Assessing the role of dietary acid load in the development of hypertensive disorders during pregnancy: uncovering the association through prospective cohort analysis.

BACKGROUND: Hypertensive disorders of pregnancy (HDPs) are common complications encountered in pregnancy that affect between 5% and 15% of pregnancies worldwide. Some studies have associated adherence to a diet with a high acid load with an increased risk of HDPs. This study investigates the association between Dietary Acid Load (DAL) and the incidence of preeclampsia, chronic hypertension (HTN), and gestational hypertension (GHTN). METHODS: Pregnant women aged 18 to 45 in the first trimester of pregnancy were selected and followed up until delivery. Diet was evaluated using a 168-question semi-quantitative food frequency questionnaire (FFQ). After calculating the DAL score, the inverse probability weight of the propensity scores, estimated from augmented generalized models, was used to obtain a causal risk ratio (RR) adjusted for potential confounders. RESULTS: Out of 1,856 women, 92 (4.95%) developed preeclampsia. The potential renal acid load (PRAL) score ranged from - 16.14 to 0.58, while the net endogenous acid production (NEAP) score ranged from 34.61 to 50.15. Multivariable analysis revealed a significant association between PRAL and preeclampsia in the first (aRR: 1.87, 95% CI: 1.01, 3.49, p = 0.048) and third (aRR: 2.01, 95% CI: 1.07, 3.81, p = 0.030) quartiles compared to the reference group (Q2). No significant linear association was found in continuous analyses. For chronic HTN, significant associations were observed in the first (aRR: 2.56, 95% CI: 1.21, 5.42, p = 0.014) and fourth (aRR: 4.79, 95% CI: 2.37, 9.71, p < 0.001) PRAL quartiles, with similar findings for NEAP. Continuous analysis showed a significant linear association between both PRAL and NEAP scores and chronic HTN. Regarding GHTN, significant associations were found in the first (aRR: 1.48, 95% CI: 1.02, 2.16, p = 0.041) and fourth (aRR: 1.88, 95% CI: 1.31, 2.70, p = 0.001) PRAL quartiles, and in Q4 for NEAP (aRR: 1.56, 95% CI: 1.10, 2.21, p = 0.012), with no significant linear association in continuous analysis. CONCLUSION: Extremes in DAL, as indicated by PRAL and NEAP, are associated with an increased risk of preeclampsia, chronic HTN, and GHTN, particularly in the highest and lowest quartiles. These findings highlight the potential impact of DAL on HDPs.

The association of dietary total antioxidant capacity and gestational diabetes: a prospective cohort study from the Mothers and their children's health (MATCH).

BACKGROUND/OBJECTIVES: There is evidence to support the hypothesis that a diet rich in antioxidants can help safeguard against the development of gestational diabetes mellitus (GDM). This study aimed to investigate the association between dietary total antioxidant capacity (DTAC) during early pregnancy and the risk of GDM. SUBJECTS/METHODS: We included 1856 pregnant women in their first trimester from the Mothers and their Children's Health (MATCH) prospective cohort study. Prepregnancy dietary intake was assessed using a validated food frequency questionnaire (FFQ) and was used to calculate the DTAC score. Incident GDM was diagnosed based on the American Diabetes Association criteria. We estimated the association between DTAC and GDM using propensity score-based inverse probability weighting (IPW). RESULTS: Overall, 369 (14.6%) of the pregnant women were identified with GDM. The mean DTAC score and the corresponding standard deviation (SD) was 2.82± (2.56) mmol/100 g, with a range of 0.01 to 18.55. The adjusted risk of GDM decreased by 34% (95% CI = 10%, 52%, p = 0.023) for each DTAC score increase. The results showed that women in the highest quartile of DTAC had a lower risk of developing GDM compared to those in the lowest quartile (adjusted RR: 0.29, 95% CI: 0.12, 0.68, p = 0.005). CONCLUSION: DTAC in early pregnancy is significantly associated with a lower risk of GDM. Additional larger cohort studies are needed to validate these findings.

Promotion of cardiac microtissue assembly within G-CSF-enriched collagen I-cardiogel hybrid hydrogel.

Tissue engineering as an interdisciplinary field of biomedical sciences has raised many hopes in the treatment of cardiovascular diseases as well as development of in vitro three-dimensional (3D) cardiac models. This study aimed to engineer a cardiac microtissue using a natural hybrid hydrogel enriched by granulocyte colony-stimulating factor (G-CSF), a bone marrow-derived growth factor. Cardiac ECM hydrogel (Cardiogel: CG) was mixed with collagen type I (ColI) to form the hybrid hydrogel, which was tested for mechanical and biological properties. Three cell types (cardiac progenitor cells, endothelial cells and cardiac fibroblasts) were co-cultured in the G-CSF-enriched hybrid hydrogel to form a 3D microtissue. ColI markedly improved the mechanical properties of CG in the hybrid form with a ratio of 1:1. The hybrid hydrogel demonstrated acceptable biocompatibility and improved retention of encapsulated human foreskin fibroblasts. Co-culture of three cell types in G-CSF enriched hybrid hydrogel, resulted in a faster 3D structure shaping and a well-cellularized microtissue with higher angiogenesis compared to growth factor-free hybrid hydrogel (control). Immunostaining confirmed the presence of CD31+ tube-like structures as well as vimentin+ cardiac fibroblasts and cTNT+ human pluripotent stem cells-derived cardiomyocytes. Bioinformatics analysis of signaling pathways related to the G-CSF receptor in cardiovascular lineage cells, identified target molecules. The in silico-identified STAT3, as one of the major molecules involved in G-CSF signaling of cardiac tissue, was upregulated in G-CSF compared to control. The G-CSF-enriched hybrid hydrogel could be a promising candidate for cardiac tissue engineering, as it facilitates tissue formation and angiogenesis.

The potential causal effect of the pre-pregnancy dietary phytochemical index on gestational diabetes mellitus: a prospective cohort study.

BACKGROUND: Phytochemicals are non-nutritive bioactive compounds with beneficial effects on the metabolism of glucose. This study aimed to clarify the possible causal effect of the pre-pregnancy dietary phytochemical index (DPI) on gestational diabetes mellitus (GDM). METHODS: In this prospective cohort study 1,856 pregnant women aged 18-45 years who were in their first trimester, were recruited and followed up until delivery. The dietary intakes of participants were examined using an interviewer-administered validated 168-item semi-quantitative food frequency questionnaire (FFQ). Inverse probability weighting (IPW) of propensity scores (PS), estimated from the generalized boosted model (GBM) were used to obtain a adjusted risk ratio (aRR) for potential confounders. RESULTS: During the follow-up period, 369 (19.88%) women were diagnosed with GDM. DPI scores ranged from 6.09 to 89.45. There was no association between DPI scores and GDM (aRR: 1.01, 95% confidence interval [CI]: 0.92, 1.08; p trend = 0.922). When comparing DPI quartile 4 (most pro-phytochemical content) to quartile 1 (few phytochemical contents), there was no significant difference between them (aRR: 0.97; 95% CI: 0.75, 1.25; p = 0.852). Also, there was no significant difference between DPI quartile 3 and quartile 1 (aRR: 1.04; 95% CI: 0.81, 1.34; p = 0.741) as well as DPI quartile 2 and quartile 1 (aRR: 0.92; 95% CI: 0.71, 1.21; p = 0.593). CONCLUSIONS: Although this data did not support the association between pre-pregnancy DPI scores and GDM, further cohort studies to ascertain the causal association between them are warranted.

Breastfeeding success and perceived social support in lactating women with a history of COVID 19 infection: a prospective cohort study.

BACKGROUND: Given the limited availability of research on the association between COVID-19 infection and breastfeeding success, the primary objective of this study is to conduct a comprehensive evaluation of this relationship. METHODS: This prospective cohort study included 260 women who were on the postnatal ward of an academic hospital affiliated with Tehran University of Medical Sciences during the COVID-19 pandemic (between March and August 2021). Among these women, 130 had tested positive for COVID-19 in pregnancy, while the remaining 130 were considered healthy. The study aimed to assess various factors, including sociodemographic characteristics and the results of four validated questionnaires: The Bristol Breastfeeding Questionnaire, The Multidimensional of Perceived Social Support (MPSS), The Breastfeeding Self-Efficacy Scale (BSES), and The Postpartum Partner Support Scale (PPSS). These questionnaires were administered to each participant to gather relevant data. After eight weeks, a telephone follow-up was carried out to assess the success of breastfeeding. The evaluation focused on determining if exclusive breastfeeding was maintained or not. Data was collected by questioning mothers about their infants' feeding habits in the past 24 h. Exclusive breastfeeding refers to the exclusive use of breast milk without the introduction of other liquids or solid foods. RESULTS: Women with a previous COVID-19 infection (case group) had a lower mean infant gestational age (P < 0.001) and a higher prevalence of cesarean section (P = 0.001) compared to the control group. The proportion of women who exclusively breastfed was higher in the control group (98.5%) than in women with a history of COVID-19 infection (89.2%) (P = 0.011). Furthermore, the case group reported lower scores in perceived social support and the Breastfeeding Self-Efficacy Scale, in contrast to the control group. Notably, there was a significant correlation between breastfeeding success and women's breastfeeding self-efficacy score. CONCLUSIONS: The findings of this study offer valuable insights for healthcare professionals, enabling them to promote early initiation of breastfeeding in mothers with a history of COVID-19 infection, while ensuring necessary precautions are taken.

Co-culture of human cryopreserved fragmented ovarian tissue with theca progenitor cells derived from theca stem cells.

PURPOSE: Despite the significant advances in the in vitro development of human primordial follicles, it is still a challenging approach with great potential for improvements. Therefore, the present study aimed to investigate the effect of a feeder layer of human theca progenitor cells (hTPCs) on the development of primordial follicles embedded in human ovarian tissue. METHODS: Fragments of frozen-thawed ovarian tissue were activated using the vanadate-derivative dipotassium bisperoxo (5-hydroxy-pyridine-2-carboxylic) oxovanadate (V) and kit ligand for 24 h. Then, the specimens were divided into the co-culture and mono-culture groups and were cultured with and without a hTPC feeder layer for 6 days, respectively. Afterward, the follicles were counted and classified, and the hormone levels and expression levels of apoptosis- and folliculogenesis-related genes were assessed. RESULTS: Both culture groups showed significant follicle growth (P < 0.05). However, the co-culture group had a significantly higher number of growing follicles compared to the other group (P < 0.05). Moreover, the expression levels of ZP1, ZP2, ZP3, BMP-7, AMH, and GDF9 were significantly higher in the co-culture group compared to the other group (P < 0.05), while the expression levels of P53 and CASP3 were significantly lower (P < 0.05). Also, the concentrations of estradiol, progesterone, testosterone, and androstenedione were significantly higher in the co-culture group compared to the other group (P < 0.05). CONCLUSION: The present study results provided novel evidence on the direct role of hTPCs in the growth and development of human primordial follicles. However, there is a need for future studies to illustrate the underlying mechanisms. Schematic summary of the results. According to our results, the expression of ZP1, ZP2, ZP3, and GDF9 in the oocytes, AMH in the granulosa cells, and BMP4 in the theca cells of the co-culture group were significantly higher than those of the mono-culture and non-culture groups, while the expression of apoptotic genes (BAX, CASP3, and P53) was significantly lower. Moreover, the co-culture group showed significantly increased levels of estradiol, progesterone, testosterone, and androstenedione in its culture media compared to the mono-culture groups.

COVID­19 vaccine hesitancy among pregnant women and their reported reasons for vaccine refusal - A prospective study in Tehran, Iran.

OBJECTIVE: Evaluation of covid­19 vaccine hesitancy among pregnant women and their reported reasons for vaccine refusal. METHODS: This prospective study was performed in Arash women's Hospital, Tehran, Iran, between December 1, 2021 and January 1, 2022. All pregnant women who were attended to prenatal care unit were considered eligible for inclusion. A validated questionnaire was used for data gathering. Written informed consent was obtained from all participants. RESULTS: Finally, 477 pregnant women were recruited and were divided into two groups according the status of vaccine acceptance (237 accepted and 240 women refused vaccination). The mean age of accepted participants was higher (31.65 ± 5.69 vs 30.39 ± 5.5; P = 0.01). There was a significant statistical difference between the groups regarding education level. Access to internet and social media were also significantly different between the two groups (94.8% in accepted vs 86.6% in refused group; P = 0.002). There was more rate of severe COVID-19 infection in friends or relatives of accepted group (50% vs 38%). we did not find any statistically significant differences in obstetric characteristics and the rate of obstetric complications between the two groups. The most common reasons reported by participants for vaccine refusal, was fear of vaccination side effects on the fetus (86.5%), and the less common reported reasons were husband's disagreement (9.7%), use of traditional medicine (5.6%), religious beliefs (3.7%), and information obtained from social media (2.8%). After advices from medical staff, most of these mothers (86.5%) still refused vaccination. CONCLUSION: Based on the results of the present study,rate of COVID-19 vaccine hesitancy was about 50% and its most common reported reason was fear of probable side effects of vaccine on the fetus.

The effect of hydroxychloroquine on pregnancy outcomes in patients with unexplained recurrent pregnancy loss: a placebo-controlled study "pilot study".

This double-blind placebo-controlled study investigated the effect of hydroxychloroquine on pregnancy outcomes in people with unexplained recurrent pregnancy loss (URPL). The inclusion criteria included gestational age ≤6 weeks and a history of at least two miscarriages. The exclusion criteria included any known cause for previous abortions or a history of any chronic diseases. Participants were given 200 mg hydroxychloroquine or placebo twice a day until gestational week 20. Twenty-nine women were enrolled. There was no statistically significant difference between the two groups in terms of age, BMI, gravidity, previous abortion, relative married couple, and infertility. Miscarriage occurred in five women including one in the hydroxychloroquine group (7.69%) and four women in the placebo group (28.57%) (OR: 2.36, 95% PL CI:1.07, 8.93). However, after adjusting for potential confounders, there was no significant difference between the two groups (aOR: 2.96, 95%CI: 0.91, 10.02).IMPACT STATEMENTWhat is already known on this subject? Miscarriage, a prevalent concern in the field reproductive medicine, causes psychological and family problems for couples. Unfortunately, no effective treatment has been yet found for URPL. There are some hypotheses about the role of immunological factors in URPL. Hydroxychloroquine (HCQ) has various immunological effects and may theoretically have a role in the treatment of URPL. Although few studies have been registered to investigate the effect of HCQ on URPL, none of them has been published.What do the results of this study add? In our double-blind placebo-controlled trial, the prevalence of abortion in the HCQ group was four times lower than that in the placebo group, however, this difference was not statistically significant, which can be attributed to the small sample size.What are the implications of these findings for clinical practice and/or further research? We hope that HCQ will be of interest to researchers and future research help clarify the role of HCQ in preventing URPL.

Differential expression of Hsa-miR-517a/b in placental tissue may contribute to the pathogenesis of preeclampsia

Objective: Preeclampsia (PE) is a pregnancy hypertensive disorder that affects both maternal and fetal health. Many studies have investigated possible mechanisms in the pathogenesis of PE although the role of the placenta is undeniable. Evaluation of placental-specific microRNAs may provide additional data about the pathogenic mechanism of PE. This study compared the expression levels of Hsa-miR-517a/b in placental tissues obtained from PE patients and healthy controls. Material and Methods: One hundred tissues were obtained from fetal and maternal sides of the placenta of PE patients and healthy controls. Expression analysis was performed using quantitative real-time polymerase chain reaction. Results: Hsa-miR-517a/b level was significantly decreased in PE compared to controls (expression ratio: 0.40; p=0.007). Down-regulation of Hsa-miR-517a/b was also detected in fetal-side placental samples when compared to maternal-side in PE (expression ratio: 0.33; p=0.04). Furthermore, decreased expression of Hsa-miR-517a/b was detected in fetal-side tissue from PE cases compared to fetal-side samples from healthy pregnancies (expression ratio: 0.36; p=0.03). In maternal-side placental samples the expression level did not differ between PE and healthy pregnancies (p=0.1). Conclusion: These results demonstrate a differential expression of Hsa-miR-517a/b within placentas in pregnancies affected by PE and between placentas from PE and healthy pregnancies. Further studies are required to investigate a possible role for Hsa-miR-517a/b in the pathogenesis of PE.

Prenatal blood levels of some toxic metals and the risk of spontaneous abortion.

High-level toxic metal exposure has become rare in the recent years. Although, it has not known whether relatively lower exposure may adversely affect human reproductive system. Spontaneous abortion (SA) is a serious reproductive problem, which, in many cases, the cause(s) is not clearly understood. To assess the relationship between prenatal blood level of metals and SA risk, we compared blood concentration of some heavy metals in samples taken from mothers recruited in Tehran Environment and Neurodevelopmental Defects (TEND) study conducted on apparently healthy pregnant women in Tehran, Iran who subsequently experienced spontaneous abortion with mothers who their pregnancy ended to live births. During early gestation, 206 women were enrolled to the survey and followed up till fetal abortion or baby deliveries occur. Blood metal concentrations were measured using an inductively coupled plasma mass spectrometer. The mean blood levels of lead, antimony, and nickel were higher in SA than ongoing pregnancy; however, this difference was not statistically significant. When adjusted for covariates, the logistic regression analysis showed significant association between maternal age and the risk of SA in all models. Among toxic metals only antimony had a noticeable positive relation with the risk of SA (OR: 1.65, 95% CI:1.08-2.52, P value: 0.02). Pearson's correlation coefficient showed significant (P < 0.05) positive correlations among prenatal blood metals levels, except for nickel. Although the present study failed to provide strong evidence for the effects of toxic metals on the occurrence of SA at the relatively low-levels, these metals should be avoided in women who plan pregnancy and/or during the early stages of gestation to prevent the chance of adverse effects.

Mothers and their children's health (MATCH): a study protocol for a population-based longitudinal cohort.

BACKGROUND: The quality of prenatal care is critical for the prevention of adverse pregnancy outcomes. However, according to the World Health Organization (WHO), only 64 % of women worldwide have access to over four sessions of prenatal care throughout their pregnancy. Thus, studies that address factors affecting maternal and child health status before and after pregnancy are of immense importance. The primary aim of the mothers and their children's health (MATCH) cohort study is to evaluate the effect of nutrition, sleep quality, and lifestyle on maternal and neonatal outcomes. METHODS: A prospective cohort of > 2500 pregnant women in the first trimester (before 12 weeks' gestation) will be recruited at Arash Women's Hospital in Tehran, Iran between February 2020 and August 2021. All eligible pregnant women will be followed from their first trimester of pregnancy until delivery at four time points and assessed through a series of in-person visits with interviewer-administered questionnaires and telephone interviews. Detailed data will be collected on maternal demographics, lifestyle, medical history, reproductive history, obstetric history, dietary intake, sleep pattern, blood specimens, and anthropometric measurements, alongside paternal demographics, lifestyle, and family history. The outcomes will include antenatal, peripartum, and postnatal maternal complications and infant growth and neurodevelopment. DISCUSSION: The results of the MATCH cohort study will support the development of contextual interventions that can enhance antenatal, peripartum, and postnatal status, neonatal outcomes, and longevity mother and child.

CREB-binding protein (CREBBP) and preeclampsia: a new promising target gene.

Preeclampsia (PE) is a major complication of pregnancy and remains a leading cause of neonatal and maternal mortality worldwide. Several studies have revealed that the incidence of preeclampsia is high in mothers who carried a fetus with Rubinstein-Taybi Syndrome due to the mutation in CREBBP. We aimed to compare the expression level of the CERBBP gene between preeclamptic and healthy placenta in our study. The expression level of CREBBP gene was evaluated in a total of one hundred placental biopsies from PE patients and healthy pregnant women after delivery using quantitative real-time polymerase chain reaction (qRT-PCR). Moreover, the differential expression of CREBBP was assessed between the maternal and fetal sides of the placenta. Expression of the CREBBP gene was higher in preeclampsia patients compared with the controls (Fold change = 2.158; P = 0.018). Moreover, the gene expression was slightly higher in the fetal side of the placenta, although it was not significantly different (Fold change = 1.713, P = 0.254). Our findings show a role for CREBBP in the pathogenesis of PE. Due to the important role of CREBBP in angiogenesis and hypoxia, the gene may serve as a promising target in future studies.

Maternal and fetal effects of COVID-19 virus on a complicated triplet pregnancy: a case report.

BACKGROUND: Coronavirus disease 2019 (COVID-19), the global pandemic that has spread throughout the world, is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the limited scientific evidence on the manifestations and potential impact of this virus on pregnancy, we decided to report this case. CASE PRESENTATION: The patient was a 38 year-old Iranian woman with a triplet pregnancy and a history of primary infertility, as well as hypothyroidism and gestational diabetes. She was hospitalized at 29 weeks and 2 days gestational age due to elevated liver enzymes, and finally, based on a probable diagnosis of gestational cholestasis, she was treated with ursodeoxycholic acid. On the first day of hospitalization, sonography was performed, which showed that biophysical scores and amniotic fluid were normal in all three fetuses, with normal Doppler findings in two fetuses and increased umbilical artery resistance (pulsatility index [PI] > 95%) in one fetus. On day 4 of hospitalization, she developed fever, cough and myalgia, and her COVID-19 test was positive. Despite mild maternal symptoms, exacerbated placental insufficiency occurred in two of the fetuses leading to the rapid development of absent umbilical artery end-diastolic flow. Finally, 6 days later, the patient underwent cesarean section due to rapid exacerbation of placental insufficiency and declining biophysical score in two of the fetuses. Nasopharyngeal swab COVID-19 tests were negative for the first and third babies and positive for the second baby. The first and third babies died 3 and 13 days after birth, respectively, due to collapsed white lung and sepsis. The second baby was discharged in good general condition. The mother was discharged 3 days after cesarean section. She had no fever at the time of discharge and was also in good general condition. CONCLUSIONS: This was a complicated triplet pregnancy, in which, after maternal infection with COVID-19, despite mild maternal symptoms, exacerbated placental insufficiency occurred in two of the fetuses, and the third fetus had a positive COVID-19 test after birth. Therefore, in cases of pregnancy with COVID-19 infection, in addition to managing the mother, it seems that physicians would be wise to also give special attention to the possibility of acute placental insufficiency and subsequent fetal hypoxia, and also the probability of vertical transmission.

Placental alpha microglobulin-1 (PartoSure) test for the prediction of preterm birth: a systematic review and meta-analysis.

OBJECTIVES: To assess the accuracy of the placental alpha microglobulin-1 (PAMG-1) to predict preterm birth (PB) in women with symptoms of PB through use of formal methods for systematic reviews and meta-analytic techniques. METHODS: We performed a comprehensive search of medical bibliographic databases to identify observational studies that reported on the predictive accuracy of PAMG-1 for PB. Two investigators independently assessed studies, assessed quality of studies, and extracted data. Summary receiver operating characteristic (SROC) curves, pooled sensitivities, specificities, likelihood ratios (LR), and diagnostic odds ratio (DOR) were generated. RESULTS: Seventeen studies involving 2590 women met the inclusion criteria. Meta-analysis of 15 studies (including 1906 women) revealed a pooled sensitivity of 66.2% (95% CI: 59.1, 72.7) and specificity of 96.1% (95% CI: 95.1, 97.0) with the SROC equal to 0.97 (95% CI: 0.95, 0.98) for prediction of delivery within 7 d of testing. The summary estimates were 15.26 (95% CI: 11.80, 19.75) for LR + and 0.31 (95% CI: 0.17, 0.55) for LR - for prediction of delivery within 7 d of testing. Pooled estimate of DOR for predicting delivery within 7 d of testing was 55.13 (95% CI: 35.32, 86.06). The sensitivity, specificity and the SROC of PAMG-1 pooled from 10 studies (including 1508 women) for prediction of delivery within 14 d of testing were 64.4% (95% CI: 56.8, 71.5), 96.9% (95% CI: 95.8, 97.7) and 0.97 (95% CI: 0.95, 0.98). The overall pooled LR + and LR - of PAMG-1 for predicting delivery within 14 d of testing among the included studies were 16.72 (95% CI: 12.03, 23.23) and 0.42.1 (95% CI: 0.31, 0.56), respectively. The pooled DOR of the PAMG-1 for prediction delivery within 14 d of testing was equal to 44.65 (95% CI: 26.30, 75.78). CONCLUSION: Cervical PAMG-1 had a high accuracy to predict PB within 7 and 14 d of testing in symptomatic pregnant women.

A comparison of the effects of Two suture materials on isthmocele formation: A cohort study.

OBJECTIVE: Cesarean scar defects (CSD) are a problem that may lead to complications and excessive cost. The optimal way to suture the uterus is a matter of debate. The aim of this study was to evaluate the effect of two suture materials on cesarean scar niches. STUDY DESIGN: This was a cohort study that allocated women into two groups: uterotomy closure with vicryl or catgut sutures. Transvaginal ultrasound (TVUS) was performed six months after the cesarean section (CS) to assess the scar. RESULTS: Totally, 250 patients enrolled in this study. After six months, 20 (18.2 %) patients in the catgut suture group and 13 (9.3 %) patients in the vicryl group had isthmocele according to their sonography reports. The prevalence of isthmocele was higher in the catgut group (p = 0.03). The residual myometrial thickness was greater in the vicryl group (4.98 cm ± 2.18) compared to the catgut suture group (3.70 cm ± 1.50; p = 0.001). The prevalence of postoperative gynecological sequelae such as postmenstrual spotting and pain were similar between the two groups. CONCLUSION: Vicryl sutures were associated with a lower risk of CSD formation in comparison with catgut sutures.

Platelet-activating factor and antiphospholipid antibodies in recurrent implantation failure.

Recurrent implantation failure (RIF) refers to cases in which women have had the failure of the embryo implantation after several in vitro fertilization (IVF). The success rate for IVF depends on many different factors. Implantation is a complex step in a successful pregnancy. Antiphospholipid antibodies (aPLs) and platelet-activating factor (PAF) can be considered as effective factors in the embryo implantation. The first purpose of this study is to compare the levels of aPLs and PAF among RIF and fertile control women. The second purpose is evaluating correlations between the blood levels of these factors in this two groups. The levels of twelve types of aPL and PAF in peripheral blood samples of RIF and fertile control women were checked with ELISA method. The results showed that levels of Anti Cardiolipin antibody IgG was above the normal level in 3% of RIF patients. This study examined for the first time the correlation between twelve types of aPLs and PAF in RIF and fertile women. The results of these correlations show that the serum levels of aPLs affects themselves and the serum levels of PAF. The correlation of aPLs levels and PAF levels was different in the two groups. Differences in the correlations of aPLs levels and PAF levels in two groups show that the equal changes in the level of variables examined can have different effects in RIF and the fertile control groups. It is suggested that the correlation between these variables be evaluated in other studies.

Contribution of long noncoding RNA HOTAIR variants to preeclampsia susceptibility in Iranian women.

Objective: To investigate the possible association of lncRNA HOTAIR rs920778 and rs874945 polymorphisms with preeclampsia risk in a sample from the Iranian population. Method: The study subjects included 250 preeclamptic women and 250 healthy women. The genotyping for rs920778 and rs874945 polymorphisms were performed using the TP-ARMS-PCR method. Results: HOTAIR rs920778 increased the risk of preeclampsia under the dominant and recessive inheritance patterns (OR = 4.84, 95% CI: 3.30-7.10, P < 0.0001; OR = 6.86, 95% CI: 3.51-13.42, P < 0.0001; respectively). Conclusion: This study confirmed the association of HOTAIR rs920778 polymorphism with preeclampsia in Iranian women. Further studies should be performed to confirm our findings.

Tehran environmental and neurodevelopmental disorders (TEND) cohort study: Phase I, feasibility assessment.

PURPOSE: To advance knowledge about childhood neurodevelopmental disorders and study their environmental determinants, we conducted a study in Tehran, Iran to assess the feasibility of prospective birth cohort study. METHODS: We evaluated participation of pregnant women, feasibility of sampling biological material, and health care services availability in Tehran in four steps: (1) first trimester of pregnancy; (2) third trimester of pregnancy; (3) at delivery; and (4) two to three months after delivery. We collected related data through questionnaires, also various biological samples were obtained from mothers (blood, urine, milk and nails-hands and feet) and newborns (umbilical cord blood, meconium, and urine samples) from February 2016 to October 2017. RESULTS: overall 838 eligible pregnant women were approached. The participation rate was 206(25%) in our study and about 185(90%) of subjects were recruited in hospitals. Out of 206 participants in the first trimester, blood, urine, hand nail, and foot nail samples were collected from 206(100%),193(93%), 205(99%), and 205(99%), respectively. These values dropped to 65(54%), 83(69%), 84(70%), and 84(70%) for the remaining participants 120(58%) in the third trimester, respectively. Also, we gathered milk samples from 125(60%) of mothers at two to three months after delivery. CONCLUSION: Our findings suggest that hospitals were better places for recruitment of subjects in a birth cohort in Tehran. We further concluded that birth cohort study recruitment can be improved by choosing appropriate gestational ages. Obtaining the newborn's urine, meconium, and umbilical cord blood were challenging procedures and require good collaboration between hospital staff and researchers.

An Overview on Guidelines on COVID-19 Virus and Natural and Assisted Reproductive Techniques Pregnancies.

In this article, we reviewed and compared some of COVID-19 and pregnancy guidelines; this can be useful for pregnant women including those with a history of infertility specially those undergone assisted reproductive techniques (ART). The general advice given for prenatal care is to reduce face-to-face visits. All women who refer for prenatal visits should be evaluated for signs of the infection at the time of entry. The triage of suspected women should be done separately from other patients. Outpatient monitoring with a 14-day selfquarantine can be considered for asymptomatic infected women and for those with mild symptoms. Inpatient management criteria include moderate to severe symptoms and the target level of oxygen saturation is 92 to 95% in different guidelines. In the presence of fever, it is important to conduct a thorough examination of other causes of the fever. It is important to monitor fluid intake and output, maintain fluid and electrolyte balance and prevent fluid overload. Thromboembolic prophylaxis is recommended. Corticosteroid administration is based on obstetrics indications, while in critical ill cases, it should be based on multi-disciplinary teams (MDT) decision. A positive COVID-19 result in the absence of other obstetrics causes, cannot be considered an indication for delivery in mild and asymptomatic cases. In critically ill pregnant women, an individualized decision should be made about delivery time by the MDT. General anesthetic should be avoided unless inevitable for standard procedures such as intubation is an aerosol-generating procedure (AGP). There is agreement on the point that babies born to infected mothers, even if isolated from the mother at birth, should be considered a close contact of the mother and tested for COVID-19 and separated from other neonates. Breastfeeding is encouraged and hand hygiene and face mask during feeding are highly recommended by all guidelines.

Maternal and neonatal outcomes in COVID-19 infected pregnancies: a prospective cohort study.

BACKGROUND: Despite the large number of pregnant women with the coronavirus disease 2019 (COVID-19), there is not enough analytical study to compare maternal and fetal consequences of COVID-19 infected with non-infected pregnancies. This cohort study aimed to compare maternal and fetal consequences of COVID-19 infected with non-infected pregnancies. METHODS: We included pregnant women with and without COVID-19 who were admitted to Arash Hospital in Tehran, Iran, from 1 March to 1 September 2020. Clinical features, treatments, and maternal and fetal outcomes were assessed. RESULTS: A total of 199 women enrolled, including 66 COVID-19 infected and 133 non-infected pregnant women prospectively. Caesarean section was carried out in total 105 women (52.76%). A significant difference was found in term of delivery type between COVID-19 infected and non-infected pregnant women [adjusted risk ratio (aRR): 1.31, 95% confidence interval (CI): 1.04, 1.65, P = 0.024]. No significant association was found between COVID-19 infection and preterm birth (aRR: 1.16, 95% CI: 0.54, 2.48, P = 0.689), low birth weight (aRR: 1.13, 95% CI: 0.55, 2.31, P = 0.723), gestational diabetes (aRR: 1.67, 95% CI: 0.81, 3.42, P = 0.160), pre-eclampsia (aRR: 2.02, 95% CI: 0.42, 6.78, P = 0.315), intrauterine growth restriction (aRR: 0.16, 95% CI: 0.02, 1.86, P = 0.145), preterm rupture of membrane (aRR: 0.19, 95% CI: 0.02, 2.20, P = 0.186), stillbirth (aRR: 1.41, 95% CI: 0.08, 18.37, P = 0.614), postpartum haemorrhage (aRR: 1.84, 95% CI: 0.39, 8.63, P = 0.185), neonatal intensive care unit (ICU) admission (aRR: 1.84, 95% CI: 0.77, 4.39, P = 0.168) and neonatal sepsis (aRR: 0.84, 95% CI: 0.48, 1.48, P = 0.568). The percentage of patients (4/66, 6.06%) being admitted to the ICU was significantly higher than the control group (0%) (P < 0.001). CONCLUSION: Basically, although pregnancy and neonatal outcomes were not significantly different, the need for ICU care for pregnant women with COVID-19 was significantly higher compared with those without COVID-19.