Relationship between False Positive Screening Results of Down Syndrome and Adverse Pregnancy Outcomes.

Background: Maternal serum sample screening in the first and second trimesters has been commonly used to identify women who are at risk of fetal trisomy 21. In addition, these serum markers are associated with adverse perinatal outcomes. Hence, the present study was conducted to determine the relationship between false positive screening results of Down syndrome and adverse pregnancy outcomes. Material and Methods: This prospective, two-group, cohort study was conducted on 608 pregnant women who had undergone fetal contingent screening. They were selected through convenience sampling in the twentieth week of pregnancy and were followed up until delivery. The raw Odd Ratios (OR), Relative Risk (RR), and adjusted OR of adverse pregnancy outcomes were calculated in the false positive and true negative groups. Results: The adjusted OR of developing preeclampsia was 1.98 (95%CI: 1.14-3.42), and its RR was 2.13 (95%CI: 1.34-3.38) times higher in the false positive group. Moreover, the adjusted OR of Small for Gestational Age (SGA) was 2.80 (95%CI: 1.76-4.47), and its RR was 2.28 (95%CI: 1.54-3.36) times higher in the false positive group. The adjusted OR of Low Birth Weight (LBW) was 3.34 (95%CI: 1.97-5.64), and its RR was 2.65 (95%CI: 1.72-4.11) times higher in the false positive group. In addition, no significant difference was observed between false positive and true negative groups in terms of preterm birth. Conclusions: Women with a false positive fetal screening test result are more likely to suffer from preeclampsia, SGA, and LBW and require planned prenatal care.

Evaluation of Fetal and Maternal Outcomes in Chorion Villus Sampling (CVS).

Background: Chorionic villus sampling (CVS) is one of the invasive diagnostic methods used to diagnose chromosomal, genetic, and metabolic diseases in the embryonic period. The use of this method is associated with maternal and fetal consequences, the most serious of which is abortion. Therefore, the present study was conducted to investigate the incidence of these consequences and the factors affecting the incidence of abortion. Materials and Methods: A cross-sectional study was performed on 98 pregnant women with CVS indications. Maternal and fetal outcomes including abortion, vaginal bleeding, subchorionic hematoma, premature rupture of membrane (PROM), chorioamnionitis, preterm delivery, limb abnormality, fetal growth retardation, and preeclampsia were recorded. Results: The results of the present study showed that the incidence of fetal outcomes including fetal growth failure, premature rupture of membranes, abortion, and limb abnormalities was 4.1%, 7.1%, 3.1%, and 1%, and the incidence of maternal outcomes including preterm delivery, subchorionic hematoma, preeclampsia, and hemorrhage was 14.3%, 3.1%, 6.1%, and 10.2%, respectively. In addition, a decrease in free BHCG and an increase in NT were significantly associated with the occurrence of abortion (OR: 0.11 and 4.25, respectively, P value < 0.05). Conclusion: It should be noted that due to a long time between placental sampling and the occurrence of vaginal bleeding, premature rupture of membrane, and preterm delivery, it seems that placental sampling has no effect. In addition, only a decrease in free BHCG or an increase in NT significantly increased the chance of miscarriage.

Predictive Value of Middle Cerebral Artery to Umbilical Artery Pulsatility Index Ratio for Neonatal Outcomes in Hypertensive Disorders of Pregnancy.

Background: Hypertension may lead to notifying adverse perinatal events that should be diagnosed and managed precisely. This study aims to investigate the values of cerebroplacental ration for the prediction of adverse perinatal events in hypertensive disorders of pregnancy. Materials and Methods: The current descriptive-comparative study has been conducted on 100 singleton pregnant women with the diagnosis of preeclampsia or pregnancy-induced hypertension. The Cerebroplacental ratio (CPR) was measured for the included population and divided into normal and abnormal ranges of >1 and ≤1. The adverse perinatal outcomes, including abnormal 5 min APGAR, low birth weight, perinatal death, neonatal intensive care unit (NICU) admission, academia, seizure, emergency cesarean delivery, and Tchirikov index as the general manifestation of adverse perinatal outcomes were compared between the groups. The specificity, sensitivity, positive predictive value, negative predictive value (NPV), and accuracy were measured for the adverse perinatal outcomes. Results: The two groups were remarkably different in terms of 5 min APGAR, low birth weight, cesarean section delivery, and Tchirikov index (P < 0.05). The specificity of CPR for prediction of small-for-gestational age, poor APGAR, requirement of assisted respiration, academia, Tchirikov score and NICU admission was 93.1%, 93.1%, 67.1%, 91.8%, 71.2%, and 63%, and its sensitivity was 26%, 14.8%, 51.8%, 14.8%, 51.8%, and 37%, respectively. Conclusion: CPR seems to be an appropriate means for the prediction of adverse perinatal outcomes with diversity in the prediction values of different determinants of adverse perinatal outcomes; however, in general, it had sensitivity, specificity, PP, NPV, and accuracy of 51.8%, 71.2%, 40%, 80%, and 66%, respectively.

Biallelic Variants in the Ectonucleotidase ENTPD1 Cause a Complex Neurodevelopmental Disorder with Intellectual Disability, Distinct White Matter Abnormalities, and Spastic Paraplegia.

OBJECTIVE: Human genomics established that pathogenic variation in diverse genes can underlie a single disorder. For example, hereditary spastic paraplegia is associated with >80 genes, with frequently only few affected individuals described for each gene. Herein, we characterize a large cohort of individuals with biallelic variation in ENTPD1, a gene previously linked to spastic paraplegia 64 (Mendelian Inheritance in Man # 615683). METHODS: Individuals with biallelic ENTPD1 variants were recruited worldwide. Deep phenotyping and molecular characterization were performed. RESULTS: A total of 27 individuals from 17 unrelated families were studied; additional phenotypic information was collected from published cases. Twelve novel pathogenic ENTPD1 variants are described (NM 001776.6): c.398_399delinsAA; p.(Gly133Glu), c.540del; p.(Thr181Leufs*18), c.640del; p.(Gly216Glufs*75), c.185 T > G; p.(Leu62*), c.1531 T > C; p.(*511Glnext*100), c.967C > T; p.(Gln323*), c.414-2_414-1del, and c.146 A > G; p.(Tyr49Cys) including 4 recurrent variants c.1109 T > A; p.(Leu370*), c.574-6_574-3del, c.770_771del; p.(Gly257Glufs*18), and c.1041del; p.(Ile348Phefs*19). Shared disease traits include childhood onset, progressive spastic paraplegia, intellectual disability (ID), dysarthria, and white matter abnormalities. In vitro assays demonstrate that ENTPD1 expression and function are impaired and that c.574-6_574-3del causes exon skipping. Global metabolomics demonstrate ENTPD1 deficiency leads to impaired nucleotide, lipid, and energy metabolism. INTERPRETATION: The ENTPD1 locus trait consists of childhood disease onset, ID, progressive spastic paraparesis, dysarthria, dysmorphisms, and white matter abnormalities, with some individuals showing neurocognitive regression. Investigation of an allelic series of ENTPD1 (1) expands previously described features of ENTPD1-related neurological disease, (2) highlights the importance of genotype-driven deep phenotyping, (3) documents the need for global collaborative efforts to characterize rare autosomal recessive disease traits, and (4) provides insights into disease trait neurobiology. ANN NEUROL 2022;92:304-321.

Role of pregnancy-associated plasma protein A (PAPP-A) and human-derived chorionic gonadotrophic hormone (free ß-hCG) serum levels as a marker in predicting of Small for gestational age (SGA): A cohort study.

BACKGROUND: Small-for-gestational-age (SGA) is one of the most important conditions, which is associated with the risk of perinatal mortality and morbidity. The levels of pregnancy-associated plasma protein A (PAPP-A) and ß-human-derived chorionic gonadotrophic (ß-hCG) in the first trimester can predict this adverse outcome, considering the controversial nature of studies in this area, this cohort study was conducted to investigate the role of PAPP-A and freeß-hCG levels for predicting SGA. MATERIALS AND METHODS: In this cohort study, from 16 randomly selected health centers in Isfahan, Iran, 4605 volunteer pregnant women who had performed first-trimester fetal anomalies screening tests were chosen based on the census, from July 2016 to June 2018. The multiples of the median (MoM) PAPP-A <0.4 and MoM ß-hCG >3 were considered as abnormal; the samples were followed up after childbirth. The biomarkers' serum levels, relative risk, and odds ratio (OR) of SGA were compared in both SGA and appropriate for gestational age (AGA) groups. RESULTS: In the SGA group, the mean of MOM PAPP-A was significantly lower (0.96 vs. 1.1 with P = 0.001) and MoM ßhCG was significantly higher (1.24 vs. 1.15 with P = 0.01) than the AGA group. Odds for SGA in subjects with MoM PAPP-A <0.4 were 3.213; P = 0.001 and for subjects with MoM ßhCG >3 reported as 0.683; P = 0.111. CONCLUSION: The results of the study showed that the low levels of PAPP-A would cause 3.213 times increase in the chance of developing SGA and no association between high level of ßhCG >3 with SGA. Therefore, low level of the PAPP-A is a warning indicator for SGA.

Obstetrics Healthcare Providers' Mental Health and Quality of Life During COVID-19 Pandemic: Multicenter Study from Eight Cities in Iran.

BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic has become the most challenging issue for healthcare organizations and governments all over the world. The lack of evidence-based data on the management of COVID-19 infection during pregnancy causes an additional stress for obstetrics healthcare providers (HCPs). Therefore, this study was undertaken to evaluate depression, perceived social support, and quality of life among obstetrics HCPs. MATERIALS AND METHODS: This cross-sectional multicenter study was conducted in eight cities in Iran. During the study period, 599 HCPs were separated into direct, no direct, and unknown contact groups according to their exposure to COVID-19-infected pregnant patients. The Patient Health Questionaire-9 (PHQ-9), Multidimensional Scale of Perceived Social Support (MSPSS), and Short Form-36 (SF-36) were used to assess depression, perceived social support, and quality of life. RESULTS: Obstetrics and gynecology specialists had significantly higher social functioning and general health scores compared to other HCPs (residents/students or nurses/midwives). Depression was negatively correlated with most of the domains of quality of life, regardless of the COVID-19 contact status of the study participants. Social support, however, was positively correlated with some domains of quality of life, such as physical functioning, energy/fatigue, and emotional well-being, among staff members who had either direct contact or no contact with COVID-19 patients. CONCLUSION: During the COVID-19 outbreak, the depression score among obstetrics HCPs was negatively associated with quality of life. Social support, however, had a reinforcing effect on quality of life.

Developing a perinatal palliative care service package for women with fetal anomaly diagnosis: protocol for mixed methods study.

BACKGROUND: Diagnosis of perinatal anomalies is a stressful experience that can negatively affect mothers, families, health-care systems, and societies. Perinatal palliative care (PPC) is a new development in maternity services which focuses on emotional, spiritual, social, and symptom management and provides care for women and families with fetal anomaly diagnosis. Therefore, this study aimed to develop a service package for women with fetal anomaly diagnosis in socio-cultural context of Iran. METHODS: This research is an exploratory mixed methods study with the qualitative-quantitative sequencing design that consists of four sequential phases. In the first phase, following a qualitative approach, the researcher will explore the needs and experiences of women with fetal anomaly diagnosis, their families, health care providers and policy-makers. At the second phase, based on the review of the literature, Program, guideline, service package and protocol for care of women and their families after perinatal anomaly diagnosis will be identified in other countries. In the third phase, recommendations from qualitative phase and literature review will be combined, the initial protocol of the palliative care service package for perinatal anomaly diagnosis will be identified and prioritized. In the fourth phase, the opinion of experts about this service package will be collected by using RAND/UCLA Appropriateness Method technique and the applicability of the service package's recommendations in clinical settings will be determined. DISCUSSION: The results of this Mixed Methods study are expected response the needs and experiences of the women with perinatal anomaly diagnosis being met in the socio-cultural context of Iran and a service package for palliative care of these women developed.

Assessment of ß-human-derived chorionic gonadotrophic hormone (ßhCG) and pregnancy-associated plasma protein A (PAPP-A) levels as predictive factors of preeclampsia in the first trimester among Iranian women: a cohort study.

BACKGROUND: Preeclampsia (PE) is a leading cause of maternal and perinatal mortality. There are controversial findings regarding the prediction of PE through the assessment of the Pregnancy-Associated Plasma Protein A (PAPP-A) and ß-Human-Derived Chorionic Gonadotrophic hormone (ßhCG) levels in the first trimester of pregnancy. Therefore, this cohort study was conducted to evaluate of PAPP-A and ßhCG levels as predictive factors for PE development in the first trimester among Iranian women. METHODS: In this cohort study, a total of 4605 volunteer Primigravida and Multigravida women were selected by the census from 16 randomly selected Health Centers in Isfahan, Iran, from July 2016 to June 2018. Eligible pregnant women participated in the study had already undergone fetal anomalies screening tests between 11 + 0 and 13 + 6 weeks of pregnancy and their PAPP-A and ßhCG biomarkers were adjusted to the Multiples of the Median (MOM). MOM PAPP-A <  0.4 and MOM ßhCG > 3 were considered abnormal. The samples were followed up until delivery. The biomarkers' levels were compared in the two groups of women with and without PE and Relative risk (RR) and odds ratio (OR) of PE calculated. RESULTS: In the PE group, the mean MOM PAPP-A was significantly lower (1 vs. 1.09 with P = 0.006) and MOM ßhCG was significantly higher (1.51 vs. 1.14 with P = 0.001) than the group without PE. RR and OR for PE in subjects with MOM PAPP-A <  0.4 were reported as follows: RR = 2.49, (p = 0.001) and OR = 2.09, (p = 0.001). RR and OR for PE in subjects with MOM ßhCG > 3 were also reported as follows: RR = 4.02, (p = 0.001) and OR = 5.65, (p = 0.001). Adjusted OR for MOM PAPP-A <  0.4 and MOM ßhCG > 3 was obtained as follows: OR = 2.09 (P = 0.001) and OR = 5.65 (P = 0.001), respectively. CONCLUSION: The results of the study showed that the high levels of ßhCG would cause 5.65 times increase and the low levels of PAPP-A would cause 2.09 times increase in the chance of developing PE.

A Survey of Venous Thromboembolism (VTE) Prophylaxis in Obstetrics Patients in Iran.

Objective: The purpose of the present study was a survey of venous thromboembolism (VTE) prophylaxis in obstetrics patients in Iran. Materials and methods: A national, multicenter, non-interventional, prospective study was performed on 1000 women at 11 different parts of Iran. Primary outcome was to assess the situation of VTE prophylaxis in pregnant and postpartum women and the secondary outcome was risk stratification in obstetrics patients and to evaluate the guideline adherence in physician's practice of VTE prophylaxis. Results: 1,036 women entered the final analysis. The three main VTE risk factors before hospitalization were BMI > 30 kg/m2, history of oral contraceptive (OCP) use, and the age over 35.VTE risk factors upon enrollment were detected in 780 (75.28%) patients. 219 women (28.07%) were deemed eligible for drug prophylaxis, however, only 37 women (17%) received it. A total of 113 (10.9%) patients received VTE prophylaxis, of which 76 (67.25%) women had no clear indications. Concordance between theory and practice was detected with a Cohen's Kappa coefficient to be 0.74 (p < 0.001), which fell within "good agreement". Multivariate analysis for association between VTE prophylaxis and VTE risk factors showed that history of VTE [OR = 9.06 (CI 95% 1.16 - 70.8) p = 0.036] was the most frequent risk factor for receiving VTE prophylaxis followed by obesity (BMI > 30 Kg/m2); [OR = 3.74 (CI 95% 1.79 - 5.69), p = <0.001], multiple pregnancy [OR= 2.81 (CI 95% 1.70 - 4.64), p = < 0.001] and age > 35 years; [OR =1.09 (CI 95% 0.82 - 1.21), p = 0.026]. Varicose Veins [OR= 0.22 (CI 95% 0.56 - 0.87), p = 0.031], PROM / PPROM [OR= 0.33 (CI 95% 0.12 - 0.91), p = 0.032] and history of using OCP [OR= 0.36 (CI 95% 0.24 - 0.53), p = < 0.001] were the most missed risk factors for receiving VTE prophylaxis respectively. Conclusion: History of VTE, obesity, multiple pregnancy and age > 35 years were the most frequent risk factors for receiving VTE prophylaxis and varicose veins, PROM / PPROM and history of using OCP were the most missed risk factors for receiving VTE prophylaxis.

The Assessment of Association between Uterine Artery Pulsatility Index at 30-34 Week's Gestation and Adverse Perinatal Outcome.

BACKGROUND: Given the high prevalence of adverse perinatal outcome in the developing countries and the association between uterine artery (UtA) blood flow and fetal status in the uterine, in the current study, we assess the association between UtA pulsatility index (UtA-PI) at 30-34 week's gestation and adverse perinatal outcome. MATERIALS AND METHODS: This cohort study included 100 pregnant women at 30-34 weeks' gestation. At baseline, UtA-PI was evaluated with color Doppler through abdominal ultrasound. Then, adverse perinatal outcomes including preterm labor, intrauterine fetal death, preeclampsia, low 5-min Apgar score (<7), low umbilical arterial cord blood pH, admitted to Intensive Care Unit in the first 3 days of birth, low birth weight, infant with low weight, death of newborns, cesarean section for respiratory distress, and meconial amniotic fluid were recorded. Ultimately, the collected data were analyzed using SPSS, version 20. RESULTS: The presence of small-for-gestational-age fetuses indicated the highest prevalent adverse prenatal outcome with the incidence of 13.3% and 58.5%, respectively, among pregnancies with normal UtA-PI as well as those with high UtA-PI (P < 0.001). Overall, given that sensitivity and specificity of high UtA-PI were 37.5% and 73.3%, respectively, it could not properly predict adverse perinatal outcome (P = 0.360). CONCLUSION: According to the results, although the incidence of some of adverse perinatal outcomes in pregnant women with high UtA-PI was higher compared to those with normal UtA-PI, this factor alone cannot predict adverse perinatal outcome well. Therefore, this factor may predict these outcomes well, in the subgroups with high-risk pregnancies or with some blood factors or with pregnancy complications.

Evaluation of the predictive value of fetal Doppler ultrasound for neonatal outcome from the 36th week of pregnancy.

BACKGROUND: Early prediction of adverse neonatal outcome would be possible by Doppler impedance indices of middle cerebral artery (MCA), umbilical artery (UmA), and descending aortal artery (AO) that result in decrease neonatal morbidity and mortality rate. The aim of the present study was a determination of optimal value for the ratio of MCA to descending aorta blood flow (MCA/AO) impedance indices and its comparison with the ratio of MCA to UmA (MCA/UmA) impedance indices and their relationship with neonatal outcome. MATERIALS AND METHODS: This was a prospective cohort study on 212 pregnant women with gestational age 36 weeks or more, in three hospitals in Tehran, from April 2012 to April 2013. We investigated AO, MCA, and UmA impedance indices Doppler ultrasound every 2 weeks till delivery. The mother was monitored for adverse pregnancy outcome (hypertension [HTN], fetal growth retardation, and other maternal complications) then infant birth weight, cord blood of pH, and Neonatal Intensive Care Unit (NICU) admission during the first 24 h after delivery were assessed. Finally, we investigated relationships between Doppler indices and neonatal outcomes include neonatal body weight (NBW), cord blood of pH, and NICU admission. RESULTS: MCA/AO resistance index (RI) and MCA/AO pulsatile index (PI) showed an area under the receiver operating characteristics curve (area under the curve) of 0.905 (95% confidence interval (CI): 0.850, 0.959) and 0.818 (95% CI: 0.679, 0.956), respectively. The cutoff values for pH (≥7.2 vs. <7.2) based on MCA/AO RI and MCA/AO PI indices were 0.951 (sensitivity, 80% and specificity, 86%) and 0.853 (sensitivity, 91% and specificity, 83%), respectively. The cutoff value for NBW (≥2500 vs. <2500 g) based on MCA/UmA PI index was 1.467 (sensitivity, 73% and specificity, 63%). The cutoff value of NICU admission of child based on MCA/AO PI index was 1.114 (sensitivity, 73% and specificity, 54%). CONCLUSION: In the end of third-trimester pregnancies with the assessment of MCA and AO artery Doppler ultrasonography, it is possible to prevent many cases of neonatal acidosis caused by prenatal asphyxia as well as inappropriate interventions which are applied on mother. If MCA/AO PI was <0.85, the fetus needs to be evaluated further because it is at risk for acidosis.

Is preterm placental calcification related to adverse maternal and foetal outcome?

This prospective cohort study aimed to evaluate the role of premature placental calcification in adverse pregnancy outcomes and identify its associated potential risk factors. We consecutively enrolled 293 women who presented to three academic medical centres from September 2011 to March 2013. Participants underwent transabdominal sonographies between 28-36 weeks of gestation in an attempt to determine placental maturity. We compared maternal and foetal outcomes between two groups of women, those with grade III placenta (n = 69) and those without grade III placenta (n = 224). Passive smoking was the only predictor of early placental calcification. There were more abnormal Doppler, low birth weight (LBW) and caesarean section (CS) deliveries observed in the preterm calcification group. No definite relationship existed between maternal hypertension (HTN), diabetes and other medical diseases with placental calcification. In conclusion, umbilical artery (UA) resistance index (RI) and absent or reversed end-diastolic velocity (AREDV) were observed more often in preterm placental calcification. Serious antepartum follow-up should be advised for these mothers. Impact Statement • Placental calcification is a physiological phenomenon but normally, a grade III placenta is not frequently found until 36 weeks of gestation (so is called preterm placental calcification - PPC). There is currently a lack of consistent evidence on the clinical significance of PPC and pregnancy outcome. The present study was designed to evaluate the role of PPC in adverse pregnancy outcomes. • In our study, although none of the pregnant women were smokers, we found that passive smoking was the only predictor of PPC. Abnormal umbilical artery Doppler waveforms considerably and absent end diastolic velocity pattern significantly were observed more often in the PPC group. • We observed that PPC can be a landmark for high-risk pregnancy and an alarm sign for placental dysfunction. So, close antepartum follow up should be advised for these mothers. Regular and frequent foetal wellbeing tests should be done to prevent pregnancy complications. Certainly larger and more extensive study can provide more valid results.

Evaluation the effect of low-dose aspirin on endothelial dysfunction in preeclamptic patients.

BACKGROUND: Preeclampsia complicates up to 3% of pregnancies in developing countries. Endothelial dysfunction plays an important role in pathogenesis of preeclampsia. In this study, we aim to evaluate the effect of low-dose aspirin on endothelial dysfunction in preeclamptic patients. MATERIALS AND METHODS: in this triple-blind randomized clinical trial, enrolled patients were divided randomly into two groups. Acetylsalicylic acid (ASA) 80 mg or placebo will be taken daily by oral administration from the initiation of diagnosis until 2 months after delivery. Every patient's flow-mediated dilation (FMD) were evaluated at the beginning of study and 2 months after delivery with the same experienced operator at a same period of the time (3-5 pm) by high-resolution B-mode ultrasonographic. T-test or Mann-Whitney test was used in the comparison of means between the intervention and placebo groups. To compare FMD in each group, before and after the intervention, paired t-test was used. RESULTS: Mean value of FMD in intervention (9.61 ± 5.58) and control group (9.40 ± 4.33) have no significant differences before drug consumption (P = 0.089). FMD in intervention group significantly increased after ASA consumption ([9.61 ± 5.58 vs. 13.65 ± 7.91] [P = 0.044]). CONCLUSION: Increase mean of FMD in intervention group shows that this supplement can improve endothelial function.

Evaluation of the effect of high-dose folic acid on endothelial dysfunction in pre-eclamptic patients: A randomized clinical trial.

BACKGROUND: Pre-eclampsia as a hypertensive disorder of pregnancy complicates up to 5-10% of pregnancies worldwide. Endothelial dysfunction plays an important role in the pathogenesis of pre-eclampsia. In this study, we aim to evaluate the effect of high-dose folic acid on endothelial dysfunction in pre-eclamptic patients. MATERIALS AND METHODS: In this triple-blinded randomized clinical trial, the enrolled patients were divided randomly into two groups. Folic acid 5.0 mg or placebo was taken daily by oral administration from the initiation of diagnosis until 2 months after delivery by the participants. Every patient's flow-mediated dilation (FMD) was evaluated at the beginning of the study and 2 months after delivery with the same experienced operator at the same period of time (3-5 p.m.) by high-resolution B-mode ultrasonography. Potential confounding variables were included in the independent samples t-test. t-test or Mann-Whitney U-test was used in the comparison of means between the intervention and placebo groups. To compare FMD in each group, before and after the intervention, paired t-test was used. RESULTS: Mean value of FMD in intervention (9.64 ± 5.57) and control group (9.30 ± 4.25) has no significant difference before the consumption of drugs (P > 0.05). FMD in intervention group (13.72 ± 7.89) significantly increases after daily consumption of 5 mg folic acid in comparison with control group (10.02 ± 4.81) after daily consumption of placebo (P = 0.002). CONCLUSION: Increased mean of FMD in intervention group shows that this supplement can improve endothelial function and can be significantly affected by maternal blood pressure during pregnancy and some endothelium-dependent disease such as pre-eclampsia and its associated adverse outcomes.

Evaluation the effect of 17-alpha hydroxyprogesterone caproate on gestational diabetes mellitus in pregnant women at risk for preterm birth.

BACKGROUND: The mellitus exact role of 17-alpha hydroxyprogesterone caproate in increasing the rate of gestational diabetes mellitus (GDM) is still unclear. This study was aimed to investigate the association of treatment with 17-alpha hydroxyprogesterone caproate with GDM in pregnant women who are at risk for preterm birth (PTB). MATERIALS AND METHODS: In this clinical trial, 200 singleton pregnant women included 100 pregnant women at risk for PTB or with history of PTB as case group (received weekly injections of 17-alpha hydroxyprogesterone caproate) and 100 healthy pregnant women without history of PTB as control group (did not receive any drug) were evaluated. All women followed until detect or reject of GDM, and abnormal glucose challenge test (GCT) and GDM were calculated in all of them. RESULTS: During study follow-up, 36 women in both groups were excluded and 81 cases 83 controls completed the study and analyzed. Mean of GCT in all studied pregnant women was 128.2 ± 18.1, whereas, in cases was higher than controls but no significant difference was noted between groups (P = 0.56). Abnormality in GCT was observed in 32 (19.5%) of 164 studied women, (18 of cases and 14 of controls), which was not statistically significant (P = 0.34). The frequency of GDM among all studied women was 7.9% (13 of 164), 7 of cases and 6 of controls, which was not significant (P = 0.74). CONCLUSION: In summary, results demonstrated that weekly administration of 17-alpha hydroxyprogesterone caproate is not associated with higher rates of GDM in pregnant women at risk for PTB.

An overview of systematic reviews of normal labor and delivery management.

BACKGROUND: Despite the scientific and medical advances for management of complicated health issues, the current maternity care setting has increased risks for healthy women and their babies. The aim of this study was to conduct an overview of published systematic reviews on the interventions used most commonly for management of normal labor and delivery in the first stage of labor. MATERIALS AND METHODS: The online databases through March 2013, limited to systematic reviews of clinical trials were searched. An updated search was performed in April 2014. Two reviewers independently assessed data inclusion, extraction, and quality of methodology. RESULTS: Twenty-three reviews (16 Cochrane, 7 non-Cochrane), relating to the most common care practices for management of normal labor and delivery in the first stage of labor, were included. Evidence does not support routine enemas, routine perineal shaving, continuous electronic fetal heart rate monitoring, routine early amniotomy, and restriction of fluids and food during labor. Evidence supports continuity of midwifery care and support, encouragement to non-supine position, and freedom in movement throughout labor. There is insufficient evidence to support routine administration of intravenous fluids and antispasmodics during labor. More evidence is needed regarding delayed admission until active labor and use of partograph. CONCLUSIONS: Evidence-based maternity care emphasizes on the practices that increase safety for mother and baby. If policymakers and healthcare providers wish to promote obstetric care quality successfully, it is important that they implement evidence-based clinical practices in routine midwifery care.

Women's needs and expectations during normal labor and delivery.

BACKGROUND: Pregnancy and birth are unique processes for women. Women and families hold different expectation during childbearing based on their knowledge, experiences, belief systems, culture, and social and family backgrounds. These differences should be understood and respected, and care is adapted and organized to meet the individualized needs of women and families. The purpose of this study was to explore Iranian parturient needs, values and preferences during normal labor and delivery. MATERIALS AND METHODS: An exploratory qualitative study was used. Twenty-four parturient women from three governmental medical training centers in Isfahan, Iran were recruited using purposive sampling. Participants were recruited to low-risk women after they had given birth, but before they were discharged from hospital. Data were collected through semi-structured in-depth interviews, informal observations and field notes. Interviews were transcribed verbatim and analyzed by the conventional content analysis according to Graneheim and Lundman approach. RESULTS: Women's needs and expectations fell into seven main categories: Physiological, psychological, informational, social and relational, esteem, security and medical needs. All of the key needs in these data relates to a fundamental need, named "sense of control and empowerment in childbirth." CONCLUSION: Knowing a woman's needs, values, preferences and expectations during normal labor and delivery assists healthcare professionals especially midwives in providing high-quality care to parturient women.

Accuracy of amniotic fluid lamellar body counting for evaluating fetal lung maturity.

BACKGROUND: Respiratory distress syndrome (RDS) is one of the important causes of mortality in neonates. This study was designed to assess the role of the amniotic fluid lamellar body counting in predicting fetal lung maturity. METHOD: This study was conducted during 2010, April to 2011, February, at Isfahan University of Medical Sciences, Isfahan, Iran. One hundred and twenty eight amniotic fluid samples were obtained during normal delivery, or before rupturing the membrane in cesarean, and lamellar body was assessed by cellular counter. The respiratory statuses of neonates were determined at delivery and the optimal cut-off point was assessed by receiver operating characteristic (ROC) curve. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were evaluated in optimal cut-off point. RESULTS: One hundred and twenty eight amniotic samples and 131 infants were evaluated. The means of maternal and gestational ages were 28.12 +/- 3.84 years and 32.56 +/- 2.72 weeks, respectively. The mean of lamellar body was 31266 +/- 15831 microl in matured lung infants compared to 63081 +/- 16966 microl in immature lung infants (p < 0.001). The optimal cut-off point was evaluated as 47500 microl in predicted pulmonary maturity with sensitivity of 85.1%, specificity of 91.2%, positive predictive value of 92.6% and negative predictive value of 82.5%. CONCLUSION: This study indicated that lamellar body counting test has a high positive predictive value with a good sensitivity, specificity and negative predictive value. Future studies for different cellular counters are warranted.

Effect of estrogen receptor ß A1730G polymorphism on ABCA1 gene expression response to postmenopausal hormone replacement therapy.

The estrogen receptor ß (ERß) mediates the action of estrogen on metabolism of lipids and lipoprotein. Therefore, its gene is a promising candidate gene for cardiovascular disease. The aim of the present study was to investigate whether the ERß A1730G polymorphism modifies the metabolic response to hormone replacement therapy (HRT) in postmenopausal women. The population included 60 normolipidemic postmenopausal women with equal numbers of each A1730G genotype followed during a 90-day experimental period. All subjects received oral estrogen together with a progestin therapy during the HRT. ABCA1 gene expression and serum lipid and lipoprotein concentrations were measured at the beginning and end of the HRT trial. At baseline, ABCA1 gene expression, lipid or lipoprotein concentrations were not significantly different among the ERß A1730G genotype groups. After HRT, however, subjects with GG genotype had a greater increase in ABCA1 gene expression (p = 0.002) and a trend toward greater increase in apoA-I (p = 0.058) than subjects carrying the A allele. An interaction effect between genotype and HRT effect was observed on ABCA1 gene expression. In conclusion, the positive changes of ABCA1 gene expression and apoA-I were affected by the ERß A1730G polymorphism in women taking estrogen-progesterone therapy.