Comparison of Phototherapy Effect with and without Phenobarbital on the Newborns with Hyperbilirubinemia.

Objectives: Jaundice occurs in 60% of full-term and 80% of pre-term newborns. This study compared the effect of phototherapy with and without phenobarbital on icteric newborns. Materials & Methods: This study is a randomized clinical trial conducted from July until March 2018 at Imam Reza Hospital, Mashhad University of Medical Science, Iran. Full-term and near-term neonates with more than 2000 grams who were hospitalized in the mentioned period for jaundice were entered into the study. The newborns were divided into two groups using block randomization. Data were analyzed by SPSS version 19. Results: The average gestational age was 36.4 weeks (SD 2.39) in the intervention group and 36.9 weeks (SD 2.16) in the control group, with no significant difference between them. The mean hospital stay for the intervention group was 72 hours (SD 1.66), compared to 55 hours (SD 1.88) for the control group. At discharge, the serum bilirubin level in the intervention group was 11.53 mg/dL (SD 0.77), while it was 10.80 mg/dL (SD 1.09) in the control group, a statistically significant difference. Conclusion: According to this study, phototherapy with phenobarbital is not more effective than phototherapy alone in neonatal hyperbilirubinemia.

A comprehensive study of modified three-month pediatrics training curriculum at Shahid Beheshti University of Medical Sciences and its impact on student satisfaction.

OBJECTIVES: Continuous curriculum improvements reveal the dedication of policy-makers to raising the quality of education and student learning. This study aims to report the impact of curriculum changes to the three-month pediatric course curriculum at Shahid Beheshti University of Medical Sciences (SBMU) on the satisfaction levels of medical students. METHODS: One hundred eighteen 4th-5th years medical students, who had completed their pediatric clinical rotation in SBMU-affiliated teaching hospitals including Mofid Children Hospital, Loghman Hakim Hospital, Shohada-e-Tajrish Hospital, and Imam Hossein Hospital from January to December 2022 were included in this cross-sectional study. After obtaining informed consent, a questionnaire was sent out to all participants, that included 27 statements about the impact of the modified curriculum on their satisfaction with their learning and performance. SPSS version 22 was used to analyze the data. RESULTS: The level of satisfaction of trainees from attending clinics was 82-56%, prior introduction to the course was about 82%, and attending general hospitals (all hospitals except Mofid Children hospital, which is the only children hospital affiliated to SBMU) was 82-97%. The quality of patients-based learning was reported in terms of attendance at morning report sessions which was 92.3%, attendance at ward rounds, which was 71.8%, and attendance at clinics, which was 62.4%. The satisfaction rate from the senior attending mentor was 96.5%. The satisfaction rate of the pathology course was 67.2%, and the radiology was 82.4%. The satisfaction level of medical students from the infectious disease department was 70% and the gastroenterology department was 83.8%. The level of satisfaction with the implementation of the twelve-week program was 68.7%, with the expressiveness and usability of the presentation of materials was 53.9%, with the compatibility of the exams with the presented materials was 92%, and withholding weekly exams was 86.8%. The satisfaction rate of using the materials presented in the final exam in the digestive department and the infectious department was 85% and 68%, respectively. The overall satisfaction rate of the training course was 76.66%. CONCLUSION: The results provide vital insights for improving medical education. According to this study, medical student satisfaction with the pediatric curriculum after its recent revisions was in a satisfactory range. Attendance at clinics, information sharing, patient-based learning, practical training, attending mentorship, curriculum clarity, and alignment with student expectations all contributed to participants' high levels of satisfaction.

Prediction of breath-holding spells based on electrocardiographic parameters using machine-learning model.

BACKGROUND: Breath-holding spells (BHS) are common in infancy and early childhood and may appear like seizures. Factors such as autonomic dysfunction and iron deficiency anemia are thought to contribute to the incidence of BHS. In this study, electrocardiographic (ECG) parameters of patients with BHS were compared to those of healthy, normal children. Logistic regression and machine-learning (ML) models were then created to predict these spells based on ECG characteristics. METHODS: In this case-control study, 52 BHS children have included as the case and 150 healthy children as the control group. ECG was taken from all children along with clinical examinations. Multivariate logistic regression model was used to predict BHS occurrence based on ECG parameters. ML model was trained and validated using the Gradient-Boosting algorithm, in the R programming language. RESULTS: In BHS and control groups, the average age was 11.90 ± 6.63 and 11.33 ± 6.17 months, respectively (p = .58). Mean heart rate, PR interval, and QRS interval on ECGs did not differ significantly between the two groups. BHS patients had significantly higher QTc, QTd, TpTe, and TpTe/QT (all p-values < .001). Evaluation of the ML model for prediction of BHS, fitting on the testing data showed AUC, specificity, and sensitivity of 0.94, 0.90, and 0.94 respectively. CONCLUSION: There are repolarization changes in patients with BHS, as the QTc, QTd, TpTe, and TpTe/QT ratio were significantly higher in these patients, which might be noticeable for future arrhythmia occurrence. In this regard, we developed a successful ML model to predict the possibility of BHS in suspected subjects.

Non-Pharmacologic Interventions in COVID-19 Pandemic Management; a Systematic Review.

Introduction: Different countries throughout the world have adopted non-pharmacologic interventions to reduce and control SARS - CoV-2. In this systematic approach, the impact of non-pharmacologic interventions in management of COVID-19 pandemic was assessed. Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, systematic search was carried out on the basis of a search strategy on PubMed, Web of Science, Scopus, and WHO databases on COVID-19. The impact of travel ban, personal protective equipment, distancing, contact tracing, school closure, and social distancing and the combined effect of interventions on COVID-19 were assessed. Results: Of the 14,857 articles found, 44 were relevant. Studies in different countries have shown that various non-pharmacological interventions have been used during the COVID-19 pandemic. The travel ban, either locally or internationally in most of the countries, movement restriction, social distancing, lockdown, Personal Protective Equipment (PPE), quarantine, school closure, work place closure, and contact tracing had a significant impact on the reduction of mortality or morbidity of COVID-19. Conclusion: Evidence shows that the implementation of non-pharmacologic interventions (NPIs), for this study suggests that the effectiveness of any NPI alone is probably limited, thus, a combination of various actions, for example, social distancing, isolation, and quarantine, distancing in the workplace and use of personal protective equipment, is more effective in reducing COVID-19.

Development and evaluation of a customized checklist to assess the quality control of disease registry systems of Tehran, the capital of Iran in 2021.

BACKGROUND: Clinical registries facilitate medical research by providing 'real data'. In the past decade, an increasing number of disease registry systems (DRS) have been initiated in Iran. Here, we assessed the quality control (QC) of the data recorded in the DRS established by Shahid Beheshti University of Medical Sciences in Tehran, the capital city of Iran, in 2021. METHODS: The present study was conducted in two consecutive qualitative and quantitative phases and employed a mixed-method design. A checklist containing 23 questions was developed based on a consensus reached following several panel group discussions, whose face content and construct validities were confirmed. Cronbach's alpha was calculated to verify the tool's internal consistency. Overall, the QC of 49 DRS was assessed in six dimensions, including completeness, timeliness, accessibility, validity, comparability, and interpretability. The seventy percent of the mean score was considered a cut-point for desirable domains. RESULTS: The total content validity index (CVI) was obtained as 0.79, which is a reasonable level. Cronbach's alpha coefficients obtained showed acceptable internal consistency for all of the six QC domains. The data recorded in the registries included different aspects of diagnosis/treatment (81.6%) and treatment quality requirements outcomes (12.2%). According to the acceptable quality cut-point, out of 49 evaluated registries, 48(98%), 46(94%), 41(84%), and 38(77.5%), fulfilled desirable quality scores in terms of interpretability, accessibility, completeness, and comparability, however, 36(73.5%) and 32(65.3%) of registries obtained the quality requirement for timeliness and validity, respectively. CONCLUSION: The checklist developed here, containing customized questions to assess six QC domains of DRSs, provided a valid and reliable tool that could be considered as a proof-of-concept for future investigations. The clinical data available in the studied DRSs fulfilled desirable levels in terms of interpretability, accessibility, comparability, and completeness; however, timeliness and validity of these registries needed to be improved.

Evaluating the efficacy of inhaled amikacin as an adjunct to intravenous combination therapy (ceftazidime and amikacin) in pediatric cystic fibrosis pulmonary exacerbation.

Background: Pseudomonas aeruginosa is the most common microorganism found in the sputum culture of Cystic fibrosis (CF) patients causing the pulmonary destruction. Aminoglycosides have a low diffuse rate from lipid membranes, and respiratory system secretions. Regarding the burden of pulmonary exacerbation caused by the pseudomonas aeruginosa in cystic fibrosis patients in the long term and the limited number of clinical trials focused on appropriate treatment strategies, the present study evaluated the concurrent inhaled and intravenous aminoglycoside antibiotics for pulmonary exacerbation caused by the pseudomonas aeruginosa as a safe and effective treatment in children. Method: This study was a blinded, randomized clinical trial phase conducted in a tertiary referral pediatric teaching hospital from May 2021 to May 2022. The patients were randomly allocated to receive intravenously administered ceftazidime and Amikacin alone or with inhaled Amikacin. Forced expiratory volume (FEV1), Amikacin via the level, kidney function tests, audiometry, inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), hospital stay, and bacterial eradication rate were compared in two therapy groups. Results: the average FEV1 has increased by 47% in Neb + group compared to Neb- group following treatment. Hospital stay was lower in Neb + group. No renal toxicity or ototoxicity was observed in both therapy groups. Pseudomonas aeruginosa eradication rate Neb- and Neb + groups were 44% and 69%, respectively (p-value = 0.15). Conclusion: Concurrent inhaled and intravenous Amikacin is safe and effective to treat Pseudomonas aeruginosa exacerbation in CF patients. Moreover, co-delivery antibiotics' route treatment increased the eradication rate. Although not statistically significant, never the less, it is clinically relevant. The intervention reduced the length of hospitalization in this group. Clinical Trial Registration: clinicaltrials.gov, identifier [IRCT20120415009475N10].

Evaluation of the heart sounds in children using a Doppler Phonolyser.

BACKGROUND: Heart auscultation is an easy and inexpensive tool for early diagnosis of congenital heart defects. In this regard, a simple device which can be used easily by physicians for heart murmur detection will be very useful. The current study was conducted to evaluate the validity of a Doppler-based device named "Doppler Phonolyser" for the diagnosis of structural heart diseases in pediatric patients. In this cross-sectional study, 1272 patients under 16 years who were referred between April 2021 and February 2022, to a pediatric cardiology clinic in Mofid Children Hospital, Tehran, Iran, were enrolled. All the patients were examined by a single experienced pediatric cardiologist using a conventional stethoscope at the first step and a Doppler Phonolyser device at the second step. Afterward, the patient underwent trans-thoracic echocardiography, and the echocardiogram results were compared with the conventional stethoscope as well as the Doppler Phonolyser findings. RESULTS: Sensitivity of the Doppler Phonolyser for detecting congenital heart defects was 90.5%. The specificity of the Doppler Phonolyser in detecting heart disease was 68.9% in compared with the specificity of the conventional stethoscope, which was 94.8%. Among the most common congenital heart defects in our study population, the sensitivity of the Doppler Phonolyser was 100% for detection of tetralogy of Fallot (TOF); In contrast, sensitivity of both the conventional stethoscope and the Doppler Phonolyser was relatively low for detecting atrial septal defect. CONCLUSIONS: Doppler Phonolyser could be useful as a diagnostic tool for the detection of congenital heart defects. The main advantages of the Doppler Phonolyser over the conventional stethoscope are no need for operator experience, the ability to distinguish innocent murmurs from the pathologic ones and no effect of environmental sounds on the performance of the device.

Blood lead level evaluation in children presenting with chronic constipation in Tehran-Iran: a cross-sectional study.

Constipation is a common reason for children seeking medical care worldwide. Abdominal complaints and constipation are also common in lead-poisoned children. This study evaluates the prevalence of abnormal blood lead levels (BLL) among pediatric and adolescent patients and examines the association of constipation with elevated BLL. This was a prospective data collection of patients younger than 18 years old with the chief complaint of constipation seen in the Mofid Children's Hospital gastroenterology clinic and Loghman Hakim pediatric and pediatric gastroenterology clinics were eligible for enrollment in this study. Constipation was defined as infrequent or difficult defecation according to ROME IV criteria lasting 2 months or more. BLL was measured with a fresh capillary whole blood capillary sample. The LeadCare II device assays BLL using an electrochemical technique (anodic stripping voltammetry). A total of 237 patients were enrolled in the study. 122 (51.48%) were female and 115 (48.52%) were male. About one fifth of patients (49; 20.67%) had BLL ≥ 5 µg/dL. The mean BLL in the sample was 3.51 µg/dL. Abdominal pain was the most common symptom accompanying constipation (134; 56%). Multivariate analysis found endoscopic evaluation (P values 0.024, OR 3.646, 95% CI 1.189-11.178), muscle pain (P values 0.020, OR 24.74, 95% CI 1.67-365.83), and maternal education (P values 0.02, OR 4.45, 95% CI 1.27-15.57) with significant differences in groups of patients with normal and elevated BLL. Elevated BLL necessitates an assessment and plans to reduce childhood lead exposure. BLL screening in childhood constipation with refractory chronic abdominal pain may also eradicate the need for invasive procedures like endoscopic evaluation.

Development of a Thalassemia International Prognostic Scoring System (TIPSS).

A prognostic scoring system that can differentiate ß-thalassemia patients based on mortality risk is lacking. We analysed data from 3145 ß-thalassemia patients followed through a retrospective cohort design for the outcome of death. An a priori list of prognostic variables was collected. ß Coefficients from a multivariate cox regression model were used from a development dataset (n = 2516) to construct a formula for a Thalassemia International Prognostic Scoring System (TIPSS) which was subsequently applied to a validation dataset (n = 629). The median duration of observation was 10.0 years. The TIPSS score formula was constructed as exp (1.4 × heart disease + 0.9 × liver disease + 0.9 × diabetes + 0.9 × sepsis + 0.6 × alanine aminotransferase ≥42 IU/L + 0.6 × hemoglobin ≤9 g/dL + 0.4 × serum ferritin ≥1850 ng/mL). TIPSS score thresholds of greatest differentiation were assigned as <2.0 (low-risk), 2.0 to <5.0 (intermediate-risk), and ≥5.0 (high-risk). The TIPSS score was a good predictor for the outcome of death in the validation dataset (AUC: 0.722, 95%CI: 0.641-0.804) and survival was significantly different between patients in the three risk categories (P < 0.001). Compared to low-risk patients, the hazard ratio for death was 2.778 (95%CI: 1.335-5.780) in patients with intermediate-risk and 6.431 (95%CI: 3.151-13.128) in patients with high-risk. This study provides a novel tool to support mortality risk categorization for patients with ß-thalassemia that could help management and research decisions.

The association of fecal calprotectin and respiratory exacerbation in cystic fibrosis patients.

BACKGROUND: CF patients experience several episodes of pulmonary exacerbations and reduction in their lung function progressively. Lung function is not the only diagnostic index by physicians to decide if CF patients require antibiotic therapy following pulmonary exacerbations. Non-invasive fecal indicators are increasingly being used to assess intestinal inflammation. Calprotectin is the most extensively utilized fecal biomarker in recent CF researches. METHODS: In this longitudinal study, 30 CF patients (1-18 years) without current infectious gastroenteritis were recruited from Mofid Children's Hospital and Masih Daneshvari Hospital, Tehran, Iran. Then, fecal calprotectin levels were evaluated before treatment, two weeks after systemic antibiotic administration, as well as recurrence of pulmonary exacerbation after first post-hospital discharge. RESULTS: The initial fecal calprotectin level in CF patients receiving antibiotics was 651.13 ± 671.04, significantly decreasing two weeks after antibiotic therapy and following recurrence (171.81 ± 224.40, 607.93 ± 549.89, respectively; P < 0.01). Following systemic antibiotic treatment, the patient's respiratory and GI symptoms improved (P < 0.01). CONCLUSION: Our findings revealed that fecal calprotectin modifications are associated with CF pulmonary exacerbations and antibiotic treatment could reduce calprotectin levels. Therefore, the fecal calprotectin level could be considered as a diagnostic tool and an index to follow the response to treatment in CF pulmonary exacerbations.

Factors Associated with Infant Mortality Due to Congenital Anomalies: A Population-Based Case-Control Study.

Background: Congenital anomalies are one of the major public health problems and one of the leading cause of infant mortality and morbidity. We aimed to investigate some factors associated with infant mortality due to congenital anomalies in several provinces of Iran. Methods: This case-control study was conducted on 2199 women referring health centers of nine provinces of Iran 2015-2018. Cases were defined as mothers with infant death due to congenital anomalies, and control group comprised of mothers with live birth or infant deaths due to other causes (n=1986). The descriptive data were expressed as percentage and frequency. Factors associated with infant death due to congenital anomalies were evaluated and analyzed at 95% confidence level by logistic regression analysis. Results: The multiple logistic regression analysis reveal that history of cesarean delivery [OR:2.13 ;95%CI (1.58-2.87)], maternal age [OR:1.94 ;95%CI (1.31-2.86)])], area of living [OR: 1.69;95%CI (1.22-2.33)], maternal smoking during pregnancy [OR: 1.41; 95%CI (1.02-1.95)], consanguineous marriage [OR:1.53;95%CI (1.12-2.08)], also low birth weight [OR: 3.09; 95%CI (2.23-4.30)] were significantly associated with infant death due to congenital anomalies. Conclusion: Identification of factors associated with congenital anomalies has been shown to reduce treatment costs and medical complications of neonates. Therefore, genetic counseling and educational programs for high-risk women, and prenatal screening are essential to identify and prevent factors contributing to congenital abnormalities.

Serum matrix metalloproteinase-7 levels in infants with cholestasis and biliary atresia.

BACKGROUND: The aim of this study was to evaluate the serum level of matrix metalloproteinase 7 (MMP7) in infants with cholestasis and the diagnostic values of this biomarker to differentiate biliary atresia (BA) from other causes of cholestasis. METHODS: This multi-center study is conducted during 2 years in Mofid children's hospital and Children's Medical Center, Pediatrics Center of Excellence Tehran, Iran. 54 infants with cholestasis were enrolled in this study with a control group consists of 41 healthy infants with the same age. Serum samples were taken from all these patients to assess serum levels of MMP7, Gamma-glutamyl Transferase (GGT). For each biomarker, we calculated the sensitivity and specificity and other statistical characteristics. RESULTS: There were 89 subjects, 22 patients with BA, 32 patients with non-BA cholestasis and 41 subjects as control group. The mean serum MMP7 levels in BA, non-BA cholestasis and control group was 15.91 ng/ml ± 6.64, 4.73 ng/ml ± 2.59 and 0.49 ng/ml ± 0.33, respectively. The best cut-off point is calculated 7.8 ng/ml for MMP7 and 434.5 U/L for GGT. The area under curve (AUC) for these two markers are 0.988 ± 0.008 and 0.854 ± 0.052, respectively. The sensitivity and specificity of MMP7 to differentiate biliary atresia from nonbiliary atresia cholestasis in our study was 95.5% and 94.5%, respectively. The sensitivity and specificity of GGT was 77.3% and 77.8%, respectively. These results show that the MMP7 has more sensitivity and specificity in differentiation. CONCLUSION: MMP7 demonstrated good accuracy to differentiate biliary atresia from other causes of cholestasis.

Benefits of metformin add-on insulin therapy (MAIT) for HbA1c and lipid profile in adolescents with type 1 diabetes mellitus: preliminary report from a double-blinded, placebo-controlled, randomized clinical trial.

OBJECTIVES: Metabolic control during puberty is impaired in Type 1 Diabetes Mellitus (T1DM) patients due to increased insulin resistance. Metformin is one of the oral medications typically used in type 2 diabetes mellitus to reduce insulin resistance. We aimed to examine the effect of metformin on glycemic indices and insulin daily dosage in adolescents with T1DM. METHODS: The present clinical trial was carried out on 50 adolescents aged 10-20 years with T1DM referred to the Endocrinology Clinic of Mofid Children's Hospital in Tehran for nine months. The patients were randomly divided into two groups. In the first group, metformin was added to insulin therapy, while the second group continued routine insulin therapy combined with placebo. Hemoglobin A1c (HbA1c), weight, BMI, insulin dosage, and blood pressure were measured at the beginning of the study and repeated every three months. Serum lipid profile, creatinine, blood urea nitrogen, and liver enzymes were also measured twice: At the beginning and end of the study (after nine months). RESULTS: The HbA1c level (p<0.001) and insulin dosage (p=0.04) were lower in the metformin group than in the placebo group after nine months. Daily insulin dosage variability was significantly lower in the metformin recipient group (p=0.041). Serum triglyceride, cholesterol, and creatinine were significantly lower in the metformin arm than in the placebo arm (p<0.05). However, metformin did not affect LDL, HDL, liver enzymes, and BUN. CONCLUSIONS: Adjunctive metformin therapy reduces insulin dosage by inhibiting insulin resistance and weight gain. It helps decrease daily insulin dosage variability, which may prevent hypoglycemia. Also, metformin reduces creatinine, preventing renal failure in the long term.

Primary HBB gene mutation severity and long-term outcomes in a global cohort of ß-thalassaemia.

In ß-thalassaemia, the severity of inherited ß-globin gene mutations determines the severity of the clinical phenotype at presentation and subsequent transfusion requirements. However, data on associated long-term outcomes remain limited. We analysed data from 2109 ß-thalassaemia patients with available genotypes in a global database. Genotype severity was grouped as ß0 /ß0 , ß0 /ß+ , ß+ /ß+ , ß0 /ß++ , ß+ /ß++ , and ß++ /ß++ . Patients were followed from birth until death or loss to follow-up. The median follow-up time was 34·1 years. Mortality and multiple morbidity outcomes were analyzed through five different stratification models of genotype severity groups. Interestingly, ß0 and ß+ mutations showed similar risk profiles. Upon adjustment for demographics and receipt of conventional therapy, patients with ß0 /ß0 , ß0 /ß+ , or ß+ /ß+ had a 2·104-increased risk of death [95% confidence interval (CI): 1·176-3·763, P = 0·011] and 2·956-increased odds of multiple morbidity (95% CI: 2·310-3·784, P < 0·001) compared to patients in lower genotype severity groups. Cumulative survival estimates by age 65 years were 36·8% for this subgroup compared with 90·2% for patients in lower genotype severity groups (P < 0·001). Our study identified mortality and morbidity risk estimates across various genotype severity groups in patients with ß-thalassaemia and suggests inclusion of both ß+ and ß0 mutations in strata of greatest severity.

Quality of Life and Related Factors in ß-Thalassemia Patients.

The ß-thalassemias are a group of genetic disorders defined by decreased levels of functional hemoglobin (Hb). In light of pivotal improvements in patient survival, the load of consistent treatment harms patients' quality of life (QOL). This study aimed to determine the QOL in patients with ß-thalassemia (ß-thal) in Iran and identify associated factors. This cross-sectional study was conducted among 1240 patients with ß-thal. Data for this study were obtained from the General, the TranQol (Transfusion-dependent QoL) Standard, and the Multidimensional Scale of Perceived Social Support (MSPSS) questionnaires. The univariate and multivariable linear regression was used in STATA version 14 to identify factors related to QOL. Overall, the QOL score was 103 ± 21.96, and adults had a higher score than children under 15 years old. Emotional health had the highest score (39.96 ± 11.54), and sexual activity in adults (1.87 ± 2.08) and activities related to education in children (10.43 ± 7.46) had the lowest. The multivariable linear regression analysis showed that the age, gender, age of blood transfusion initiation, Hb level, number of underlying diseases, and social support level by family and community significantly impact QOL. In exchange for an increase in comorbidities, patients' QOL decreased by 86.0% [odds ratio (OR) = 0.14, 95% confidence interval (95% CI): 0.04-0.45]. Many factors affecting the QOL can be controlled, so social support, increased Hb levels, regular and timely blood transfusions, and treatment can improve the thalassemia patients' QOL.

Maternal Sleep and Related Pregnancy Outcomes: A Multicenter Cross-Sectional Study in 11 Provinces of Iran.

Objective: Sleep disturbance during pregnancy is one of the most common maternal complaints. Not only does it play a crucial role in a mother's life, but also it comes with a multitude number of complications. This study aimed at assessing the association between sleep disturbance in pregnancy and maternal and child outcomes. Materials and methods: This was a multicenter cross-sectional study, conducted on pregnant women across 11 provinces in Iran in 2018. Sleep disturbance as a composite variable was defined using the principal component analysis based on five questions. Abortion, anemia in the first and third trimester, gestational diabetes, gestational age, glucose tolerance test (GTT), fasting blood sugar (FBS), mode of delivery, low birth weight and stillbirth were defined as study outcomes. Results: Totally, 3675 pregnant women enrolled in the study. Most of the participants (84.5%) reported that their sleep duration is less than 8 hours per day. The prevalence of sleep disturbance was 20.7% (95% CI: 19.1, 22.3). After adjusting for maternal age, education, job, place of residency and physical violence, sleep disturbance would increase the odds of abortion (p=0.009), anemia in both first (p=0.001) and third (p=0.003) trimester, gestational age (p=0.049), abnormal FBS (p=0.015) and cesarean section (p<0.001). Conclusion: Regarding the effect of sleep quality on maternal outcomes, planning and implementing a suitable intervention in the context of primary health care is necessary. Increasing the awareness of mothers, health workers and medical personnel about the suitable quality and quantity of sleep during pregnancy is of great importance.

Utilization of dental care in Iranian pregnant women: Findings from a population-based study.

BACKGROUND: Although dental care attendance during pregnancy has been recommended by guidelines and institutions, the demand for dental services is still low among pregnant women. The aim of this study was to examine the prevalence of not receipt dental care and also determinants of that during pregnancy. MATERIALS AND METHODS: This population-based study was conducted on 4071 mothers in 10 provinces of Iran, during 2014-2015. We calculated the prevalence of not receipt of dental care, and reasons for nonreceipt of care. We used logistic regression to estimate odds of nonreceipt of care by demographics variables. In the analyses, the level of statistical significance was set at P < 0.05. RESULTS: Overall, 54.70% of women had no dental visit during pregnancy. In mothers who had a history of stillbirth, neonatal death and live birth, the prevalence of not receipt dental care during pregnancy were 54.56%, 48.92%, and 58.76%, respectively. The logistic regression analyses showed that parity second-to-fourth birth than first birth (odds ratio [OR] 1.37 confidence interval [CI] 95% 1.17-1.59, residence in rural (OR 1.68 CI 95% 1.45-1.95), and not intended pregnancy (OR 1.32 CI 95% 1.03-1.68) associated with not received dental care during pregnancy. CONCLUSION: Most pregnant women in this study received insufficient dental care. The need for dental care during pregnancy must be promoted widely among women of reproductive age, and family barriers to dental care should be addressed.

Prevalence of gestational diabetes and its association with stillbirth, preterm birth, macrosomia, abortion and cesarean delivery: a national prevalence study of 11 provinces in Iran.

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders during pregnancy that significantly affects perinatal outcomes. Objective: The aim of this study was to determine the prevalence of GDM and its relation with the incidence of stillbirth, preterm birth, macrosomia, abortion and cesarean section (C-section) delivery in pregnant women. Methods: This cross-sectional study was conducted on 3675 pregnant women in 11 provinces across Iran. Cluster sampling was used to select samples from mothers covered by health plans in 11 provinces of Iran. Prevalence of adverse pregnancy outcomes, including preterm delivery, type of delivery, macrosomic preterm birth, miscarriage, stillbirth, infant death, and birth weight were measured, using family record and face-to-face interviews. Data were analyzed by logistic regression, using STATA14.2 software. Results: About four percent of Iranian pregnant women had GDM during pregnancy. Prevalence of C-section was significantly higher in diabetic women than in the non-diabetic ones (53.19 vs 46.81, respectively, P < 0.001). Abortion in diabetic mothers was more than twice that of the non-diabetic mothers (P < 0.001). In the adjusted logistic regression model, the odds of stillbirth in mothers with GDM were 1.8 (95% CI: 1.11, 2.91, P = 0.018) times higher than that of the non-diabetics. The odds of macrosomia in diabetic women was about 7 times higher than the non-diabetic women (95% CI: 2.81, 17.14, P < 0.001). The odds of GDM had an increasing trend according to the BMI (p < 0.001). The risk of GDM were significantly lower, according to the daily physical activity (PA) (p < 0.001). Conclusion: The GDM prevalence has a decreasing trend in Iran. It increases the adverse pregnancy outcomes such as stillbirth, neonatal deaths, macrosomia, preterm birth, abortion and C-section delivery. As, some of these consequences like macrosomia are not treatable, thus early prevention is very crucial.