Comparison of treatment outcomes of infertile women by clomiphene citrate and letrozole with gonadotropins underwent intrauterine insemination

This study was designed to compare the effect of clomiphene and letrozole in ovulatory stimulation in infertile women under intrauterine insemination who referred to Mahdiyeh infertility clinic during 2008-2009. 106 infertile women were randomly divided into two equal groups. Patients were treated with 5 mg of letrozole daily [in letrozole group] or 100 mg of clomiphene citrate daily [in clomiphene group] for five days starting on day 3 of their menses. Dose and time of FSH was similar in the two groups. Number of follicles, endometrial thickness, Pregnancy rate and prevalence of complications were compared in the two groups. Mean [ +/- SD] of age in letrozole and clomiphene groups was 26.3 +/- 3.9 and 25.2 +/- 4.9 respectively [P=0.186]. Average number of follicles was 2.5 +/- 1.65 in letrozole group and 2.36 +/- 1.4 in clomiphene group [P=0.764]. Beta-hCG was positive in 11 [20.8%] in letrozole and 12 [22.6%] in clomiphene groups [P=0.814]. Pregnancy rate was 20.8% and 22.6% in letrozole and clomiphene group respectively [P=0.814]. There was no difference in rate of abortion between groups. Endometrial thickness [ET] at the time of hCG administration in the letrozole [6.8 +/- 1.5 mm] and in clomiphene [6.6 +/- 1.2 mm] [P=0.615]. But ET>7.4 mm was found in 2 cased [3.8%] in clomiphene group and 12 cases [%22.8] in letrozole groups [P=0.01]. It appears that letrozole and clomiphene have similar outcome infertile women under intrauterine insemination and these drugs are good alternative for each others

Maternal and neonatal complications of substance abuse in Iranian pregnant women

There is an increased prevalence of maternal substance abuse during pregnancy in younger women in all socioeconomic classes and races. Our aim was to determine the prevalence and correlates of self-reported substance abuse among pregnant women and obstetric complications or neonatal outcomes in Iran. This retrospective cohort study is covering a five year period on medical records of pregnant women attending the maternity unit of four major hospitals [Mahdieh, Taleghani, Imam Hossein and Akbarabadi Hospitals]. Women who reported using opium, heroin, crack, cannabis or methamphetamine were compared with women with no reported history of drug abuse for obstetric complications and prenatal morbidity and neonatal mortality. From 100,620 deliveries substance abuse was recorded for 519 women giving a prevalence of 0.5%. Opium was the most prevalent substance abused followed by crack [a mix of heroin and amphetamines]. The exposed group had significantly more obstetric complications including preterm low birth weight and postpartum hemorrhage than the non-exposed group. The exposed group had significantly worse prenatal outcomes including more admissions to intensive care unit and higher infant mortality than the non-exposed group. None of the women in the exposed group was on methadone treatment at time of delivery. Risks of maternal and neonatal complications were increased in substance using pregnant women, especially preterm birth and low birth weight. We recommend a multidisciplinary team to provide methadone maintenance therapy for substance using pregnant women and urinary screen of all pregnant women presenting to hospital

Perinatal complications in substance using in pregnancy

Substance abuse is a major public health issue in all over the world. The types and ingredients of drugs used in our country are different from other countries. The study was conducted to determine relationship between substance abuse during pregnancy, and perinatal complications in Iran. A retrospective cohort study was carried out over a 6 years period on all the substance user pregnant women [519 cases] and 519 non users attending 4 major educational university hospitals labor ward. All the substance user pregnant mothers abusing heroin, opium, crack, cannabis, crystal, methadone, and polydrug were included and compared to non-exposed ones. Our study demonstrated a 0.5% prevalence of substance abuse in pregnant women. Opium [62.6%] was the most prevalent substance followed by crack [20.3%]. Pre-term birth was higher in all substance user groups, the most in crack group [45.8%] with relative risk of 2.55. Neonatal abstinence syndrome developed in 38.7% of infants born of addicted mothers [40.4% crack, 38.6% opiates, 35.3% crystal and 45.5% poly drug use]. Neonatal birth weight of infants of mothers using crack, opium and polydrug were significantly lower to non users [P<0.05]. Neonatal Intensive Care Unit [NICU] admission in substance using mothers was significantly higher than non-users [P < 0.001]. Neonatal death was 10.1% in crack group [RR=3.48] and 5.8% in opium user group [RR=2.79] with significant difference with non-users [P<0.05]. The frequent types of substances used during pregnancy in our country are different from others [opium was the most prevalent substance]. Subsequently the frequencies of the complications during pregnancy are different. Substance abuse during pregnancy has increased risk of pre-term birth, Small for Gestational Age, NICU admission and neonatal death