A thirty-year analysis of cesarean section rate in gestational diabetes and normal pregnant population in Tehran, Iran: a concerning trend.

BACKGROUND: The aims of this study were to analyze the trend of cesarean section (CS), determining possible risk factors and also comparing the rate of CS in mothers with gestational diabetes (GDM) and normal pregnant population. MATERIALS AND METHODS: A hospital-based midwives data collection including 37,997 pregnancies in Tehran was used for this study. The study population included all women giving birth between 1 January 1980 and 31 December 2009. RESULTS: The global rate for CS was 37.8 and 85.9% in normal pregnant population and GDM subjects, respectively. An increase in the rate of CS was observed in normal population from 16.97% during 1980-1989 to 71.08% during 2000-2009. There was a similar upward trend for GDM subjects from 79.17 to 93.55%. The most frequent indications for CS in GDM subjects were unsuccessful induction (31%) and repeat CS (22.76%). CONCLUSION: The rate of CS is surprisingly very high in normal pregnant population as well as subjects with GDM. This should be an alarming issue for healthcare policy-makers and a trigger for monitoring situation in the country.

Impact of maternal zinc status on fetal growth in an Iranian pregnant population.

BACKGROUND: To evaluate the impact of mild to moderate maternal zinc deficiency on birth weight of offsprings in a group of Iranian pregnant population. MATERIALS AND METHODS: One hundred forty pregnant subjects with no history of medical complications during pregnancy and without any inter-current illness enrolled in the study. Serum zinc concentration, ferritin, hemoglobin, iron, and total iron binding capacity (TIBC) were measured at the time of delivery. The receiver operator characteristic (ROC) curve analysis used to determine plasma zinc cutoff value for comparison. RESULTS: Of 140 live neonates, 30% were below 2500 g. Mean serum zinc concentration was 56.60 ± 17.91 µg/dl which indicated mild to moderate zinc deficiency. None of the subjects were anemic. There was an inverse statistically significant relationship between maternal serum zinc concentration and neonatal birth weight. CONCLUSION: In this group of Iranian pregnant subjects with mild to moderate zinc deficiency, we observed no relationship between low maternal zinc status and low birth weight infants.

Rise in cesarean section rate over a 30-year period in a public hospital in Tehran, Iran.

BACKGROUND: Numerous studies show a growing trend in cesarean section rates throughout the world, including Iran. However, existing evidence in our country is scant and previous reports are restricted to short time periods. The aim of the current study is to measure the trend in cesarean sections (CS) rates over the past 30 years in a referral hospital in Tehran. METHODS: We routinely collected data on the demographic characteristics of all women who gave birth in the hospital during the study period. The mode of delivery and the personnel in charge of delivery has likewise been recorded for each birth during the study period. The data were extracted from medical records and entered into a structured checklist. RESULTS: The rate of CS out of all deliveries increased from 14.3% in 1979 to 22.7% in 1989, 52.5% in 1999, and 85.3% in 2009 (P < 0.001). The most common reason for CS was a repeated section. The percentage of vaginal deliveries performed by midwives has not changed significantly and the number of both midwives and obstetricians per 1000 births has increased, from 2.8 to 15.4 midwives per 1000 births and from 5.5 to 23.0 obstetricians per 1000 births. CONCLUSION: Immediate strategies should be adopted to prevent the rising trend and increasing number of unnecessary CS in Iran.