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.

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.

Risk of Stillbirth in Women with Gestational Diabetes and High Blood Pressure.

BACKGROUND: Both Gestational diabetes and hypertension almost affect 10.5% of the pregnancies. This study was conducted to investigate and compare the pregnancy outcomes in women with gestational diabetes or high blood pressure with outcomes belonging to healthy mothers. METHODS: This population-based case-control study was conducted in 8 provinces and two cities of Iran on women referred to the public health centers during 2015 to 2018. Descriptive statistics for variables presented by percentages and frequencies and logistic regression analysis was used to analyze data at a significance level of less than 0.05. RESULTS: Some variables such as ethnicity, maternal education and age, gestational diabetes, high blood pressure and previous pregnancy outcome were significantly associated with stillbirth. Maternal age greater than 35 yr (OR=1.78, CI: 1.29-2.48), maternal illiteracy (OR=3.67, CI: 2.25-5.98), a previous stillbirth (OR=9.92, CI: 4.98-19.78), gestational diabetes among women who had never had a screening test (OR =3.91, CI: 2.96-5.18) and high blood pressure (OR =1.95, CI: 1.38-2.77) were important factors associated with stillbirth. Maternal and paternal occupation, paternal education and age, place of residence, smoking and maternal BMI were significantly associated with stillbirth. CONCLUSION: Gestational diabetes, hypertension, a previous miscarriage, stillbirth, first pregnancy, low education level, advanced maternal age and ethnicity were associated with an increased risk of stillbirth. It is necessary to provide high-quality healthcare services before and during pregnancy particularly for those at heightened risk and improve knowledge of mothers on the side effects of each of the mentioned risk factors in order to control these factors more effectively and thus reducing the risk of stillbirth.

Evaluating the association between neonatal mortality and maternal high blood pressure, heart disease and gestational diabetes: A case control study.

BACKGROUND: Prevention of noncommunicable diseases (NCDs) during pregnancy is recommended due to severe complications for mothers and infants. Considering that NCDs have a significant impact on infant mortality, this study was conducted to investigate the relationship between mothers' underlying diseases and gestational diabetes and infant mortality in Iran. MATERIALS AND METHODS: Mothers who referred to the health centers in nine provinces of Iran were included. This case-control study used data collected from pregnant women. There were 1162 cases and 1624 controls. The required data were collected from mothers' health records and through interviews. RESULTS: The chances of neonatal mortality in women with a body mass index (BMI) of 30-35, 1.7 times (odds ratio [OR] = 1.7, confidence interval [CI]: 1.19-2.44, P = 0.003) was higher compared with women with a normal BMI. The chance of neonatal mortality among mothers with high blood pressure was three times higher compared with healthy mothers (OR = 3.04, 95% CI: 1.98-4.65, P < 0.001). The chance of neonatal mortality in women with kidney disease was also 1.64 times higher than mothers without kidney problems (OR = 1.64, 95% CI: 1.1-2.45, P = 0.015). In the study of gestational diabetes, the chance of neonatal mortality among the mothers who had at risk was 1.63 times higher than mothers without gestational diabetes (OR = 1.63, 95% CI: 0.84-3.16, P = 0.014). Furthermore, the chance of neonatal mortality among the mothers who had heart disease was 1.10 times higher than mothers without heart disease (OR = 2.10, 95% CI: 0.88-4.99, P = 0.014). CONCLUSION: This study showed that undiagnosed underlying diseases were related to neonatal mortality, which highlights the importance of caring for and counseling about the underlying diseases, screening, and controlling blood sugar levels before and during pregnancy to prevent infant mortality by all means possible.

Assessing the risk factors before pregnancy of preterm births in Iran: a population-based case-control study.

BACKGROUND: Preterm birth is a major cause of prenatal and postnatal mortality particularly in developing countries. This study investigated the maternal risk factors associated with the risk of preterm birth. METHODS: A population-based case-control study was conducted in several provinces of Iran on 2463 mothers referred to health care centers. Appropriate descriptive and analytical statistical methods were used to evaluate the association between maternal risk factors and the risk of preterm birth. All tests were two-sided, and P values < 0.05 were considered to be statistically significant. RESULTS: The mean gestational age was 31.5 ± 4.03 vs. 38.8 ± 1.06 weeks in the case and control groups, respectively. Multivariate regression analysis showed a statistically significant association between preterm birth and mother's age and ethnicity. Women of Balooch ethnicity and age ≥ 35 years were significantly more likely to develop preterm birth (OR: 1.64; 95% CI: 1.01--2.44 and OR: 9.72; 95% CI: 3.07-30.78, respectively). However, no statistically significant association was observed between preterm birth and mother's place of residence, level of education, past history of cesarean section, and BMI. CONCLUSION: Despite technological advances in the health care system, preterm birth still remains a major concern for health officials. Providing appropriate perinatal health care services as well as raising the awareness of pregnant women, especially for high-risk groups, can reduce the proportion of preventable preterm births.

Life expectancy and years of life lost in HIV patients under the care of BandarAbbas Behavioral Disorders Counseling Center.

BACKGROUND: HIV epidemic is mostly targeted adults and has numerous negative health, social, economic, cultural and political consequences. In this study Life Expectancy (LE) and Average Years of Life Lost (AYLL) in HIV/AIDS patients are estimated. MATERIALS AND METHODS: In this descriptive study all the patients at the age of 18 and more under the care of BandarAbbas Behavioral Disorders Counseling Center (BBDCC) during 2005-2015 are included. The town of BandarAbbas is center of Hormozgan Province in southern Iran. LE and AYLL have been estimated based on Life Table. RESULTS: One hundred thirty four of the 426 eligible patients died during the study period. Compared to the general population LE for HIV/AIDS patients at age 20 is 46 years less in comparison with the general population of BandarAbbas. Moreover, a total of 8839 years of life lost during 2005-2015. CONCLUSION: LE in HIV/AIDS patients is less than LE among BandarAbbas general population and AYLL among them is more than general population. Most of the years of life lost are preventable if the health care system seriously will implement programs to control HIV/AIDS.

Factors associated with preterm labor in Hormozgan province in 2013.

INTRODUCTION: Preterm labor is the main cause of infants' death, and the main reason for undesirable consequences of pregnancy which still occur in some births, despite all of the interventions in this regard. The aim of this study was to evaluate every preterm birth and determine its maternal risk factors in Hormozgan province in 2013. METHODS: This case-control study was conducted in 2013 on the health and hospital records of 735 pregnant mothers with preterm labor (20-37 weeks) which were located in Bandar Abbas in southeast Iran. The sampling method would be multi-stage cluster sampling. The data collecting tool was a valid questionnaire by the Iran Ministry of Health and Medical Education, which included 5 components (demographic information, checking the current pregnancy of the mother, the maternal factors related to preterm labor in the previous pregnancy, evaluating the fetal factors associated with preterm labor in the current pregnancy and other additional information related to the factors associated with prematurity). Data were analyzed using descriptive statistics, regression and Chi-square tests. RESULTS: The prevalence of preterm labor in Hormozgan province in 2013 was 5.5%. In our study and among the effective factors on preterm labor, revealed genital-urinary tract infections during pregnancy were (35.8%), PROM (30.3%), history of abortion (19.9%) and unplanned pregnancy (18.1%) in between pregnant women with preterm labor. Our study showed that most mothers had delivered in 33 to 37 weeks among the mothers who had preterm labor in 2013 (75%) and the statistic of very preterm labor (less than 32 weeks) in Hormozgan was 5%. CONCLUSION: Identification of the prevalence and associated factors with preterm labor can reduce the mortality rate and infants' complications of it in addition to help find a way to prevent this problem.