Do Postpartum Maternal Iodine Status or Supplementation Affect Thyroid Function After Delivery? A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was, for the first time, to explore whether postpartum maternal iodine status or supplementation is associated with thyroid function after delivery. The MEDLINE/PubMed, Web of Science, Embase, and Scopus were searched up to December 2021 to identify relevant studies. The pooled mean thyroid stimulating hormone (TSH), free thyroxine (fT4), and thyroxine (T4) concentrations and 95% confidence intervals (CIs) were estimated based on maternal urinary iodine concentration (UIC) (< 50, 50-100, 100-200, and > 200 µg/L) or breast milk iodine concentration (BMIC) (< 100 µg/L vs. ≥ 100 µg/L) during postpartum. A fixed/random effects model was used based on the absence/presence of heterogeneity, respectively. The study is registered with PROSPERO, number CRD42022336145. A total of 2175 studies were identified, of which 18 were eligible for the meta-analysis. The pooled values for TSH, fT4, and T4 concentrations in all subgroups were within the normal range; however, except for TSH, comparing the 95% CI showed no statistically significant difference among different subgroups. The pooled mean for TSH concentration in women with UIC > 200 µg/L was 2.23 mIU/L, whereas the corresponding values in women with UIC < 50, 50-100 and 100-200 µg/L were 0.56, 0.56 and 0.95 mIU/L, respectively. Thyroid hormones in women with BMIC < 100 µg/L and ≥ 100 µg/L were within the normal range. Iodine supplementation during postpartum was not associated with any differences in thyroid parameters, compared to non-supplemented women. In conclusion, iodine status or supplementation had no effect on thyroid hormones in postpartum women.

Improving the health status of Afghan mothers living in the Islamic Republic of Iran.

Background: The healthcare system of the Islamic Republic of Iran provides special maternal health care services for mothers, regardless of their nationality. Aim: This study, supported by the United Nations Population Fund, was conducted to review available data associated with health indicators of Afghan mothers living in Islamic Republic of Iran. Methods: This descriptive study used data from the electronic registration system of the Maternal Health Office of the Ministry of Health and Medical Education on characteristics, morbidity and mortality among Afghan mothers in the Islamic Republic of Iran from 2017 to 2019. The data were analysed using SPSS version 23.0. Based on the results, we propose interventions to improve health services for vulnerable Afghan mothers. Results: There were 168 488 deliveries over the 3 years of the study (2017-2019). Deliveries by Afghan women increased from 3.4% in 2017 to 5.2% in 2019, and more than 70% of these Afghan women were vulnerable. Ten percent of deliveries among Afghan mothers were performed by traditional birth attendants. The rate of caesarean section among Afghan mothers was 30%. Maternal mortality ratio among the Afghan mothers was 43 per 100 000 for the 3 years. Conclusion: Afghan mothers in the Islamic Republic of Iran use primary health care services provided for mothers in the country. However, healthcare delivery to these mothers is inadequate, although considered better than the care provided to Afghan mothers living in Afghanistan. We recommend targeted interventions to improve the health status of Afghan women living in the Islamic Republic of Iran.

Effects of iodine supplementation during pregnancy on pregnant women and their offspring: a systematic review and meta-analysis of trials over the past 3 decades.

OBJECTIVE: The current systematic review aimed to provide comprehensive data on the effects of iodine supplementation in pregnancy and investigate its potential benefits on infant growth parameters and neurocognitive development using meta-analysis. METHODS: A systematic review was conducted on trials published from January 1989 to December 2019 by searching MEDLINE, Web of Science, the Cochrane Library, Scopus, and Google Scholar. For most maternal and neonatal outcomes, a narrative synthesis of the data was performed. For birth anthropometric measurements and infant neurocognitive outcomes, the pooled standardized mean differences (SMDs) with 95% CIs were estimated using fixed/random effect models. RESULTS: Fourteen trials were eligible for inclusion in the systematic review, of which five trials were included in the meta-analysis. Although the findings of different thyroid parameters are inconclusive, more consistent evidence showed that iodine supplementation could prevent the increase in thyroglobulin concentration during pregnancy. In the meta-analysis, no differences were found in weight (-0.11 (95% CI: -0.23 to 0.01)), length (-0.06 (95% CI: -0.21 to 0.09)), and head circumference (0.26 (95% CI: -0.35 to 0.88)) at birth, or in cognitive (0.07 (95% CI: -0.07 to 0.20)), language (0.06 (95% CI: -0.22 to 0.35)), and motor (0.07 (95% CI: -0.06 to 0.21)) development during the first 2 years of life in infants between the iodine-supplemented and control groups. CONCLUSION: Iodine supplementation during pregnancy can improve the iodine status in pregnant women and their offspring; however, according to our meta-analysis, there was no evidence of improved growth or neurodevelopmental outcomes in infants of iodine-supplemented mothers.

Supplement Usage Pattern in a Group of COVID- 19 Patients in Tehran.

Objective: The coronavirus disease 19 (COVID-19) is a highly transmittable and pathogenic viral infection, causes severe acute respiratory syndrome and was spread throughout the world in early 2020. The effects of vitamin and micronutrient supplements on the prevention and treatment of COVID- 19 seems challenging in scientific considerations. On the other side generally, experts warn against over-consumption of these supplements. Materials and methods: This study aimed to investigate the vitamin and micronutrient supplementation usage pattern in past history of patients with COVID-19 via a cross-sectional inquiry. Totally 510 patients referring to the infectious disease clinic of Imam Khomeini Hospital in Tehran from March 2020 to May 2020 were recruited. The inclusion criterion was suspected patients for COVID-19 based on clinical findings and CT scans of the lung. The infected patients included both inpatients (171) and outpatients (339). Demographic information, clinical signs, and the supplement pattern use were collected through a questionnaire and the data were statistically analyzed. Results: Vitamin D3 intake was reported in 30% (103 patients) of outpatients and 16.5% (28 patients) of hospitalized patients, which is statistically significant (P=0.001). It shows that, the frequency of vitamin D3 consumption in the outpatient group was higher than inpatient group. This significant difference has also been shown in zinc consumption, in 29 patients (9%) outpatients versus 4 patients (2%) inpatients were reported (P=0.007). Multi nominal regression showed that vitamin D3 intake has a supportive effect and reduces the risk of exacerbation and worsening of the disease. (OR=0.291; 95% CI 0.102-.0834, P=0.022). Conclusion: According to the results of the present study and the findings of other studies, considering the supportive effect of vitamin D3 in reducing the severity of infectious diseases; Clinical trials with an appropriate sample size are recommended to investigate the functional role of this vitamin in improving viral diseases of the respiratory tract.

Exclusive Breastfeeding Duration and its Effect on the Health of the Children in Iran, a Meta Analysis.

PROBLEM: Given the importance of exclusive breastfeeding (EB) duration on growth and to maintain health in children, we decided to systematically review the existing research on EB duration and its effect on the health of 2- to 5-year-old children in Iran. ELIGIBILITY CRITERIA: A systematic literature search was conducted in the Database of Abstracts of Reviews of Effects (DARE), Google Scholar, PubMed, Psyc INFO, Thomson Reuters, Cochrane, and Medical Library (MedLib) to detect appropriate studies (1994 to 2016). Outcomes of mean, mean difference, and proportions were pooled. SAMPLE: In this meta-analysis, 38 studies met the eligibility criteria. RESULTS: The pooled mean of EB was calculated as 4.1 months (CI 95%: 3.2, 4.99). The meta prevalence of EB up to 4 months and 5 to 6 months was estimated 65.0% (CI 95%: 54.0, 77.0) and 54% (CI 95%: 46.0, 62.0) respectively. Based on studies conducted over the years from 1994 to 2016, an increasing trend of EB was found in infants up to 4 months (p ≤ 0.0001). Among children with anemia and respiratory diseases EB until 5 to 6 months was more common than in healthy children (CI 95%; 1.1, 2.11, and 1.01, 1.47 respectively). CONCLUSION: The duration of EB (4.1 months) was equal to the lower limit recommended by the World Health Organization (WHO). Overall, the duration of EB until 5 to 6 months is sufficient if the child's iron intake is well-monitored. IMPLICATION: Monitoring of the implementation of recent guidelines or even modification of the duration period of the iron administration is potentially necessary.

Comparative Study of the Effects of Chamomile (Matricaria Chamomilla L.) and Cabergoline on Idiopathic Hyperprolactinemia: A Pilot Randomized Controlled Trial.

Chamomile is a fascinating plant quoted in several traditional medicine texts, which has broad-spectrum pharmacological activity and medicinal uses. The aim of this study was to assess the efficacy of chamomile syrup in reducing serum prolactin in women with idiopathic hyperprolactinemia. The study was a randomized, controlled clinical trial that was conducted on 56 women with idiopathic hyperprolactinemia for a study period of four weeks. Patients were randomly enrolled in two parallel arms and were treated by chamomile syrup at a dose of 5 mL twice daily or cabergoline tablet orally at a dose of 0.25 mg twice weekly. Serum prolactin levels were measured at baseline and the end of the 4-week study period. Any report of adverse events was also recorded. Results revealed that within the cabergoline group the reduction in the mean prolactin level was significantly greater than that of the chamomile group (p <0.0001). It was also found that decline in the mean prolactin level was statistically significant within the chamomile group (p <0.0001). Chamomile syrup seems to be effective on serum prolactin reduction in women with idiopathic hyperprolactinemia. However, studies with a larger sample size and for a longer follow-up period are recommended.

Risk Factors for Hearing Loss and Its Prevalence in Neonates Older than 6 Months with History of Hospitalization in Intensive Care Unit.

OBJECTIVES: Hearing loss is one of the most important disabilities in neonates. Delay in the detection of hearing loss leads to impaired development and may prevent the acquisition of speech. We aimed to determine the risk factors associated with hearing loss in neonatal patients aged more than 6 months with a history of hospitalization in Neonatal Intensive Care Unit (NICU). METHODS: In this case-control study, screening for hearing loss was carried out on 325 neonates aged 6-12 months referred to Pediatric Neurology Office of Vali-e-Asr Hospital, Tehran, Iran up to 2011. Hearing loss was confirmed using Auditory Brainstem Response screening test (ABR). RESULTS: The prevalence of mildly and moderately hearing loss in neonates was determined as 3.6%. The most significant risk factors for hearing loss in neonates were neonatal icterus associated with phototherapy, respiratory distress syndrome (RDS) and lower Apgar score. CONCLUSION: It seems to quantitative auditory system screening using ABR is necessary for all neonates; because rehabilitation support such as speech therapy and hearing training in this age period is more effective than older ages.

The effect of a short course of moderate pressure sunflower oil massage on the weight gain velocity and length of NICU stay in preterm infants.

OBJECTIVE: The aim of this study was to evaluate the efficacy of five-day course of sunflower oil massage with moderate pressure on the weight gain and length of NICU stay in preterm infants. METHODS: Forty-four healthy preterm infants with a corrected gestational age of 30-36 weeks at the time of the study, were randomly assigned to the study group receiving body massage with sunflower oil and the control group receiving only routine NICU care. The massage was performed three times per day, each session including three consecutive five-minute stages, for five days. The primary outcome was to evaluate the efficacy of a short course of moderate pressure sunflower oil massage on the weight gain velocity. The secondary outcome was to compare the length of NICU stay between the two groups. RESULTS: During the study period, the increase in the average daily and fifth-day weight gain was significant in the intervention group. The length of NICU stay was shorter in the intervention group significantly. CONCLUSION: Our findings suggest that even a short course of body massage with sunflower oil for only five days increases preterm infants' weight gain and decreases their duration of NICU stay significantly.

Is early breast milk fortification more effective in preterm infants?: a clinical trial.

OBJECTIVE: Breast feeding alone does not provide adequate nutrition for growth in preterm infants; therefore, fortifiers are added when over 70-80 cc/kg/day of breast milk is tolerated. As there are few studies comparing early and late breast milk fortification, the following study was conducted. STUDY DESIGN: This double-blind clinical trial was performed on 80 preterm infants (gestational age of 28-34 weeks, birth weight <2 kg). The newborns were randomly divided into two groups to receive either early or late fortification. The primary and secondary outcomes were the difference in growth indices and complications (including feeding intolerance, necrotizing enterocolitis (NEC), and septicemia) between the two groups, respectively. RESULTS: Both groups showed increases in growth indices; however, there was no statistically significant difference in increments of growth indices and complications between the two groups. CONCLUSION: Our findings suggest that early fortification from the first feeding in neonates with exclusive breast feeding did not improve growth in the first 4 weeks in preterm neonates in comparison with late fortification; so early fortification may not be cost effective.

The efficacy of early iron supplementation on postpartum depression, a randomized double-blind placebo-controlled trial.

PURPOSE: Evaluating early iron supplementation in non-anemic mothers with postpartum depression (PPD). METHODS: This randomized, double-blind, placebo-controlled trial evaluated 70 mothers with PPD. One week after delivery, the mothers were randomly allocated in the iron-treated (50 mg elemental iron/daily) and placebo-treated groups. After 6 weeks, the improvement of PPD symptoms was compared between the groups. RESULTS: Ferritin significantly increased in the iron-treated group (p < 0.001), but not in the placebo group (p = 0.09). After intervention, ferritin was higher in the iron-treated group (medians: 78.2 vs. 37 mg/dl, p = 0.01). The rate of iron deficiency significantly decreased in the iron-treated group (p = 0.009), but not in the placebo group (p = 0.4). After intervention, the rate of iron deficiency was higher in the placebo group (31.4 vs. 8.5 %, p = 0.01). The Edinburgh Postnatal Depression Scale (EPDS) score significantly decreased in the iron-treated group (p < 0.001), but not in the placebo group (p = 0.13). After intervention, the EPDS score was lower in the iron-treated group (medians 9 vs. 12, p = 0.01). The improvement rate for PPD was significantly higher in the iron-treated group (42.8 vs. 20 %, p = 0.03). After intervention, mothers with continued PPD had lower ferritin than the improved mothers (41.8 vs. 67 mg/dl, p = 0.03). Mothers with continued depression had higher rate of iron deficiency compared to the improved mothers (27.1 vs. 4.5 %, p = 0.02). CONCLUSIONS: Early iron supplementation in mothers with PPD significantly improves the iron stores and causes a significant improvement in PPD with a 42.8 % improvement rate during 6 weeks. Continued PPD might be related to the lower postpartum ferritin levels in untreated mothers.

Positive effects of low intensity recorded maternal voice on physiologic reactions in premature infants.

OBJECTIVE: To evaluate the effect of low intensity recorded maternal voice on the physiologic reactions of healthy premature infants in the neonatal intensive care unit (NICU). METHODS: Physiologic responses of 20 healthy preterm infants in the NICU of Shariati Hospital, Tehran, were obtained during a 15min intervention including three 5min periods (no-sound control, audio recorded playback of mother's voice, no-sound post-voice). The intervention was presented three times a day for three consecutive days. During each intervention, oxygen saturation (%, OSPR), heart rate (HR), and respiratory rate (RR) were recorded at 1min intervals over the 15min and then averaged over each 5min period, resulting in 3 averages for each variable for each intervention. RESULTS: Repeated Measures Analysis of Variance were employed to examine each variable separately. Over the three days, comparison of oxygen saturation over each of the three periods (before, during voice, after) revealed an increase in oxygen saturation during the voice period, compared to the pre-voice period, which persisted over the post-voice period; there were no differences between the voice and post-voice periods. Analyses of the HR and RR data showed a decrease in both variables during the voice period compared to the pre-voice period which persisted over the post-voice period. Again, there were no differences between the voice and post-voice periods. CONCLUSION: Exposure to low intensity recorded maternal voice has positive effects on the preterm infants 'physiologic responses.

Evaluation of Serum Zinc Levels in Hyperbilirubinemic Neonates Before and After Phototherapy.

BACKGROUND: The existing therapeutic methods for neonatal jaundice are costly, time-consuming and potentially risky. Zinc salts can reduce phototherapy duration by precipitating unconjugated bilirubin in the intestine (bilirubin and zinc can form a complex in physiologic pH); however, zinc toxicity is an issue that must be considered since theoretically bilirubin reduction by phototherapy may increase serum zinc levels, making additional zinc supplementation the potential cause of zinc toxicity. OBJECTIVES: So, our purpose was evaluating the serum zinc level alterations before and after phototherapy, in hyperbilirubinemic newborns. MATERIALS AND METHODS: A prospective cohort study was performed at the children's medical center of Tehran University of Medical Sciences from 2012 to 2014. Healthy, full-term exclusively breast fed newborns with non-hemolytic jaundice were enrolled in the study. Participants were divided into two groups based on serum bilirubin levels (TSB < 18 mg/dL and TSB ≥ 18 mg/dL) at admission. Pre- and post-phototherapy total serum zinc level was measured before and 12 - 24 hours after termination of phototherapy. RESULTS: Phototherapy was associated with a significant increase in the serum zinc level in neonates with severe hyperbilirubinemia (TSB ≥ 18 mg/dL) but not in those with mild-moderate hyperbilirubinemia (TSB < 18 mg/dL). In addition, phototherapy caused a significant increase in the rate of zinc with potentially toxic levels (zinc > 200) in only neonates with severe hyperbilirubinemia. CONCLUSIONS: Phototherapy increases serum zinc level by reducing bilirubin level so that additional supplementation of this element can lead potentially to zinc toxicity.

Effects of baby massage on neonatal jaundice in healthy Iranian infants: A pilot study.

OBJECTIVE: To evaluate the effects of baby massage on transcutaneous bilirubin levels and stool frequency of healthy term newborns. METHODS: This Pilot study was conducted on 50 healthy newborns in Valiasr Hospital of IKHC. The infants were randomly allocated to two treatment (massage) and control group. The massage group received massage therapy (according to Touch Therapy) for four days from the first day postnatal while the control group received routine care. Main variable studied were transcutaneous bilirubin level (TCB) and stool frequency which were compared in two groups. RESULTS: There were 50 newborns in the study 25 in each group (50%). There was a significant difference in the TCB levels between two groups (p=0.000) with those in the massage group having lower bilirubin levels. As for the stool frequency there was a significant difference in two groups on the first day showing more defecation in the control group (p=0.042) which on the consequent days was not significant and the frequencies were almost similar. CONCLUSION: Massage group had a lower transcutaneous billirubin levels compared to the control group, thus, these pilot results indicate that massaging the newborns can be accompanied by a lower bilirubin level in the healthy term newborn.

The effects of two different breastfeeding workshops on improving knowledge, attitude, and practice of participants:a comparative study.

Health professionals play crucial roles on the self-confidence of nursing mothers and their knowledge of breastfeeding. The aim of this study was a comparison of two different breastfeeding workshops on participants' knowledge, attitude, practice (KAP) and related factors. A cross-sectional study took place in Fetal and neonatal Research Centre (2011- 2012). The intervention composed of two different training courses in breastfeeding. Two workshops were held during three days in two parts: lectures and practical. Each speech regarded the most important aspects of breastfeeding. In training part, a breastfeeding consultant managed the practical exercises. In the second workshop the lecturers used different methods (didactic, strategies to enhance active involvement, educational devices and so on). A questionnaire was used to evaluate participants' KAP before and after each workshop. Among 40 participants in the first workshop, the average age was 37.78 years old, 32 were midwives-nurses and 8 were GPs-residents. Twenty six had children from which 19 breastfed successfully. Of 27 participants in a second workshop with an average age of 38.59 years, 19 were midwifes-nurses. Fourteen reported having children from which 11 breastfed successfully. Our data showed that both workshops improved participants' KAP scores significantly. No significant differences were seen between two groups' attitude before workshops (P. Value =0.093) but this difference, after the workshop was noticeable (P. Value =0.000). The pertained background factors in changing KAP were: having children, successful breastfeeding experience and age (P. Value< 0.05). In-service breastfeeding training program improves KAP; however, the interactive, practical method is much more effective in changing attitudes of participants.

Frequency of exclusive breastfeeding and its affecting factors in Tehran, 2011.

This study was designed to assess the frequency of exclusive breastfeeding in two health centers of Shahid Beheshti University of Medical sciences in Khak Sefid, Tehran, Iran. A total of 175 mothers, referred for the third dose of their infants' DPT vaccination program participated in the study by completing a questionnaire regarding characteristics of their pregnancy, delivery and exclusive breastfeeding within the first six months of birth. Two-variable analysis and logistic regression test were applied to evaluate factors influencing exclusive breastfeeding. Results indicated that the frequency of exclusive breastfeeding, i.e., breastfeeding within the first six months of birth without the use of any other food with or without vitamin supplementation, was 31.17% (95% CI=23.77%-38.57%), which means 48 infants of 154<179 days old Among 154 infants (<179 days old) 48 did not have a history of being separated from their mothers. In logistic regression analysis, the variables which were directly associated with exclusive breastfeeding, with 0.05 significance level of alpha, included breastfeeding within the first hour of birth, eight times or more breastfeeding per day and receiving breastfeeding education during pregnancy. Variables with a negative association with breastfeeding included lack of breast milk, presence of a breast problem that could hinder breastfeeding, bottle feeding, physician or family's advice not to breastfeed and infant's refusal to breastfeed. Frequency of breastfeeding within the six months of birth is less than similar frequencies which are obtained by asking about breastfeeding on the day of the interview. It is recommended to apply real frequency for assessment, evaluation and programming of exclusive breastfeeding during the first six months of birth.

Neonatal urinary tract infection: clinical response to empirical therapy versus in vitro susceptibility at Bahrami Children's Hospital- Neonatal Ward: 2001-2010.

Urinary tract infection (UTI) is a neonatal life threatening infection which is usually treated with ampicillin plus an aminoglycoside or a third-generation cephalosporin. Recently, growing number of Escherchia coli species resistant to ampicillin and aminoglycosides have raised concerns regarding the necessity to change the empirical therapy. This motivates us to determine neonatal UTI clinical response to the used empirical antibiotics. This study was designed as a Case Series. All neonates admitted to Bahrami Children Hospital, Tehran, Iran, during 2001- 2010 with a diagnosis of UTI surveyed by simple non-random sampling. Totally, 97 cases (including 83 (85.6%) term, 8 (8.2%) post-term and 6 (6.2%) preterm neonates) with a mean age of 15.85 ± 7.05 days at admission ,average weight of 3195.57 ± 553g at birth and 3276.29 ± 599.182 g at admission were studied. Ampicillin resistance in 93 cases (95.9%), gentamicin resistance in 51 cases (52.6%) and trimethoprim- sulfamethoxazole resistance in 44 cases (45.4%) were the leading resistances in this study. Escherichia coli was the dominant organism in 76.3% (74 patients) of study population which was resistant to ampicillin in 95.9% (71 cases). Despite the observed resistant to initial empirical regimen antibiotics (especially ampicillin), 81.4% of patients responded to empirical therapy. However, we believe till conductance of more detailed studies regarding the relationship between empirical therapy and antibiogram concordance, physicians take ampicillin-resistant E coli infection issue into accounts from the first steps of management of critically ill neonates.

Prevalence of maternal vitamin D deficiency in neonates with delayed hypocalcaemia.

Maternal vitamin D deficiency is one of the major risk factors for neonatal vitamin D deficiency followed by neonatal hypocalcaemia. The aim of this study is to determine the relationship between delayed neonatal hypocalcaemia and maternal vitamin D deficiency. This is a descriptive cross-sectional study. Target population of this study included all term and preterm neonates with delayed hypocalcaemia (after the first 72 hours of birth) admitted to Ali-Asghar Hospital. The sample size was 100 neonates included in the study. Demographic, clinical and paraclinical data including Ca, P, PTH and level of maternal and neonatal vitamin D were recorded according to patients records. 67 neonates (67%) were term and 33(33%) were preterm neonates. The mean of serum calcium in neonates was 6.49± 0.68mg/dL (in the range of 4.3-7.8 mg/dL). 85% of neonates and 74% of mothers had vitamin D deficiency. 100% of neonates born to mothers with vitamin D deficiency were hypocalcaemia. A statistically significant difference was seen between the mean values of serum Ca (6.67 in term vs. 6.12 in preterm neonates) and vitamin D in term and preterm neonates was 16.34 vs. 20.18 (P= 0.0001 and P=0.01 respectively). Also, a significant correlation was seen between maternal and neonatal level of vitamin D (P=0.0001, r=0.789). With regard to the socio-cultural status in Iran besides women's clothing style and nutritional deficiencies before and during pregnancy, health authorities and policy makers are responsible to focus their serious attention on hypocalcaemia and hypovitaminosis D in neonates.

Effects of calcium supplement therapy in women with premenstrual syndrome.

OBJECTIVE: Scientific evidence suggests that cyclic fluctuations in a variety of nutrients, especially calcium, may help to explain some features of premenstrual syndrome (PMS). We determined the efficacy of calcium supplementation in women suffering from PMS. MATERIALS AND METHODS: A double-blind clinical trial was designed to evaluate the effect of calcium supplement therapy on PMS symptoms. The study groups were selected from young female college students, based on PMS criteria. The subjects were divided in two groups; one group received placebo and the other received 500 mg of calcium carbonate twice daily for 3 months. The severity and intensity of symptoms, including early fatigability, changes in appetite, and depression, were evaluated using a standard questionnaire. Symptoms were compared before and after treatment. RESULTS: The mean age was 21.4 +/- 3.6 years. Early tiredness, appetite changes, and depressive symptoms were significantly improved in the group receiving calcium treatment compared with the placebo group. CONCLUSION: Our results showed that calcium supplements reduced early fatigability, changes in appetite, and depression in women with PMS.