most important risk factors affecting mental health during pregnancy: a systematic review

Background: Pregnant women comprise a vulnerable population owing to the changes they experience in various stages that affect their mental health. Mental health problems affects nearly one-fifth of pregnant women during the prenatal and postpartum periods. Millennium Development Goals 4 and 5 focus on maternal and child health and specify that overall health cannot be reached without mental health.

Aims: The aim of this comprehensive systematic review was to evaluate research evidence on the determinants of antenatal mental health disorders among Iranian women.

Methods: Using a systematic literature review of observational studies in English and Farsi we focused on Iranian women being evaluated for the determinants of antenatal mental health problems. PubMed, Scopus, ISI Web of Science, Scientific Information Databases [SID], Global Medical Article Limberly, Iranian Biomedical Journal and the Iranian Journal Database were independently searched to identify articles published during 2000–2016.

Results: Thirty-one studies met the inclusion criteria and the results showed a significant relationship between antenatal mental health risks and variables such as lack of social support, marital status, domestic violence, unintended pregnancy and socioeconomic status. The paucity of high quality research evidence limited proper evidenced-based planning and generating results deemed essential to address antenatal mental health issues for Iranian pregnant women.

Conclusions: Our results showed that socioeconomic status and marital quality are the most important risk factors for disturbing mental health among Iranian pregnant women

Studying the relationship between the attitude to infertility and coping strategies in couples undergoing assisted reproductive treatments

Background: Using appropriate coping strategies has a positive influence on moderating mental pressures caused by infertility and the stress during treatment. Using these strategies needs personal skills and they could be influenced by individual's inner psychological and environmental factors. The aim of this study was to assess the relationship between the attitude toward infertility and coping strategies considering the couple's social and financial situation

Methods: This was a cross sectional study conducted on 133 volunteered couples undergoing assisted reproductive treatment. Coping strategies and the attitude toward infertility were assessed using a self-report questionnaire. Higher scores of attitude indicated positive attitudes. Data was analyzed using paired-samples t test and multiple regression model

Results: Independent from demographic information and causes of infertility, using self-blame and self-focused rumination coping strategies were negatively related to attitude toward infertility in both men and women [p<0.05]. Also, using self-blame coping strategy had a positive correlation with female infertility and negative correlation with male infertility

Conclusion: Regardless of the economic and social conditions, in infertile couples, downward trend in attitude toward infertility is mostly associated with the use of maladaptive coping strategies

relations between dietary antioxidant vitamins intake and oxidative stress in follicular fluid and ART outcomes

Oxidative stress [OS] in the follicular environment may affect on oocyte competence and antioxidant vitamins may modify its effects. This study was conducted to examine the effect of dietary intake of vitamin A, C and E on OS in follicular environment and assisted reproduction technology [ART] outcomes. In this obsevationalprospective study, the intake levels of vitamin A, C, and E were matured by validated food frequency questionnaire and Malondialdehyde and the total antioxidant capacity [TAC] levels of follicular fluid [FF] in 219 women undergoing ART were assessed. The number of retrieved oocytes, percentages of metaphase II MII] stage oocytes, fertilization rate, and embryo quality were also determined. No significant association was found between vitamins intake levels and OS biomarkers, but the mean of TAC level in FF among women who received vitamin C greater than 75 mg/d was higher than women with lower intakes [p<0.05]. The ART parameters were not related to the vitamin E intake level, but the normal cleaved embryo rate was positively related to vitamin A [p<0.05] and vitamin C [p=0.02] intake levels. Also, the percentage of MII oocytes [p=0.02] and the fertilization rate [p<0.05] were related to the vitamin C intake level. The relation between the TAC level in FF and ART outcomes were not significant. Current results indicated that high dietary intake of vitamin C would be followed by increasing the TAC level in FF and improving the oocyte competence, but this effect of vitamin C is not dependent of increasing of antioxidant defense in follicular environment

Relationship between dietary fat intake, its major food sources and assisted reproduction parameters

High dietary fat consumption may alter oocyte development and embryonic development. This prospective study was conducted to determine the relation between dietary fat consumption level, its food sources and the assisted reproduction parameters. A prospective study was conducted on 240 infertile women. In assisted reproduction treatment cycle, fat consumption and major food sources over the previous three months were identified. The number of retrieved oocytes, metaphase II stage oocytes numbers, fertilization rate, embryo quality and clinical pregnancy rate were also determined. The data were analyzed using multiple regression, binary logistic regression, chi-square and t-test. The p-value of less than 0.05 was considered significant. Total fat intake adjusted for age, body mass index, physical activity and etiology of infertility was positively associated with the number of retrieved oocytes and inversely associated with the high embryo quality rate. An inverse association was observed between sausage and turkey ham intake and the number of retrieved oocytes. Also, oil intake level had an inverse association with good cleavage rate. The results revealed that higher levels of fat consumption tend to increase the number of retrieved oocytes and were adversely related to embryonic development. Among food sources of fat, vegetable oil, sausage and turkey ham intake may adversely affect assisted reproduction parameters

Relationship between energy expenditure related factors and oxidative stress in follicular fluid

Background: This study evaluated the impact of body mass index [BMI], total calorie intake and physical activity [PA] as energy expenditure related factors on oxidative stress [OS] in follicular fluid [FF]

Materials and Methods: This prospective study conducted on 219 infertile women. We evaluated patients' BMI, total calorie intake and PA in their assisted reproduction treatment cycles. Malondialdehyde [MDA] and total antioxidant capacity [TAC] in pooled FF at oocyte retrieval were additionally assessed

Results: There was no relation between OS biomarkers to total calorie intake and PA. The TAC levels in FF adjusted for age, duration of infertility, etiology of infertility, number of used gonadotrophin and PA showed a positive relation to BMI [p=0.001]. The number of used gonadotrophin and PA had a negative relation to duration of infertility [p=0.03] and anovulation disorder as an etiology of infertility. The MDA level in FF had a positive association with anovulation disorder as the etiology of infertility [p=0.02]. MDA in FF was unaffected by BMI

Conclusion: Increasing age, BMI and PA do not affect OS in FF. In women with longtime infertility and those with anovulation disorder as an etiology of infertility, decreased potent antioxidant defense in the follicular microenvironment may contribute to ovarian function. Therefore antioxidant supplements may be beneficial for these groups of women

Does dietary fat intake influence oocyte competence and embryo quality by inducing oxidative stress in follicular fluid?

Fat-rich diet may alter oocyte development and maturation and embryonic development by inducing oxidative stress [OS] in follicular environment To investigate the relationship between fat intake and oxidative stress with oocyte competence and embryo quality. In observational study follicular fluid was collected from 236 women undergoing assisted reproduction program. Malon-di-aldehyde [MDA] levels and total antioxidant capacity [TAC] levels of follicular fluid were assessed as oxidative stress biomarkers. In assisted reproduction treatment cycle fat consumption and its component were assessed. A percentage of metaphase Second stage oocytes, fertilization rate were considered as markers of oocyte competence and non-fragmented embryo rate, mean of blastomer and good cleavage [embryos with more than 5 cells on 3 days post insemination] rate were considered as markers of embryo quality. The MDA level in follicular fluid was positively related to polyunsaturated fatty acids intake level [p=0.02] and negatively associated with good cleavage rate [p=0.045]. Also good cleavage rate [p=0.005] and mean of blastomer [p=0.006] was negatively associated with polyunsaturated fatty acids intake levels. The percentage of metaphase Second stage oocyte was positively related to the TAC levels in follicular fluid [p=0.046]. The relationship between the OS biomarkers in FF and the fertilization rate was not significant. These findings revealed that fat rich diet may induce the OS in oocyte environment and negatively influence embryonic development. This effect can partially be accounted by polyunsaturated fatty acids uptake while oocyte maturation is related to TAC and oocytes with low total antioxidant capacity have lower chance for fertilization and further development

relationship between mother's parenting style and social adaptability of adolescent girls in Isfahan

Social adaptability is an important requirement of the social life of adolescents, which can be affected by their mother's parenting style [PS]. The purpose of this study is to compare the social adaptability in four parenting styles [authoritative, authoritarian, permissive and neglectful] through which mothers interact with their adolescent girls. This survey is a cross-sectional and analytical study on 737 adolescents that study in the all girls junior high schools in Isfahan. Data collection was done with a questionnaire. The questionnaires were completed by the adolescents. After data collection, the parenting styles were determined and the social adaptability of the four groups was compared. The mean social adaptability in adolescents who their mothers have the authoritative parenting style was 49.6 +/- 6.1, in the permissive parenting style 50.1 +/- 5.8, the authoritarian parenting style 44.2 +/- 6.5 and in the neglectful parenting style was 42.2 +/- 7.5. The social adaptability of the four groups was significantly different [p < 0.001]. This study shows that the permissive parenting style and after that authoritative parenting style were followed by higher social adaptability in adolescent girls.

Preconception counseling in couples undergoing fertility treatment

The preconception period is crucial to fertility and pregnancy health. Offering education and counseling to couples being treated for infertility improves the outlook of treatment. The aim of this study is to assess preconception education and counseling in a population of Iranian couples treated for infertility. This is a cross-sectional study of 268 individuals who presented to fertility clinics across the city of Isfahan, Iran. Questionnaires and patient records were used to collect data. We evaluated the components of standard preconception counseling [lifestyle, diet, sexual health, substance abuse, and social counseling] versus preconception counseling offered to couples that were receiving infertility treatment [failure, follow-up, and side effects of treatment]. We found that no counseling had been given to about 76.9% about lifestyle, 70.9% about diet, 90.7% about sexual health, and 90.7% about the psychosocial aspects of infertility. No counseling had been given to 46.6% of individuals about a follow-up and also to 46.6% of individuals about the side effects of treatment. In more than 75% of the cases, counseling was offered to couples whose etiology of infertility was unknown. We have found serious flaws in the education and preconception counseling of infertile Iranian couples; action is required by medical and health teams to address these shortcomings