic supplementation for 12 weeks in PCOS women had beneficial effects on SHBG, mFG scores, hs-CRP and NO levels, but did not affect other hormonal status and biomarkers of oxidative stress. TRIAL REGISTRATION: This study was retrospectively registered in the Iranian website ( www.irct.ir ) for registration of clinical trials ( IRCT201509115623N53 ), on 2015-09-27.

The effects of vitamin D and evening primrose oil co-supplementation on lipid profiles and biomarkers of oxidative stress in vitamin D-deficient women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial.

PURPOSE OF THE STUDY: There was inconsistent evidence about the benefit of vitamin D plus evening primrose oil (EPO) supplement intake on lipid profiles and reduced oxidative stress among women with polycystic ovary syndrome (PCOS). The current study was performed to evaluate the effects of vitamin D plus EPO supplementation on lipid profiles and biomarkers of oxidative stress in vitamin D-deficient women with PCOS. MATERIALS AND METHODS: This randomized, double-blind, placebo-controlled trial was performed among 60 vitamin D-deficient women with PCOS. Participants were randomly assigned into two groups to receive either 1000 IU vitamin D3 plus 1000 mg EPO (n = 30) or placebo (n = 30) for 12 weeks. Metabolic profiles were quantified at baseline and after the 12-week intervention. RESULTS: Compared with the placebo group, women in vitamin D and EPO co-supplementation group had significant increases in serum 25-hydroxyvitamin D (25(OH)D) (+10.7 ± 8.4 vs. -0.5 ± 1.6 ng/mL, p < 0.001) and plasma total glutathione (GSH) (+62.7 ± 58.0 vs. -0.7 ± 122.7 µmol/L, p = 0.01), while there were significant decreases in triglycerides (-7.3 ± 23.8 vs. +6.9 ± 26.3 mg/dL, p = 0.03), very low-density lipoprotein (VLDL) cholesterol levels (-1.5 ± 4.7 vs. +1.4 ± 5.3 mg/dL, p = 0.03), total/high-density lipoprotein cholesterol ratio (-0.3 ± 0.4 vs. -0.02 ± 0.4, p = 0.02), and malondialdehyde (MDA) concentration (-0.4 ± 0.4 vs. +0.5 ± 1.8 µmol/L, p = 0.008). CONCLUSION: Overall, vitamin D and EPO co-supplementation for 12 weeks among vitamin D-deficient women with PCOS significantly improved triglycerides, VLDL cholesterol, GSH, and MDA levels.

The Effects of Omega-3 Fatty Acids Supplementation on Gene Expression Involved in the Insulin and Lipid Signaling Pathway in Patients with Polycystic Ovary Syndrome.

Limited data are available evaluating the effects of omega-3 fatty acids supplementation on gene expression involved in the insulin and lipid-signaling pathway in women with polycystic ovary syndrome (PCOS). This study was conducted to evaluate the effects of omega-3 fatty acids supplementation on gene expression involved in the insulin and lipid signaling pathway in women with PCOS. This randomized double blind, placebo-controlled trial was done among 60 women aged 18-40 years old and diagnosed with PCOS according to the Rotterdam criteria. Participants were randomly assigned into 2 groups to receive either 1 000 mg omega-3 fatty acids from flaxseed oil containing 400 mg α-linolenic acid (n=30) or placebo (n=30) twice a day for 12 weeks. Gene expressions involved in the insulin and lipid-signaling pathway were quantified in blood samples of PCOS women with RT-PCR method. Quantitative results of RT-PCR demonstrated that compared with the placebo, omega-3 fatty acids supplementation upregulated peroxisome proliferator-activated receptor gamma (PPAR-γ) mRNA (p=0.005) in peripheral blood mononuclear cells of women with PCOS. In addition, compared to the placebo, omega-3 fatty acids supplementation downregulated expressed levels of oxidized low-density lipoprotein receptor (LDLR) mRNA (p=0.002) in peripheral blood mononuclear cells of women with PCOS. We did not observe any significant effect of omega-3 fatty acids supplementation on expressed levels of glucose transporter 1 (GLUT-1) and lipoprotein(a) [Lp(a)] genes in peripheral blood mononuclear cells. Overall, omega-3 fatty acids supplementation for 12 weeks in PCOS women significantly improved gene expression of PPAR-γ and LDLR.

Calcium plus vitamin D supplementation influences biomarkers of inflammation and oxidative stress in overweight and vitamin D-deficient women with polycystic ovary syndrome: a randomized double-blind placebo-controlled clinical trial.

OBJECTIVE: This study was conducted to determine the effects of calcium plus vitamin D supplementation on inflammatory factors and biomarkers of oxidative stress among overweight vitamin D-deficient women with polycystic ovary syndrome (PCOS). DESIGN, PATIENTS AND MEASUREMENTS: This randomized double-blind placebo-controlled clinical trial was performed among 104 overweight vitamin D-deficient women diagnosed with PCOS aged 18-40 years. Participants were randomly divided into four groups. Group A received 1000 mg calcium daily and vitamin D placebo weekly (N = 26), group B 50000 IU vitamin D weekly and calcium placebo daily (N = 26), group C 1000 mg calcium daily plus 50000 IU vitamin D weekly (N = 26) and group D calcium placebo daily plus vitamin D placebo weekly (N = 26) for 8 weeks. Fasting blood samples were taken at baseline and 8 weeks after intervention to measure inflammatory factors and biomarkers of oxidative stress. RESULTS: After 8 weeks, individuals taking calcium plus vitamin D supplements had greater decreases in homoeostatic model assessment beta-cell function (HOMA-B) score (-11·1 vs -8·6, -3·4 and 13·7, respectively, P = 0·03), serum high-sensitivity C-reactive protein (hs-CRP) (-948·3 vs 802·3, -383·8 and 618·2 ng/ml, respectively, P = 0·04) and plasma malondialdehyde (MDA) concentrations (-0·6 vs -0·5, -0·1 and 0·6 µmol/l, respectively, P = 0·009), and significant increases in plasma total antioxidant capacity (TAC) (35·2 vs 21·1, 22·5 and -153·8 mmol/l, respectively, P = 0·006) and glutathione (GSH) levels (216·0 vs 3·9, -47·5 and -160·8 µmol/l, respectively, P = 0·001) compared with calcium alone, vitamin D alone and placebo groups. Calcium plus vitamin D cosupplementation did not influence plasma NO and catalase levels. CONCLUSIONS: We found that calcium plus vitamin D cosupplementation for 8 weeks among overweight and vitamin D-deficient women with PCOS had beneficial effects on inflammatory factor and biomarkers of oxidative stress.

Maternal saliva visfatin level in term and preterm labor: A case control study.

Visfatin, a colony-enhancing factor (pre-B-cell), is an inflammatory biomarker that is secreted from a different number of cells and appears to have some proinflammatory or immune-regulating effects. The aim of this study was to compare maternal saliva visfatin levels in women with preterm and term delivery. In This case-control study, women in labor before 37 weeks of gestation were the case group (n = 40) and women in labor after 37 weeks of gestation were in control group (n = 40). The saliva of the participants was sampled and maternal saliva visfatin level was measured by ELISA test. In this study, 80 pregnant women were studied in case and control groups. The mean age of case and control group was 29.1±6.9 and 30.55±5.3 years, respectively. The results revealed that the mean maternal saliva visfatin level in the preterm group (4.75±2.2) is significantly (p = 0.001) lower than that in term birth group (6.7±3.1). The results of adjusted logistic regression revealed that after adjusting for GDM, preeclampsia, pre pregnancy BMI and weight gain, the mean of maternal saliva visfatin level in the preterm group is significantly lower than that in the term group (p = 0.026). Considering that during the term pregnancy visfatin levels increase and visfatin may play a role in initiating labor, in our study due to the high visfatin level in case group although the level of maternal saliva visfatin was lower than the control group but high levels of visfatin in the case group can represent the role of visfatin in initiating labor and due to this issue can be use the role of this adipokine for early diagnosis of preterm delivery can be used to prevent, treat and improve the prognosis of this disease. Also, this study is the first study to compare the maternal saliva visfatin level between SGA and AGA group and there is no difference between these groups.

Gingival crevicular fluid levels of visfatin in patients with chronic periodontitis and polycystic ovary syndrome.

OBJECTIVE: Recently, the association between periodontal diseases and polycystic ovary syndrome (PCOS) has been established, and it has been revealed that visfatin levels increase in chronic periodontitis (CP) and PCOS. However, there was no study comparing the mean visfatin levels between advanced CP and PCOS. Therefore, the probable role of visfatin linking these diseases remains unknown, and this study was conducted to address this gap. METHODS: In this age- and weight-matched case-control study (cases with PCOS disease and controls without it), 110 female participants were divided into 4 groups based on clinical findings. The 1st group participants had both PCOS and advanced CP (n=30), 2nd group participants had only PCOS (n=25), 3rd group participants had only advanced CP (n=23), and 4th group comprised of healthy participants (n=32). Enzyme-linked immunosorbent assay was used to investigate visfatin levels in the gingival crevicular fluid (GCF). Data were collected and analyzed using Stata software (version 11). RESULTS: The results revealed the significant effect of both PCOS and advanced CP on visfatin levels in the GCF (P<0.05). CONCLUSION: According to the results of this study, the visfatin level in the GCF could be the probable link of association between PCOS and advanced CP.

A Survey of Venous Thromboembolism (VTE) Prophylaxis in Obstetrics Patients in Iran.

Objective: The purpose of the present study was a survey of venous thromboembolism (VTE) prophylaxis in obstetrics patients in Iran. Materials and methods: A national, multicenter, non-interventional, prospective study was performed on 1000 women at 11 different parts of Iran. Primary outcome was to assess the situation of VTE prophylaxis in pregnant and postpartum women and the secondary outcome was risk stratification in obstetrics patients and to evaluate the guideline adherence in physician's practice of VTE prophylaxis. Results: 1,036 women entered the final analysis. The three main VTE risk factors before hospitalization were BMI > 30 kg/m2, history of oral contraceptive (OCP) use, and the age over 35.VTE risk factors upon enrollment were detected in 780 (75.28%) patients. 219 women (28.07%) were deemed eligible for drug prophylaxis, however, only 37 women (17%) received it. A total of 113 (10.9%) patients received VTE prophylaxis, of which 76 (67.25%) women had no clear indications. Concordance between theory and practice was detected with a Cohen's Kappa coefficient to be 0.74 (p < 0.001), which fell within "good agreement". Multivariate analysis for association between VTE prophylaxis and VTE risk factors showed that history of VTE [OR = 9.06 (CI 95% 1.16 - 70.8) p = 0.036] was the most frequent risk factor for receiving VTE prophylaxis followed by obesity (BMI > 30 Kg/m2); [OR = 3.74 (CI 95% 1.79 - 5.69), p = <0.001], multiple pregnancy [OR= 2.81 (CI 95% 1.70 - 4.64), p = < 0.001] and age > 35 years; [OR =1.09 (CI 95% 0.82 - 1.21), p = 0.026]. Varicose Veins [OR= 0.22 (CI 95% 0.56 - 0.87), p = 0.031], PROM / PPROM [OR= 0.33 (CI 95% 0.12 - 0.91), p = 0.032] and history of using OCP [OR= 0.36 (CI 95% 0.24 - 0.53), p = < 0.001] were the most missed risk factors for receiving VTE prophylaxis respectively. Conclusion: History of VTE, obesity, multiple pregnancy and age > 35 years were the most frequent risk factors for receiving VTE prophylaxis and varicose veins, PROM / PPROM and history of using OCP were the most missed risk factors for receiving VTE prophylaxis.

Effect of well-controlled gestational diabetes on left ventricular diastolic dysfunction in neonates.

BACKGROUND: There are some evidences supporting the relation between gestational diabetes mellitus (GDM) and diastolic dysfunction. The aim of our study was to investigate the effect of well-controlled GDM on morphological and functional myocardium. MATERIALS AND METHODS: We designed a prospective cross-sectional study to evaluate left ventricular (LV) diastolic function of 60 neonates born from mothers with well-controlled GDM (case group) on days of 3-5 after birth. The infants of diabetic mothers (IDM) group were divided into two groups: diabetic mothers treated only with diet (class A) and group of mothers on medical therapy by insulin or metformin (class B). Traditional echocardiography and pulsed-wave Doppler (PWD), tissue Doppler imaging (TDI) were performed for all the neonates. RESULTS: The study group consisted of 60 neonates as males (M) = 32, (0.53%) and females (F) = 28, (0.46%). Using M-mode echocardiography, interventricular septum thickness (IVS), and LV mass were significantly higher in IDM than control group (p = .0001). The PWD showed both a significantly more peak mitral flow at early diastolic wave (E) and an early filling deceleration time (E-DT) (p = .0001). Tissue Doppler echocardiography parameters A' (cm/s) (p = .0001), E' (cm/s) (p = .002), and E'/A' ratio (p = .0001), left ventricular myocardial performance index (LVMPI), and isovolumetric relaxation time (IVRT) were outstandingly different between the two groups (p = .0001, respectively). Evaluating the GDM group mothers of class A and class B, no significant difference was noted in PWD or TDI parameters compared with the healthy ones. CONCLUSIONS: It seems that neonates of mothers with well-controlled GDM are still at increased risk of cardiac hypertrophy, subclinical diastolic dysfunction, and impaired left ventricular relaxation. This can be interpreted that focusing only on glycemic control is not enough to prevent cardiac dysfunction.

Mid-gestational serum uric acid concentration effect on neonate birth weight and insulin resistance in pregnant women.

OBJECTIVE: To investigate the relationship between mid-gestational serum uric acid and birth weight in diabetic pregnant women with or without insulin resistance. METHODS: In a prospective cohort study, fasting uric acid, blood glucose, and serum insulin were measured in 247 pregnant women between 20-22 weeks of gestational period. Insulin resistance was estimated using the homeostasis model assessment-insulin resistance (HOMA-IR). Stratification analysis and independent t-test was used to assess the association between uric acid and birth weights regarding to insulin resistance. RESULTS: The means of the mid-gestational serum uric acid concentrations were not significantly different in women with and without insulin resistance. But stratification analysis showed that there was a significant difference between uric acid concentration and macrosomic birth in diabetic women without insulin resistance. CONCLUSIONS: Higher mid - gestation serum uric acid concentration, even if it does not exceed the normal range, is accompanied by lower birth weight only in non-insulin resistance women. Insulin resistance could have a negative confounding effect on hyperuriemia and birth weight.

Evaluation of vaginal group B streptococcal culture results after digital vaginal examination and its pattern of antibiotic resistance in pregnant women.

BACKGROUND: Group B streptococcus (GBS) colonizes the gastrointestinal and genitourinary tract of 10-40% of pregnant women and it is a major cause of neonatal morbidity and mortality. OBJECTIVE: This study was to evaluate whether vaginal GBS culture results alter after digital vaginal examination or not. Antibiotic resistance pattern of this specie has been also assessed. MATERIALS AND METHODS: A total of 186 pregnant women with gestational age of 37 weeks were enrolled to the study. Two vaginal swaps were taken before and immediately after digital vaginal examination, then third swap was taken after 48 hours of examination. The cultures were evaluated for bacterial growth and the isolated bacteria were assessed for antimicrobial drugs sensitivity. RESULTS: Positive culture of GBS was seen in 16.1%. Initially negative GBS result was found not to change immediately after examination. But positive cultures were negative in 1.6% of women after digital vaginal examination. After 48 hours 2.7% of initially negative GBS was positive and no one with initially positive GBS had negative culture. Sensitivity to penicillin and vancomycin was 100%, erythromycin 74%, ampicillin 65%, cefazolin 62.8%, cefotaxime 54.2% and ceftizoxime was 40%. CONCLUSION: The present investigation showed that the vaginal GBS culture result is minimally affected by digital vaginal examination. Drug of choice for GBS eradication is penicillin; vancomycin could be the choice in the case of penicillin hypersensitivity. This article extracted from M.D. thesis. (Mahdokht Sadat Manavi).

Correlation of nuchal translucency and thyroxine at 11-13 weeks of gestation.

OBJECTIVE: Nuchal translucency (NT) thickness is one of the major screening markers during the first trimester that could be influenced by several factors. Here, we investigated the association between NT thickness and thyroid related hormones. METHODS: NT thickness was measured with transabdominal ultrasound in 643 pregnant women between 11 and 13 weeks of gestation. Maternal thyroxine (T4), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) were evaluated. Bivariate correlations were assessed and thyroid profile was subcategorized with regard to the calculated reference ranges. RESULTS: An inverse relation was found between serum levels of maternal T4 with NT thickness (r = -0.128, p = 0.001) and CRL (r = -0.168, p < 0.001). TSH and hCG were also found to be correlated (Spearman's correlation coefficient = -0.092, p = 0.019). Prevalence of maternal hypothyroidism and subclinical hypothyroidism were 1.1% and 3.7%, respectively. CONCLUSION: Thyroid function tests are found to independently influence NT measurements in the first trimester. Assessment of hormones such as thyroxine could optimize the interpretation of screening tests for pathological conditions during pregnancy.