Association between thrombophilic genes polymorphisms and recurrent pregnancy loss susceptibility in the Iranian population: a systematic review and meta-analysis

Studies have indicated that thrombophilic genes polymorphisms are associated with recurrent pregnancy loss [RPL] in the Iranian population. We aimed to evaluate the precise association between thrombophilic genes polymorphisms [MTHFR C677T, MTHFR A1298C, Prothrombin G20210A, FVL G1691A, and PAI-1 4G/5G] and RPL risk in the Iranian population. PubMed, Web of Science, Google Scholar, and ISC were searched for eligible articles published up to April 1, 2017. In total, 37 case-control studies in 18 relevant publications were selected: 1,199, 1,194, 630, 830, and 955 RPL cases and 1,079, 1079, 594, 794, and 499 controls for MTHFR C677T, MTHFR A1298C,Prothrombin G20210A, FVL G1691A, and PAI-1 4G/5G, respectively. The results indicated a significant increased risk of RPL in all genetic models in the population. Also, Prothrombin G20210A and FVL G1691A as well as PAI-1 4G/5G polymorphisms were associated with RPL risk in the Iranian population. Hence, thrombophilic genes polymorphisms are associated with an increased RPL risk in the Iranian population

Prevalence of immunity to toxoplasmosis among Iranian childbearing age women: systematic review and meta-analysis

Our information regarding immunity to toxoplasmosis among reproductive age women is indeterminate and there is significant variation between reported results; it is necessary to perform a Meta-analysis study on subjects to obtain required findings and develop preventive measures accordingly Estimation level of immunity to toxoplasmosis in reproductive ages. All published papers in main national and international databases were systematically searched for some specific keywords to find the related studies up to 2012. We selected only original articles that either reported percentage of positive anti toxoplasma IgG or total anti toxoplasma antibody by using ELISA or IFAT method [provided that the titer >/= 1.20 is considered positive for IFAT] in childbearing age women. Studies involved a total of 13480 participants. The maximum and minimum reported prevalence rates of anti-toxoplasma IgG antibody using IFTA serological method were 21.8% and 54%; and using ELISA serological method were 23% and 64%, respectively. The overall estimation for prevalence of anti-toxoplasma IgG antibody using IFTA serological method was 34.5% [95% CI: 28.5-40.5]; and using ELISA method was 37.6% [95% CI: 30.4-44.9]. The overall estimation for prevalence of anti-toxoplasma total antibody was 39.9% [95% CI: 26.1-53.7]. In Iran, screening of toxoplasma is not routinely performed yet, while the incidence of toxoplasmosis is too high to justify routine screening. Prenatal screening can help to identify mothers susceptible to infection. Screening for the presence of antibodies allows primary prevention of toxoplasmosis infection where eating habits and hygiene practices have clearly been identified as risk factors

Applying maternal serum and amniotic fluid CRP concentrations, and cervical length to predict preterm delivery

To investigate the clinical advantage of several prognostic factors for predicting preterm delivery. Eighty and six patients with a singleton pregnancy admitted to Vali-Asr hospital underwent genetic amniocentesis between the 15[th] and 23[th] weeks were included in this study. Maternal serum C-reactive protein [CRP], transvaginal sonographic measurement of cervical length [CL], were examined on genetic amniocentesis time. Receiver-operating characteristic [ROC] analysis was performed to determine the efficacy of maternal serum and amniotic fluid CRP levels in predicting women with preterm delivery. Correlation between each factor and the duration of pregnancy was investigated. The prevalence of spontaneous preterm delivery before 37 weeks of gestation was 11%. ROC analysis revealed that maternal serum CRP level was the parameter, which had a significant power in the prediction of preterm delivery. The optimum cut-off level was 1.2 mg/L. The sensitivity and specificity were 95.1% and 91.8%, respectively. The positive predictive value for CL length with the cut off value of 25 mm was 72.1%. No statistically significant difference correlation observed between CL and the duration of pregnancy or amniotic fluid and maternal serum CRP levels. The maternal serum CRP level has a good sensitivity and specificity in the prediction of preterm delivery and this may be helpful in predicting preterm delivery during genetic amniocentesis. Maternal serum CRP measurement is a safe, simple clinically useful, cost effective, non invasive method, that may assist clinicians in evaluation for high-risk patients and determine strategies for the prevention of preterm delivery

clinical randomized trial on endocervical inflammatory cytokines and betamethasone in prime-gravid pregnant women at risk of preterm labor

There are strong evidences suggesting the secretion of different cytokines in cervical fluid during preterm labor. Betamethasone is widely administered for several reasons in preterm conditions. To Investigate the possible effect of betamethasone on endocervical cytokine concentration of women at risk of preterm labor. In a randomized clinical trial of 80 prime-gravid women in preterm labor between 34 and 37 weeks of gestation, cervical fluid was collected. Endocervical concentration of inflammatory cytokines were analyzed before and 48 hours after betamethasone treatment for the evaluation of IL-8, IL-17, IFN-gamma and TGF-beta. Wilcoxon and Mann-Whitney tests were employed for statistical analysis. chi2 and Student's t tests were used whenever needed. All the measured cytokines showed significant changes in the betamethasone treated group. IL-17 [p=0.001], IL-8 [p=0.001], and IFN- gamma [p<0.05] decreased significantly, while TGF-beta had a significant increase [p<0.05]. In the patients who delivered before or on the 7[th] day of admission, IL-17, IL-8, and IFN-gamma levels were all significantly higher. However, TGF-beta decreased significantly in the same samples in the betamethasone treated group [p<0.05]. Betamethasone significantly decreases the endocervical pro-inflammatory cytokine oncentrations in patients with preterm labor.

Evaluation of zinc supplementation effect on fetal outcomes in pregnant women with lower-than-median serum zinc concentration

Zinc is the second main element in the body after iron. Its importance in pregnancy is related to role in DNA and protein synthesis and consequently the necessity of its availability for the appropriate growth and development of the fetus and neonate. The purpose of this study was to assess the effect of zinc supplement on fetal outcomes [height, weight, head and chest circumference of the fetus, low birth weight, and pre-term birth] in pregnant women with lower-than-median serum zinc. Participants of this experimental double-blind clinical trial study were 263 healthy singleton pregnant women with a mean age of 26.46 [+/- 4.52] years and gestational age of 14.52 [+/- 4.51] weeks whose [non-fasting] serum zinc levels were lower than median of the study population. All eligible individuals were randomly divided into two groups of zinc supplement and placebo. Individuals in the zinc supplement group [128 participants] took one zinc supplement capsule including 25 mg elemental zinc and participants in the placebo group [135 people] took one placebo capsule per day until the end of pregnancy. All women were under control and supervision until the end of the pregnancy and their information about labor, delivery, and neonate measures were collected through their obstetric records and then compared. Findings of this study showed no significant difference in fetal measures at birth [weight, height, head and chest circumference], pre-term delivery, and low birth weight between zinc supplement and placebo groups. According to our findings, administration of 25mg elemental zinc per day does not improve fetal measures in pregnant women with lower-than-median serum zinc concentration; however, more in-depth studies with larger sample sizes are recommended to achieve more reliable results

[Tramadole withdrawal in a neonate: a case report]

Tramadol is a synthetics 4-phenyl-piperidine analogue of codeine used for treating moderate to severe pain. Tramadol is a FDA pregnancy category C medication which induces release of serotonin and inhibits the reuptake of norepinephrine. Chronic use of this drug during pregnancy may lead to physical dependency and withdrawal syndrome in the neonate. We report the newborn of a woman admitted in the delivery ward of Mostafa Khomeini Hospital in Tehran, Iran in 2011. The mother suffered from chronic low back pain and headache and frequently took tramadol during pregnancy. The infant had a gestational age of 38.5 w, a birth weight of 2950 gr and an Apgar score of 9/10 at 1 and 5 minutes after birth. The first signs of withdrawal syndrome occurred after 24 h with nausea, vomiting, poor feeding, and tremor. Later, agitation, tremor, hyprertonicity, and repeated multifocal myoclonus, and generalized tonic-clonic seizures developed. Clinical signs of withdrawal syndrome waned under phenobarbital therapy. Drug withdrawal syndrome should be considered in the neonates of pregnant mothers who chronically take tramadol. Tramadol administration during pregnancy should be restricted to carefully selected cases