Maternal and fetal/neonatal outcomes in pregnancy, delivery and postpartum following bariatric surgery and comparison with pregnant women with obesity: a study protocol for a prospective cohort.

BACKGROUND: Being obese can lead to various complications during pregnancy, such as Gestational Diabetes Mellitus (GDM), pregnancy induced hypertension (PIH), Pre-Eclampsia (PE), and Large Gestational Age (LGA). Although bariatric surgery is an effective way to treat obesity, it can also result in complications and may be linked to having small for gestational age (SGA) babies. This cohort study protocol aims to compare the maternal and fetal/neonatal outcomes of two groups of Iranian pregnant women: those who have undergone bariatric surgery and those who are obese but have not had bariatric surgery. METHODS: In this study Pregnant women (< 14 weeks' gestation) (n = 38 per group) are recruited either from one of the obesity clinic (exposure group = with a history of bariatric surgery) or primary healthcare clinics in Tehran city (comparison group = pregnant women with obesity and and no history of bariatric surgery). Dietary intake and nutrient status are assessed at < 14, 28, and 36 weeks. Maternal and fetal/neonatal outcomes are compared between the two groups, including gestational diabetes, preeclampsia, preterm labor, intrauterine growth restriction, severe nausea and vomiting, abortion, placenta previa and abruption, venous thrombosis, vaginal bleeding, cesarean delivery, meconium aspiration, and respiratory distress. Maternal serum levels of ferritin, albumin, zinc, calcium, magnesium, selenium, copper, vitamins A, B9, B12, and 25-hydroxy Vit D are checked during 24th to 28th weeks. Maternal and neonatal outcomes, including height, weight, head circumference, fetal abnormality, infection, small or large fetus, low birth weight, macrosomia, NICU admission, and total weight gain during pregnancy, are measured at birth. Maternal and offspring outcomes, including weight, height, head circumference, total weight gain during pregnancy, newborn diseases, postpartum bleeding, breastfeeding, and related problems, are assessed 6 weeks after delivery. Child's weight, height, and head circumference are followed at 2, 4, 6, 8, 10, and 12 months after birth. Maternal stress, anxiety, and depression are assessed with the DASS-21 questionnaire, and physical activity is evaluated using the PPAQ questionnaire in the first and third trimesters. DISCUSSION: By assessing the levels of micronutrients in the blood of pregnant women along with the evaluation of pregnancy outcomes, it is feasible to gain a more accurate understanding of how bariatric surgery affects the health and potential complications for both the mother and the fetus/newborn. This information can help specialists and patients make more informed decisions about the surgery. Additionally, by examining issues such as stress, anxiety, and depression in women undergoing surgery, this study can contribute to recognizing these problems, which can also affect pregnancy outcomes.

Waterpipe Smoking in Pregnant Women of Zahedan City in 2020: Prevalence and Associated Factors.

Background: Waterpipe smoking is associated with maternal and fetal complications, and valid data contribute to evidence-based planning. This study was conducted to determine the prevalence and factors related with waterpipe smoking among pregnant women of Zahedan city in 2020. Methods: This cross-sectional study was conducted in 2020, and 400 pregnant women in the third trimester of pregnancy who lived in Zahedan participated in it by single stage randomized cluster sampling. A questionnaire was used to measure awareness of waterpipe complications, and another one investigated the status of waterpipe smoking to collect data. For data analysis, descriptive statistics and multiple logistic regression were used through SPSS 21. Results: The findings indicated that the prevalence of waterpipe smoking was 18.8%. In the waterpipe smoking group, 46.6% smoked every day, 89.3% had tried to reduce the smoking, and 64.8% reported fetal death as their main motivation to reduce smoking. Only 5.6% of subjects stated receiving training as the reason for reduction of their waterpipe smoking. The women's level of education, economic status, ethnicity, and awareness of the risks of waterpipe smoking were the predictors for waterpipe smoking (P < 0.05, P = 0.03, P = 0.006, and P < 0.001, respectively). Conclusions: The results of this study show the high prevalence of waterpipe smoking in pregnant women of Zahedan. Further investigation and training in this regard are essential for pregnancy as well as pre-pregnancy care. Special attention should be paid to groups with better economic status and level of education, Baluch women, and those with low level of awareness.

Comparing the Effect of Foot Massage with Grape Seed Oil and Sweet Almond Oil on Physiological Leg Edema in Primigravidae: A Randomized Clinical Trial.

BACKGROUND: Leg edema is a prevalent problem in pregnancy causing activity restrictions for pregnant women. This study was performed to compare the effect of foot massage using grape seed oil and sweet almond oil on physiological leg edema. METHODS: A randomized clinical trial was conducted on 90 primigravidae referred to public health centres of Zahedan, Iran. The participants' gestational age was 30-40 weeks. The study was conducted from August 2016 to November 2017. The participants were randomly assigned to three groups (massage with grape seed oil, massage with sweet almond oil, and without intervention). After determining the extent of leg edema, foot massages were done for 20 minutes within 5 days in the two intervention groups. Then, foot circumferences were measured on day 5 after the intervention. Foot circumferences for the control group were measured on days 1 and 5. A nonelastic tape measure was used to measure the circumferences. To analyse the data, SPSS 21 software and statistical tests including one-way ANOVA, Tukey's test, and paired t-test were used. RESULTS: The results from this study showed a significant difference in the mean score change of foot circumferences between groups (P=0.001). According to the results of Tukey's test, mean score changes of foot circumferences of both intervention groups were significantly different those of the control group. However, this difference was not significant between the two intervention groups (P=0.865). CONCLUSION: The findings of this study confirmed the effectiveness of foot massage using grape seed and sweet almond oils to reduce pregnancy physiological edema. Therefore, foot massage with appropriate oils can be used as a useful technique by trained midwives in prenatal care centres or at pregnant women houses. This trial is registered with IRCT2015072723370N1.

The effect of motivational interviewing on attitude and practice about type of delivery in primigravid women requesting elective cesarean section referring to comprehensive health services centers.

BACKGROUND: Negative attitudes toward vaginal delivery are an important reason for pregnant women to undergo a cesarean section. Therefore, this study was performed to evaluate the effect of motivational interviewing on attitude and choice of primigravida women on type of delivery in requesting elective cesarean section. MATERIALS AND METHODS: In this single-blind clinical trial, 120 primigravida women in 28-31 weeks of gestation with normal pregnancy determined by a multistage sampling were randomly chosen from ten health centers of Zahedan city in 2019 and were divided into two groups. Motivational interviewing was performed in four sessions within 90 min in the experimental group, and the control group received routine care service. Attitude (before and 1 month after the intervention) and performance (after delivery) were evaluated using a valid and reliable researcher-made questionnaire. The collected data were analyzed using different proportions, paired t-test, independent t-test, covariance analysis, and Shapiro-Wilk and the Chi-square methods. RESULTS: There was a significant difference in the attitude of participants between the two groups after the intervention (P = 0.001). The mean difference of pre- and posttest was significant in relation to attitude scores in the two groups (P = 0.001), and the difference between the two groups was also statistically significant between the two groups in terms of delivery type (P = 0.03). CONCLUSION: We conclude that motivational interviewing can be a useful tool to change the attitude and decrease the rate of unnecessary cesarean among pregnant women. It is recommended to examine the impact of this method on women from different societies who have various educational backgrounds and cultures.

Effect of pre-cesarean foot reflexology massage on anxiety of primiparous women.

Introduction Anxiety is a common feeling in cesarean section and lack of attention to it is associated with negative consequences for health of mother and child. Reflexology is a way to reduce anxiety. So far, the effect of reflexology on pre-cesarean anxiety has not been evaluated. Therefore, we aimed to evaluate the effect of pre-cesarean foot reflexology massage on the anxiety of women during their first pregnancy. Materials and Methods This study is a three-group clinical trial that was conducted in 2019. The study sample consisted of 90 pregnant women hospitalized for cesarean section in Zahedan who were randomly divided into three groups of 30 women. The subjects completed the state section of Spielberger anxiety questionnaire. The control group did not receive any intervention. For two groups, 1 h before surgery, a group received reflexive massage, and the another group simple massage. Duration of massage for each group was 30 min. After 30 min, the subjects completed the state section of Spielberger questionnaire again. Statistical analysis was performed by SPSS software program, version 21.0. ANOVA and ANCOVA tests were used to compare between groups and paired t-test was used for intra-group comparisons. Results The results showed that the level of anxiety was significantly reduced in the reflexology massage group (from 55 ± 8 to 40 ± 7) as well as simple massage group (from 51 ± 10 to 47 ± 7) (p<0.001). In the control group, anxiety was increased (from 49 ± 9 to 56 ± 9) (p<0.001). Comparison between the three groups by ANCOVA indicated that reflexology massage and simple massage significantly decreased anxiety scores (p>0.001 and p>0.001,respectively). Reflexive massage significantly reduced anxiety scores (p>0.001) as compared to simple massage. Conclusion The results of this study revealed the positive effect of reflexology massage on pre-cesarean anxiety. Because reflexology massage is an inexpensive, simple, and easy approach, the use of this non-pharmaceutical method is recommended to reduce pre-cesarean anxiety.

Effectiveness of stress inoculation training on occupational stress of midwives in healthcare centers of Zahedan in Health Transformation Plan in 2017.

INTRODUCTION: Occupational stress is a main problem of healthcare workers, which significantly affects their professional and personal performance. The aim of this study was to determine the impact of a stress immunization program on occupational stress of midwives working in health centers. MATERIALS AND METHODS: In this quasi-experimental study, 80 midwives working in health centers of Zahedan (2017) were divided into test and control groups based on random allocation. The intervention involved a stress immunization program consisting of two workshops (each lasting 4 h) in two consecutive weeks, which was implemented for the intervention group. As data collection tool, Health and Safety Executive Occupational Stress Questionnaire was completed in three steps before, immediately after, and 1 month after the intervention. Data were analyzed using descriptive and analytical statistics, independent t-test, and repeated measures ANOVA. RESULTS: The findings showed that mean stress score in the intervention group was increased from 79.5 ± 9.7 before intervention to 104.5 ± 17.3 immediately after it, which was increased to 110.5 ± 18.3 1 month after intervention (P < 0.001). In the control group, mean stress score was decreased immediately after as well as 1 month after the intervention, which was statistically significant after the intervention and 1 month after it (P > 0.023). CONCLUSION: The stress immunization program is an inexpensive and effective way to reduce the stress of midwives; therefore, it is suggested to be used to effectively handle occupational stress among midwives and to improve their quality of care.

The Association of Health Literacy with Breast Cancer Knowledge, Perception and Screening Behavior.

OBJECTIVE: The incidence of breast cancer among Iranian women is increasing, and 70% of patients are diagnosed at advanced stages. The current study aimed at evaluating the association of health literacy (HL) with breast cancer knowledge, perception, and screening behavior in women. MATERIALS AND METHODS: The current cross- sectional, descriptive study was conducted on 250 women who referred to health centers in Zahedan, Iran. Data collection instrument included a demographic information form, Iranian Health Literacy Questionnaire (IHLQ), and Champion's health belief model scale. RESULTS: The majority of participants (89.6%) had limited HL. Participants with limited HL had less breast cancer knowledge, and less perceived severity than who had higher HL score. Participants with higher HL score had done breast self-exam (BSE) more than the others. There was no significant relationship between HL and clinical breast examination (CBE), and with perceived susceptibility. CONCLUSION: Interventions to enhance breast cancer knowledge and screening should notice the HL of women.

Comparing two instructional methods of role playing and lecture on primigravida females, decision about type of delivery.

INTRODUCTION: Each mother has the legal right to decide about her delivery, but this decision should be made based on scientific knowledge. Instructions during pregnancy help to choose the proper type of delivery. This study conducted aimed to compare two instructional methods of role playing and lecture on primigravida decision about type of delivery. SUBJECTS AND METHODS: In this single-blind clinical trial 67 primigravida, 34-36 week were selected using multi-stage sampling and assigned into two groups randomly. Decision-making (before, 2-week after, and at admission in maternity department) was tested by a questionnaire. In role-playing group, advantages and disadvantages of two type delivery were presented by role-playing in 90-min by three scenarios. In lecture group, it was also presented in a 90-min lecture. Data were analyzed by mean difference test, Fisher test, independent and paired t-test. RESULTS: Two groups showed a significant difference in terms of decision at admission to maternity department (P = 0.000). 75% of lecture group and 100% of role-playing group selected normal delivery. Postintervention knowledge score in lecture group was 18 ± 5.3 and in role-playing group 17.1 ± 4.0. Percent of change in knowledge scores in two groups was significant (P = 0.001). Participants' attitude, before and after the intervention, in both groups was significant (P < 0.05). Mean difference of pre- and post-test in relation to two groups' knowledge and attitude scores was not significant (P > 0.05). CONCLUSION: In this research, lecture was more effective in raising knowledge level, and role playing was more effective in raising decision to vaginal delivery and reducing elective caesarean section. It is therefore suggested to use both teaching methods altogether for pregnant women to decrease the rate of unnecessary cesarean.

Effect of role play education on primiparous women's fear of natural delivery and their decision on the mode of delivery.

BACKGROUND: The number of women who select cesarean section due to fear of childbirth has increased. Role play education seems to be a helpful method to remove or reduce the fear of childbirth. Therefore, this study aimed to investigate the effect of role play education on primiparous women's fear of natural delivery and their decision on the mode of delivery. MATERIALS AND METHODS: In this blind clinical trial, 67 primiparous women with natural pregnancy at 34-36 weeks of gestational age and with no indication of cesarean section were selected from the health care centers in Mashhad. They were randomly assigned to two groups who underwent pre-test and post-test with the help of delivery attitude questionnaire to investigate their fear of childbirth and a researcher-made pregnant women's decision investigation questionnaire. Education through role play was conducted in the form of three scenarios during seven stages. The findings were analyzed by Fisher's exact test and independent t-test through SPSS. RESULTS: The two groups were significantly different concerning the fear of childbirth after the intervention (P = 0.007), and the fear score showed a higher reduction in the role play group compared to the lecture group. There was a significant difference between the two groups concerning the reduction of elective cesarean section and the decision on the mode of delivery at the time of admission in the labor room (P = 0.000). About 75% in the lecture group and 100% in the role play group selected natural delivery. CONCLUSIONS: In the present study, the effect of role play was more in making a decision on natural delivery, reducing the fear of childbirth, and reducing the rate of elective cesarean section. It is suggested to use role play method to educate pregnant women to reduce the rate of cesarean sections.