Effect of Different Types of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Neonatal Outcomes: A Systematic Review, Meta-Analysis, and Meta-Regression

Background@#Evidence supporting various diagnostic criteria for diagnose gestational diabetes mellitus (GDM) are consensus-based, needs for additional evidence related to outcomes. Therefore, the aim of this systematic-review and meta-analysis was to assess the impact of different GDM diagnostic-criteria on the risk of adverse-neonatal-outcomes. @*Methods@#Electronic databases including Scopus, PubMed, and Web of Sciences were searched to retrieve English original, population-based studies with the universal GDM screening approach, up to January-2020. GDM diagnostic criteria were classified in seven groups and International Association of the Diabetes and Pregnancy Study Groups (IADPSG) was considered as reference one. We used the Mantel–Haenszel method to calculate the pooled odds of events. The possibility of publication bias was examined by Begg’s test. @*Results@#A total of 55 population-based studies consisting of 1,604,391 pregnant women with GDM and 7,770,855 non-GDM counterparts were included. Results showed that in all diagnostic-criteria subgroups, the risk of adverse neonatal outcomes including macrosomia, hyperbilirubinemia, respiratory distress syndrome, neonatal hypoglycemia, neonatal intensive care unit admission, preterm birth, and birth-trauma were significantly higher than the non-GDM counterparts were significantly higher than non-GDM counterparts. Meta-regression analysis revealed that the magnitude of neonatal risks in all diagnostic-criteria subgroups are similar. @*Conclusion@#Our results showed that the risk of adverse-neonatal-outcome increased among women with GDM, but the magnitude of risk was not different among those women who were diagnosed through more or less intensive strategies. These findings may help health-care-providers and policy-makers to select the most cost-effective approach for the screening of GDM among pregnant women.

Nanomedicine Approaches for Treatment of Menopausal Symptoms

No abstract available.

[In vitro diagnostic criterion of androgen excess in polycystic ovary syndrome: a community based study on Iranian reproductive aged women]

Backgrounds and Objectives: Androgen excess is a diagnostic criterion for PCOS. There are different cut off points to identify androgen excess in various societies. Since the mean levels of androgens among women of various races vary widely, it has been suggested that the normal ranges or limits of androgen levels should be determined specifically among well-characterized women of each population

Materials and Methods: Data from the study of PCOS prevalence was analyzed for purpose of the present cross sectional study. The cut off point for androgen excess was defined using K-means cluster analysis according to the level of androgens among 923 women aged 18-45. Data analysis was performed using SPSS version 15

Results: Serum concentration levels of early follicular phase equal or greater than 8.76, 1.331 nmol/L, 345.07 and 2.9 ng/milL for FAI, TT, DHEAS and A4, respectively were used as cut off levels for androgen excess. Subgroup analysis showed that androgen excess cut off point varies in age and BMI subgroups. FAI cut off for androgen excess in women aged less than 35 years were 5.1, 4.85 and 6.3 in normal weight, over weight and obese women, respectively

Conclusion: According to the findings of present study hormonal components to define androgen excess vary in early and late ages of reproductive period. Results showed that androgen excess is diagnosed as lower levels of FAI, DHEAS and A4 in women older than 35 in comparison with women aged less than 35. This disorder should also be determined in normal weight, overweight and obese women separately

Thyroid dysfunction and pregnancy outcomes

Pregnancy has a huge impact on the thyroid function in both healthy women and those that have thyroid dysfunction. The prevalence of thyroid dysfunction in pregnant women is relatively high. The objective of this review was to increase awareness and to provide a review on adverse effect of thyroid dysfunction including hyperthyroidism, hypothyroidism and thyroid autoimmune positivity on pregnancy outcomes. In this review, Medline, Embase and the Cochrane Library were searched with appropriate keywords for relevant English manuscript. We used a variety of studies, including randomized clinical trials, cohort [prospective and retrospective], case-control and case reports. Those studies on thyroid disorders among non-pregnant women and articles without adequate quality were excluded. Overt hyperthyroidism and hypothyroidism has several adverse effects on pregnancy outcomes. Overt hyperthyroidism was associated with miscarriage, stillbirth, preterrn delivery, intrauterine growth retardation, low birth weight, preeclampsia and fetal thyroid dysfunction. Overt hypothyroidism was associated with abortion, anemia, pregnancy-induced hypertension, preeclampsia, placental abruption, postpartum hemorrhage, premature birth, low birth weight, intrauterine fetal death, increased neonatal respiratory distress and infant neuro developmental dysfunction. However the adverse effect of subclinical hypothyroidism, and thyroid antibody positivity on pregnancy outcomes was not clear. While some studies demonstrated higher chance of placental abruption, preterm birth, miscarriage, gestational hypertension, fetal distress, severe preeclampsia and neonatal distress and diabetes in pregnant women with subclinical hypothyroidism or thyroid autoimmunity; the other ones have not reported these adverse effects. While the impacts of overt thyroid dysfunction on feto-maternal morbidities have been clearly identified and its long term impact on childhood development is well known, data on the early and late complications of subclinical thyroid dysfunction during pregnancy or thyroid autoimmunity are controversial. Further studies on maternal and neonatal outcomes of subclinical thyroid dysfunction maternal are needed

Antioxidants and management of polycystic ovary syndrome in Iran: a systematic review of clinical trials

Recently there is a focus on the antioxidants as adjuvant treatment of polycystic ovary syndrome [PCOS], the most endocrinopathy in reproductive age women. The aim of this review is answer to the question whether antioxidants are effective for managing of hormonal and metabolic problems in women with PCOS based on first degree evidences from Iran. A systematic review of clinical trials was done in Persian and international databases including PubMed, Scientific Information Database, Google Scholar, Iran Medex, and Magiran up to 2013. Keywords were including polycystic ovary syndrome, Iran, vitamin, antioxidant. From 440 potential studies found electronically, 11 studies; including 444 women in intervention and 390 women in control groups. Intervention in three studies was Calcium-vitamin D or calcitriol; in three studies was omega-3 fatty acids; in two studies was N-acetyl cysteine; in one study was folic acid; in one study was Zinc; and in one study was Soy. Finally, 11 studies that were relevant and met the inclusion criteria reviewed. There were 7 studies in English and 4 studies in Persian. We couldn't include all studies because all full texts were not accessible. The results showed that antioxidants and vitamins have positive effects on management of PCOS women. Although it seems more studies is necessary in this field

[Comparison of energy-restricted high protein [HP] with standard-protein [SP] diets in women with polycystic ovary syndrome]

Some researchers administer a diet with a higher ratio of protein to carbohydrates [HP] in patients with polycystic ovary syndrome [PCOS], but there is a limited number of dietary interventions compared the effects of an HP diet with a standard protein [SP] diet. Therefore, the aim of this review was to compare the effects of energy-restricted HP diets with those of iso-calorically prescribed SP diets on anthropometric, metabolic, hormonal, and reproductive outcomes in women with PCOS. Searches for English-language studies published between 2000 and 2014 were conducted using PubMed, Science Direct, and Scopus databases to identify all randomized controlled trials that compared HP diet with SP diet. There was no difference in anthropometric outcomes between two different diets. There was no difference in reproductive outcomes between the two dietary treatments. Weight loss decreased testosterone, free testosterone, or FAI [Free Androgen Index] and increased SHBG, independent of prescribed diet. There was no difference in metabolic outcomes between the two dietary treatments. A standard-protein weight-loss diet reduced HDL- cholesterol, while no changes occurred for a high protein weight-loss diet. The high-protein diet reduced total cholesterol to HDL-C ratio. Weight loss, independent of diet composition, decreased fasting insulin, insulin resistance and Improvements in lipid profiles. High protein diet caused subtle and inconsistent changes in metabolic variables, and weight loss results in clinical benefit, regardless of diet composition, in women with PCOS

[ relationship between some risk factors of cardiovascular diseases in reproductive age women with duration of oral contraceptive pills use]

Many of women use oral contraceptive pills [OCP] to prevent pregnancy. So, this study was conducted to evaluate the OCP duration consumption on some risk factors of cardiovascular diseases. Women were selected among 4689 of Tehran Lipid and Glucose Study [TLGS] participants whose data were complete. The questionnaires of TLGS were used for data gathering. Comparison of four groups, including non users and users with different duration of consumption, even with adjustment for confounding factors showed no statistical significant difference. It seems duration of consumption of current OCPs is not contributor for cardiovascular diseases

Isolation and partial characterization of human amniotic epithelial cells: the effect of trypsin

Despite the extensive information available in the literature, cell surface marker signature of human Amniotic Epithelial Cells [hAECs] remains controversial. The aim of the present study was to characterize immunophenotypic features, proliferative capacity and immunogenicity of hAECs. We also tested whether expression of some cell surface markers is influenced by the type of trypsin used for tissue digestion. Single cell suspensions of amniotic membranes from four human placentas were isolated by enzymatic digestion and expression of CD9, CD10, CD29, CD34, CD38, CD44, CD45, CD73, CD105, CD133, HLA-I, HLA-DR, HLA-G, SSEA-4, STRO-1 and OCT-4 was then evaluated by flow cytometry. The differential impact of four trypsin types on the yield and expression of CD105 and HLA-I was also determined. The proliferative capacity of cultured hAECs was assessed and compared in the presence and absence of Epidermal Growth Factor [EGF]. To test their immunogenicity, hAECs were injected into Balb/c mice and the reactivity of hyperimmunized sera was examined by immunofluorescence staining. Nearly all purified cells expressed mesenchymal markers, CD9, CD10, CD29, and CD73 and the embryonic marker, SSEA-4. A large proportion of the cells also expressed STRO-1 and OCT-4. The purified cells also expressed HLA-G and HLA-I. A very small proportion of hAECs expressed CD34, CD38, CD44, CD133 and HLA-DR. The type of trypsin used for enzymatic digestion affected both the percentage and expression of HLA-I and CD105. hAECs revealed substantial proliferative capacity only when cultured in the medium supplemented with EGF. These cells were shown to be capable of inducing high amounts of anti-donor antibodies. Here we provided evidence that hAECs are immunogenic cells with high level of HLA-I expression. Furthermore, this work highlighted the impact of isolation procedure on the immunophenotype of hAEC

Development of strategies to reduce cesarean delivery rates in Iran 2012-2014: a mixed methods study

With the change in population policy from birth control toward encouraging birth and population growth in Iran, repeated cesarean deliveries as a main reason of cesarean section are associated with more potential adverse consequences. The aim of this research was to explore effective strategies to reduce cesarean delivery rates in Iran. A mixed methodological study was designed and implemented. First, using a qualitative approach, concepts and influencing factors of increased cesarean delivery were explored. Based on the findings of this phase of the study, a questionnaire including the proposed strategies to reduce cesarean delivery was developed. Then in a quantitative phase, the questionnaire was assessed by key informants from across the country and evaluated to obtain more effective strategies to reduce cesarean delivery. Ten participants in the qualitative study included policy makers from the Ministry of Health, obstetricians, midwives and anthropologists. In the next step, 141 participants from private and public hospitals, insurance experts, Academic Associations of Midwifery, and policy makers in Maternity Health Affairs of Ministry of Health were invited to assess and provide feedback on the strategies that work to reduce cesarean deliveries. Qualitative data analysis showed four concept related to increased cesarean delivery rates including; "standardization", "education", "amending regulations", and "performance supervision". Effective strategies extracted from qualitative data were rated by participants then, using ACCEPT derived from A as attainability, C as costing, C as complication, E as effectiveness, P as popularity, and T as timing table 19 strategies were detected as priorities. Although developing effective strategies to reduce cesarean delivery rates is complex process because of the multi-factorial nature of increased cesarean deliveries, in this study we have achieved strategies that in the context of Iran could work

Evaluation of the relationship between serums visfatin and resistin levels with BMI in PCOS young women

Polycystic ovary syndrome [PCOS] is a common endocrine / metabolic disorder in women of reproductive age .Abdominal adiposity and obesity are frequently present in PCOS. It now appears that, obesity is associated with a low-grade inflammation of white adipose tissue. Adipokines play a significant role in the pathogenesis of a low-grade inflammation associated with obesity. Among variety of adipokines, resistin and visfatin are proposed as important pro inflammatory mediators and they have recently been suggested to be associated with obesity related diseases. The aim of this study is to evaluate the correlation of visfatin and resistin serum levels and the ratio of these two adipokines with BMI in PCOS women under age of 35 years old. Twenty eight young women with clinically confirmed PCOS disease [14 lean and 14 obese], and 12 young, healthy and lean women with stable weight and BMI<25 were enrolled. Blood was obtained from the included persons, and visfatin and resistin were assessed by ELISA method. We did not observe any significant differences in serum visfatin and resistin concentrations and also in the Visfatin/Resistin ratio between PCOS and control group. Also we did not found a significant correlation between visfatin and resistin with BMI. This study demonstrated that serum resistin and visfatin levels do not seem to be directly involved in the pathology of PCOS

Relationship between polymorphism of insulin receptor gene, and adiponectin gene with PCOS

Polycystic ovary syndrome [PCOS] is a complex disease having both genetic and environmental components and candidate genes on obesity and insulin metabolism have been hypothesized to be involved in its etiology. We examined the possible association of adiponectin and insulin receptor gene polymorphisms with PCOS. A total of 186 women with PCOS using NIH criteria and 156 healthy women were recruited. Their samples were genotyped for the polymorphism in exon 17 and 8 of the insulin receptor gene or exon and intron 2 of the adiponectin gene. The distributions of genotypes and alleles of both polymorphisms were not different in women with PCOS and controls. There was no significant differences on the anthropometric and hormonal profiles of various adiponectin and insulin receptor genes polymorphisms among both groups. Adiponectin and insulin receptor gene polymorphisms are not associated with PCOS in a sample of Iranian population

Sexual behavior of married Iranian women, attending Taleghani public health center

Sexual practices as an important aspect of reproductive health have many physical and psychological effects on people's lives, there is limited evidence on such practices and their pattern among Iranian women. Hence we aimed to determine different types of sexual practices among 19-45 year old married Iranian women. This cross-sectional study was conducted among 200 married women, aged 19-45 years, attending Taleghani Public Health Center for annual gynecologic examination during November 2008 to May 2009 using convenient sampling. The participants were enquired about their experience regarding different types of sex, as well as their views and feelings about such practices, using an anonymous questionnaire. The mean age of the participants was 34 years. All had ever experienced vaginal sex and 50.9% reported ever experience of other types of sex [non-vaginal], as well. Due to some stigma attached to non-vaginal sexual practices among women in Iran, the feelings of women with regard to different sexual practices were also examined in this paper. This study showed that non-vaginal sex among women is considerable and because of less favourable views of women towards such practices, it seems that these practices might have psychologically impacts on women's life. Hence, counseling and educational programs designed for married men and women can include some factual information about different types of sex

Peer education: participatory qualitative educational needs assessment

In the area of youth health, peers education is an approach to health promotion. Assess the training needs of peers educators clarifies the components, values, and quality of training protocols. Aim to that we conducted a participatory educational needs assessment of youth peer educators. Involving youth and key informants in direct collaboration with research team, a qualitative approach was planned based on grounded theory. For data collection a semi-structured guide questioning was designed. Sixteen focus group discussions and 8 in depth interview were held. The majority of participants emphasized on the importance of mental health, life skills, AIDS prevention, contraception methods, and healthy nutrition as the main training topics. They were extremely interested into the comprehensive educational material among their participatory role in peer programs. The training programs should be well defined based on the knowledge, skills and behavior of peers. During the implementation, training programs should be followed to meet the ongoing educational needs of service providers

Evaluation of sexual attitude and sexual function in menopausal age; a population based cross-sectional study

Menopause and its physical, hormonal and psychosocial changes could affect women's sexual function. There are controversial results regarding relationship between sexual attitudes and function. We aimed to evaluate sexual attitudes and sexual function among Iranian menopausal age women. This population based cross-sectional study was carried out on 225 menopausal women, aged 45-65 years. Based on a self-made questionnaire data were collected about women's socio-demographic characteristics, attitudes regarding sexuality and sexual function. Data were analyzed using SPSS and sexual function was compared between three groups of women who had positive, medium and negative attitudes regarding sexuality. The mean age of women was 53.11 +/- 4.56 years. Seventy percent of them had at least one sexual problem. Feeling of dyspareunia was significantly different between three categories of attitudes regarding sexuality [p=0.03]. Comparing data obtained on their attitudes, sexual desire, orgasm and dyspareunia demonstrated significant differences [p=0.03, 0.04, and 0.04 respectively]. Attitude regarding sexual function has a great impact on sexual activity of postmenopausal women that need to be considered in their health care programming

[Serum adiponectin levels and its association with insulin resistance and obesity in women with poly cystic ovarian syndrome]

Adiponectin is one of the adipokines derived from adipose tissue. It is involved in the regulation of glucose metabolism, Insulin Resistance [IR] and obesity-related disorders. Adiponectin in patients with Poly Cystic Ovarian Syndrome [PCOS] has a different expression. This study was performed to assess the serum levels of adiponectin in PCOS patients considering the high prevalence of insulin resistance in this patients and its relation with body mass index, fasting insulin and fasting glucose to evaluate This case-control study was performed on 45 PCOS patients and 45 controls being matched in regards to age and BMI. Adinopectin level was measured by ELISA. FBS and insulin were measured by glucose oxidase and ELISA method, respectively. Insulin resistance was determined by HOMA-IR. Serum adiponectin level in PCOS subjects and healthy women did not differ statistically. There was no significant difference between fasting insulin and fasting glucose levels in PCOS subjects and healthy women. However, HOMA-IR in PCOS subjects was significantly higher than healthy women. There was a significant negative correlation between adiponectin level and BMI [p=0.035] and fasting glucose [p=0.019]. However, after separation of the two groups there was no correlation between adiponectin and BMI. Despite the relationship between adiponectin levels and BMI, and as no relation is observed with PCOS, the role of this adipokine in the syndrome is unlikely. Thus, apparently increase in the amount of adiponectin will not be effective in preventing the syndrome

[Association of serum adipsin levels with polycystic ovarian syndrome]

Adipokines are proteins secreted from adipose tissue that are involved in metabolism control. Adipsin is one of the adipokines that has a systemic role in lipid metabolism or physiological systems relating to energy balance. Serum levels are found to be associated with BMI, and insulin resistance in several studies. The aim of this study was to assess adipsins association with Poly Cystic Ovary Syndrome [PCOS]. This case-control study was performed on patients who referred to the clinic of the Research Institute for Endocrine Sciences of Shahid-Beheshti University in 2011. Forty five patients with PCOS and 45 normal individuals as control group were selected by easy given sampling method and studied. Fasting adipsin and insulin serum levels were measured by Elisa method and fasting glucose serum level was measured by enzyme-calorimetric method. Data were analyzed using independent t-test, Pearson correlation coefficient and one-way ANOVA by SPSS 16 software. Adipsin serum levels did not correlate with insulin resistance in PCOS [15.93 +/- 7.24 ng/dl in PCOS patients and 14.21 +/- 7.53 ng/dl in control group]. Glucose and insulin serum levels increased in PCOS [104.1 +/- 13.4 mg/dl and 10.8 +/- 5.2 mU/L respectively] in comparison with controls and these PCOS patients had insulin resistance. This study does not show the correlation between adipsin level and PCOS. It is possible to find a relationship between PCOS and adipsin through expanding the population or limiting the age levels

Whether age of menarche is influenced by body mass index and lipoproteins profile? a retrospective study

Menarche, a milestone in the reproductive life span of a woman, is influenced by several genetics and environmental factors. There is no consensus regarding the impact of body mass index [BMI] and lipid profiles on the age of menarche, as the results of various studies demonstrate. To investigate the correlation between age of menarche and BMI/lipoprotein profile in a community sample of Iranian girls. In the study, 370 girls, aged 10-16 years, who began their menarche within six months prior to the study, were recruited from the Tehran Lipid and Glucose Study [TLGS] population. Information was documented regarding their body composition, including height, weight, BMI, waist and hip circumference were collected and their lipid profiles were assessed after a 12-hour fast. In this study, the mean +/- SD of age of menarche and BMI were 12.6 +/- 1.1 years and 21.7 +/- 3.9 kg/m[2], respectively. There were statistically significant relationships between age of menarche and height, BMI, waist circumference, and the maternal educational level. The relationship between age of menarche and the weight and lipid profiles of subjects was not statistically significant. Age at menarche is not influenced by lipid profiles but it is influenced by BMI

[ association between serum chemerin concentration and polycystic ovarian syndrome]

Adipokines are proteins which are secreted from the adipose tissue. These groups of proteins are involved in the control of metabolism. Chemerin is one of these adipokines with different proposed biological roles. Serum levels of chemerin have been associated with increased body mass index, insulin resistance, metabolic syndrome, diabetes and cardiovascular diseases. The aim of this study was to assess the association between serum chemerin concentrations and polycystic ovarian syndrome. This case-control study was performed in Taleghani Hospital in Tehran, Iran during 2011. On 45 patients with polycystic ovarian syndrome and 45 normal individuals as the control group. The participants were selected by easy given sampling method. Body mass index, fasting chemerin and serum insulin concentrations were measured by Enzyme-Linked Immunosorbent Assay [ELIZA] method. Fasting serum glucose was measured by the enzyme-calorimetric method and insulin resistance index [HOMA-IR] was measured by the calculation of relevant equation. Data was analyzed using independent t-test and Pearson's correlation coefficient by SPSS version 18. Serum chemerin, insulin, and glucose concentrations were significantly higher in patients with polycystic ovarian syndrome than the control group. There was no significant correlation between body mass index, serum levels of insulin, glucose, HOMA-IR, or chemerin in cases and controls. This study showed that serum chemerin levels increase in polycystic ovarian syndrome. The findings also suggest that changes in chemerin serum levels could be considered as a criterion for polycystic ovarian syndrome

Parents or school health trainers, which of them is appropriate for menstrual health education?

The purpose of this community-based participatory research was to compare different training sources for adolescents' menstrual health education. From 15 middle schools in Tehran, through quota random sampling, 1823 female students were selected proportionally and allocated randomly to three groups [parent trained, schools' health trainers trained, and control]. Following a two-year training program, the adolescents' menstrual health was compared. In the present study, the school health trainers trained group showed a better feeling for rrienarche, compared to the two other groups [P < 0.001]. The need for adolescent health training was emphasized by 82% of the participants; they also believed that the appropriate age for such empowerment courses was about 12 years. In the school health trainers trained group, the offered age was significantly lower than in other groups [P < 0.001]. The adolescents trained by the school health trainers had a better practice of habits related to menstrual and hygiene practices, like having a bath during menstruation and the use of sanitary pads or cotton, compared to their counterpart groups [P > 0.05]. It is suggested that school-based health training leads to better menstrual health promotion and healthy puberty transition, and school health trainers play a key role in this regard

[Prevalence of female sexual dysfunction and its correlated factors: a population based study]

Objective [s]: To determine the prevalence of sexual dysfunction and its effective factors in a community based study among reproductive aged women

Methods: In the present study, 784 married women, lived in urban area of Ghazvin, Golestan, Kermanshah and Hormozgan provinces, were recruited using stratified, multistage probability cluster sampling method. The sexual dysfunction was assessed using a standard questionnaire

Results: The study results demonstrated that 27.3% of women had various degrees of sexual dysfunction; 0.8%,% 20.3% and 6.3% of women had sever, moderate and mild dysfunction, respectively. Sexual desire, sexual arousal and lubrication were disturbed in 35.6%, 39.9% and18.9% of women, respectively. Furthermore 27.3% of women had orgasm's problem and 15.2% of participants were unsatisfied with sexual activity, dyspareunia was reported by 56.1% of women. There is a statistical significant relationship between sexual dysfunction with duration of the marriage, the level of attractiveness in the perspective of the husband, the overall satisfaction of common life and the ability for sexual expression

Conclusion: Sexual dysfunction is prevalent among Iranian women, as a result providing its educational facilities and counseling center is a priority for women's health