Air pollution and low birth weight: a historical cohort study from Tehran

This historical cohort study was designed to clarify the association between air pollution and low birth weight [LBW] amongst women referred to Tehran hospitals in 2007. In total, 225 eligible pregnant women who lived within 5 km of an air pollution monitoring station during their pregnancy were selected for the study. Data were collected via interview and hospital records. Exposure to each pollutant was estimated for each woman individually throughout her pregnancy and for each trimester. Exposures were modelled as categorical variables using inter-quartile ranges in a logistic regression model. The results showed a significant association between exposure to CO and LBW [OR = 2.08, 95% CI: 1.70-4.60], particularly during the second trimester [OR = 3.96, CI: 1.83-12.5. We conclude that exposure to air pollution during pregnancy may be associated with LBW

role of vaginal prolactin in diagnosis of premature rupture of membranes

Premature rupture of membranes [PROM] is one of the most common complications of pregnancy that has a major impact on pregnancy outcomes. A diagnostic tool that is non-invasive, specific and quick is needed to predict PROM. The purpose of this study was to evaluate the diagnostic power of the vaginal washing fluid prolactin for the diagnosis of premature rupture of membranes and to determine cut-off values. A total of 114 pregnant women were recruited in this diagnostic trial. The PROM group consisted of 54 pregnant women between 20 and 41 weeks of gestation with diagnosis of confirmed PROM [amniotic fluid pooling [+] and Nitrazine paper test [+] and fernt test [+]]. The control group consisted of 60 pregnant women between 20 and 41 weeks of gestation without any complaint or complication. All patients underwent speculum examination for amniotic fluid pooling, nitrazine paper test, fern test, vaginal washing fluid prolactin sampling. Vaginal fluid concentrations of prolactin was significantly different between the two groups [P<0.001]. The sensitivity, specificity, positive and negative predictive values and accuracy were 87.03%, 75.0%, 75.80%, 86.53% and 83.33% in detecting PROM by evaluation of vaginal fluid prolactin concentration with a cut-off value of 9.50 micro IU/ml, respectively. The prolactin levels in the washing fluid of the posterior vaginal fornix in our experience is reliable and non-invasive diagnostic tests of PROM

Comparison of ELISA and three rapid HCG dipsticks in diagnosis of premature rupture of membranes

The importance of accurate diagnosis of premature rupture of membranes [PROM] is quite apparent while trying to diminish false negative or positive results as much as possible. This study compares Enzyme-Linked Immunosrbent Assay [ELISA] and three rapid human chorionic gonadothropin [HCG] dipsticks in diagnosis of premature rupture of membranes. During 2008-2009, 181 pregnant women with single pregnancy from 14 to 41 weeks of gestation who referred to Ayatollah Taleghani Hospital in Tehran, Iran were divided into two groups, 91 patients with PROM and 90 controls with matched gestational weeks. All patients underwent speculum examination for cervicovaginal washing fluid, HCG three rapid tests and ELISA. The HCG concentration of vaginal fluid was significantly different between the two groups. Using receiver operating characteristic [ROC] curve and determining the threshold as 19 mlU/mL for HCG by ELISA method, the sensitivity was 94.5%; specificity, 91%; positive predictive value, 91.5%; negative predicted value, 94.2% and accuracy was 92.2%. In rapid diagnostic test, the most sensitivity was for ACON and the most specificity for DIMA. Comparing the four methods, DIMA strip showed the highest accuracy and the highest value in early diagnosis of ROM. The reliability of three rapid diagnostic tests in diagnosis of ROM in cervicovaginal discharge was acceptable

[ relationship between CO ambient and low birth weight]

LBW is the strongest factor related to prenatal, neonatal, postnatal and childhood mortality and morbidity. Air pollution is one of the risk factors that is recently gaining attention. This study was carried out to determine the relationship between the CO ambient and low birth weight in women referring to Tehran hospitals in 2007-2008. In this historical cohort study 225 pregnant women having lived within 5 kilometers of a monitoring station during pregnancy and referring to selected hospitals in Tehran were investigated. An information questionnaire was used for data collection and sampling was done by multistage sampling and convenience method. Women were assigned to low exposure group and high exposure group based on mean exposure to each pollutant during pregnancy. These two groups were matched with respect to confounding factors. SPSS software version 15, T statistics, chi2, Man Withnney, and Relative Risk procedures were used for data analysis. The result showed that 31.6% of CO high exposure group and 7.4% of CO low exposure group had Low birth weight baby. The result also showed a significant relationship between exposure to high amount of CO and LBW [p=0.001]. Relative Risk calculated with confidence interval [RR=4/67, CI=[1/76-9/43] was found to be 95% and the amount of attributable risk was 66%. Based on these finding, exposure to carbon monoxide pollution can cause LBW. There should be an educational program about the disadvantages of CO pollutant on pregnant women living in densely populated areas of the city. Moreover, practical approaches should be provided to reduce these pollutants

[Reproductive health status of women referring to addiction centers]

Addiction to drugs and substance abuse is considered a psychosocial health problem. Its prevalence in women has dramatically increased in the past two decades, who are mostly at reproductive age. The aim of this study was to determine the reproductive health status of women referring to addiction centers at Tehran in 2009. In this descriptive study, 200 addicted women were sequentially selected by a nonrandomized sampling method. A questionnaire with items related to demographic information, drug abuse, obstetrical history, menstruation and family planning was used for data collection. Its validity and reliability were achieved by content and test-retest [r=0.98] methods respectively. Opioid and crack were the most common drugs. 34% of cases had started substance abuse between 14-20 years old. The mean of parities was 2.95 +/- 1.83. The outcome of 27.6% of pregnancies was low birth weight with 7% of neonates having physical malformation. 145 women [72.5%] were at reproductive age. 82% had had regular menses before addiction and 91.7% experienced dysmenorrhea in the menstruations. The amount of bleeding and the intervals of cycles had changed after addiction in 45.5% and 33.1% of the subjects respectively. 66.2% of reproductive women with sexual activity used a contraceptive method and withdrawal method was the most common one. According to the results, reproductive health status of addicted women is in need of further assessment and supervision. Therefore, it is recommended to attend more to these women by planning appropriate programs to improve reproductive health services for them

[Relationship between maternal hemoglobin level in first trimester with gestational diabetes mellitus]

Identification of women at risk of diabetes mellitus a most prevalent disorder in pregnancy, could be useful. This 2009 study investigated whether high maternal Hemoglobin [HB/ ] level in the first trimester would be associated with Gestational Diabetes Mellitus in women referring to healthcare centers in Tehran. A case-control was conducted on 60 pregnant women with gestational diabetes [case group] and 61 pregnant women without the condition [control group] referring to healthcare clinics affiliated to the Research Center of Endocrinology and Metabolism of the Ayatolah Taleghani Hospital as well as Iran Research Institute of Endocrinology and Metabolism, selected by convenience sampling. An information form was used for collecting data by interviewing the subjects. Both groups were matched for age, number of abortions and parity. Demographic characteristics were similar in the two groups. Levels of Hb [>13.8 g/dl] in the case group were higher than in the control group [60% vs. 6.6%] significant difference between the 2 groups [p=0.0001] with an estimated odds ratio [OR] 7.61 [CI 95%=2.72 -21.28]. Findings showed a significant relationship between high maternal Hb and Gestational diabetes Mellitus. Healthcare workers can use the results of this study to monitor high maternal hemoglobin in the first trimester as a significant risk factor for gestational diabetes. Thus, in selected screening programs for gestational diabetes in terms of risk factors, women should undergo GTT and preventive measures with less time and cost can be taken decrease the complications

[Relationship between cigarette smoking and gestational diabetes mellitus]

Diabetes Mellitus is a metabolic disease and the most prevalent disorder in pregnancy. Gestational diabetes mellitus is a kind of diabetes that is recognized in pregnancy. Many risk factors have been recognized for gestational diabetes mellitus. Determining new risk factors help to identify women who are at risk for diabetes. This research was conducted in order to determine the relationship between cigarette smoking before or during pregnancy and gestational diabetes mellitus in women referring to health care centers in Tehran during 2008-2009. This case control study was conducted on 110 pregnant women with gestational diabetes [case group] and 96 pregnant women without the condition [control group] referring to healthcare clinics affiliated to Research Centers of Endocrinology and Metabolism at Ayatollah Taleghani Hospitals as well as Iran Research Institute of Endocrinology and Metabolism. A questionnaire was used for collecting data by interviewing the subjects. Both groups were matched for age and parity. Demographic characteristics were similar in both groups. There was a significant difference between the two groups in cigarette smoking before or during pregnancy and occurring diabetes mellitus [p=0.0001] with an estimated odds ratio [OR] of 3.79 [%95 CI=1.37 +/- 10.53]. The present findings showed a significant relationship between cigarette smoking and gestational diabetes mellitus

[Coitus during menstruation and cervical cancer]

Cervical cancer is a preventable disease and we can determin preventive methods by discovering ethiology of disease. There are no appropriate research about the relation between coitus during menstruation and cervical cancer in Iran. This study is done to investigate the relationship between coitus during menstruation and cervical cancer in Iran. This study is done to investigate the relationship between coitus during menstruation and cervical cancer in women referring to health care centers of Shahid Beheshti University of Medical Sciences in 2007-2008. This case-control study was carried out on 100 patients with cervical cancer [case] and 100 healthy women [control]. All participates were Moslem with Iranian nationality and habitant in Iran. They had no previous history of frequent pelvic radiotherapy and alcohol consumption. Two groups were matched with: age, age of first coitus, age of first vaginal delivery, parity and type of delivery. Data was collected through structured interview and analyzed using Chi-square and logistic-regression. The study showed that 40% of case group and 10% of control group had coitus during menstruation. Coitus during menstruation in case group was 6 times more than control group [p<0.0001, odds ratio=6.0, CI=2.7-12.9]. Coitus during menstruation may increase the risk of cervical cancer. A research is recommended to find out the best educational method which to prevent this disease

Study of the realtionship between anemia and postpartum depression

Background and Purpose: Women are subject to postpartum depression in the childbearing age, which is associated with aerious somplications for the mother, infant and the family. Its cause is not known. Many studies have the effect of psychosocial factors in this regard but there is meager information on the biological grounds. Recently, anemia has been on the focus as causing depression. This study was conducted to determine the the relationship between anemia and postpartum depression

Methods and Materials: This prospective descripe-anlytical study was conducted on the population of women admitted to the Fatemiyyeh Health Center, affiliated to Hamadan University of Medical Sciences, Iran, in 2006. The study sample included 159 normal [non depressed confirmed by the Beck test] pregnant women who were selected by convenient non-probability methods. With a gestational age of 38-40 weeks, they were divided into two groups of anemics and non-anemics by their hemoglubin levels [measured by Cyan Matt]. They were homegenized as for the confounders. On the 7th and 28th days after labor, their hemoglubin was measred again. On the 28[th] day, they completed the Edinburgh Questionnaire. The realtionship between their postpartum depression and anemia was assessed three times. Chi-square, t-test, Mann Whitney and the relative risk tests were used in SPSS to analyze the obatained data

Results: 14.6% of the non-anemics and 38.6% of the anemic [measured on the 38-40 weeks] were found t obe depresed on the 28th day after delivery, and anemia had increased the chances of postpartum depression by 1.8 times, 14.8% of the non-anemics and 35.9% of the anemics [measured on the 7th day after labor] were depressed on the 28th day, and anemia had increased the chances of postpartum depression by 1.7 times. Also, 11.5% of the nonanemics and 46% of the anemics [measured on the 28th day after labor] were depressed after labor. Anemia had increased the chances of postpartum depression by 2.5 times

Conclusion: It seems that anemia in the 38-40 weeks of gestation, on the 7th and 28th days after labor can increase the likelihood of postpartum depression

[ study of relationship between menorrhagia and gestational diabetes]

Gestational diabetes is defined as carbohydrate intolerance of variable severity with onset or recognition during pregnancy. Approximately, 4% of pregnancies are affected by diabetes mellitus, 90% of which represents gestational diabetes mellitus [GDM]. Detection of risk factors of GDM may reduce the risk of complications. One of the new risk factors is menorrhagia. This study was conducted to identify the relation between menorrhagia and gestational diabetes. This case-control study was performed on the pregnant women who were referred to GDM and prenatal clinics in the endocrinology and metabolism centers of Shariati, and Taleghani hospitals as well as Iran endocrinology and metabolism institute of Tehran. In this study, data collection from the patients were carried out by interview method. Sampling was performed by convenience method. Case group included 60 women with gestational diabetes and control group included 60 women without gestational diabetes that they were selected at the same period of time. Demographic characteristics, history of menorrhagia and its etiology, were compared between two groups. We excluded subject with history of fetal macrosomia [weight >4500g], pre-pregnancy diabetes, diabetes in previous pregnancy, neonatal morbidity and mortality, recurrent abortion, smoking before and during pregnancy and preterm delivery. The case and control subjects were matched based on their age, parity, pre-pregnancy body mass index, diabetes mellitus in first-degree relative and the history of still-birth or malformed fetus or neonates. Demographic characteristics and etiology of menorrhagia were similar between two groups. Relative frequencies of menorrhagia were 41.7% and 6% in the case and the control group, respectively [p<001, Odds Ratio=6.43]. A history of menorrhagia can be an independent predictor of gestational diabetes mellitus. If selective screening is implemented for gestational diabetes mellitus, such history should be considered in the decision of whom to test

[Diagnostic power of quantitative HCG in cervico-vaginal washings in women with premature rupture of membranes]

Premature rupture of membranes [PROM], occurs in 2-25% of pregnant women. Traditionally, clinical and laboratory tests utilized for the diagnosis of PROM are fraught with both false positive and false negative results caused by various factors that result in an equivocal or delayed diagnosis. The absence of a non-invasive 'gold standard' for the diagnosis of PROM has led to the search for alternative biochemical markers. This research has been conducted to compare HCG of cervicovaginal the diagnostic power of qualitative and quantitative washings for the diagnosis of PROM.s This Diagnostic-Experimental study was undertaken with cervico-vaginal samples collected from singleton pregnancies between 14-41 weeks of gestation. Totally 86 pregnant women referred to Vali-Asr Hospital, Zanjan, in 2006, were enrolled in this study. Subjects were divided in two groups: 43 subjects with confirmed PROM [amniotic fluid pooling [+], nitrazine paper test [+], and fern test [+]], and 43 women in the control group [amniotic fluid pooling [-], nitrazine paper test [-], and fern test [-]]. Washings were then collected from the posterior vaginal fornix with the use of 5 ml of sterile saline irrigation and aspiration techniques. We measured HCG levels with the ELISA test. The median HCG levels were 250.60 [mIU/mL] and 6.2 [mIU/mL] in PROM and control group respectively. With, 22 [mIU/mL] set as a cutoff value on the receiving operating characteristic curve, [ROC], sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.3, 97.7, 97.6, 95.5 and 96%, respectively. Quantitative HCG measurement of cervico-vaginal washings was an accurate test for the diagnosis of PROM in our study

[ effects of menastil on primary dysmenorrhea]

Considering the prevalence of dysmenorrhea and its importance for women as well as social qualities and public tendency toward alternative complementary and herbal drugs, this study was carried out to determine the effect of Menastil on primary dysmenorrhea on students residing in Dormitories' universities of Saveh 2005. This placebo-controlled double-blind clinical trial was performed on 72 single students between 18 and 26 years old with primary dysmenorrhea. Data were collected through a questionnaire which included demographic factors, exercise, stress factors, use of medicines, and the McGill pain ruler for determining of pain severity. Subjects were classified into two groups of moderate [4

[Association of irregular menstruation with gestational diabetes: observations from a survey in university-affiliated medical centers in Tehran]

Gestational diabetes is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Approximately 4% of pregnancies are affected by diabetes mellitus, 90% of which represent gestational diabetes mellitus [GDM]. Detection of GDM permits the identification of women who are at risk for development of type 2 diabetes mellitus later in life. Appropriate treatment may reduce the risk of fetal and neonatal complications. One of the risk factors identified recently is "irregular menstruation". Several studies have reported the relationship between irregular menstruation and insulin resistance. The aim of this case-control study was determination of relationship between irregular menstruation and gestational diabetes. Pregnant women who were referred to prenatal clinics affiliated to Endocrinology and Metabolism centers of Shariati and Taleghani hospitals, and Iran Endocrinology and Metabolism institute, were studied. Mothers were interviewed by trained members of the study team and relevant information recorded on a structured questionairre. Sampling was performed by convenience method. Case group including 60 women with gestational diabetes and control group comprising of 60 women without gestational diabetes were matched for age, parity, BMI, family history of diabetes, history of still-birth, or delivery of a previous malformed newborn. Demographic characteristics, history of irregular menstruation and its etiology were compared between the two groups. We excluded subjects with history of fetal macrosomia [weight>4500 g], pre-pregnancy diabetes, diabetes in previous pregnancy, smoking before or during pregnancy, recurrent abortion and preterm delivery. Demographic characteristics and etiology of irregularity were similar between cases and controls. Irregular cycles were more prevalent in the case group, [36.7% vs. 15.0%, P=0.007, Odds Ratio=3.28, CI=95%, 1.40-7.90]. A history of irregular menstrual cycles was a significant independent predictor of gestational diabetes mellitus. If selective screening is implemented for gestational diabetes mellitus, such history should be considered in the decision of whom to test

Relation between duration of menstruation and gestational diabetes in women referring to teaching hospitals in Tehran

Gestational diabetes is defined as carbohydrate intolerance of variable severity at or during pregnancy. Approximately, of pregnancies is affected by diabetes mellitus, of which represents gestational diabetes mellitus [GDM]. Detection of risk factors in GDM may reduce the risk of complications. A new risk factor suggested is abnormal menstrual duration. This case-control study was conducted to determine the relation between duration of menstruation and gestational diabetes in women referring to teaching hospitals at Tehran in 2005. 120 women [60 in case group with GDM and 60 in control group without GDM] referring to GDM and Prenatal Clinics in Shariati and Taleghani hospitals were selected by convenience sampling. An information form was completed by interview for data collection. Content and test re-test methods were used for validity and reliability respectively. Demographic characteristics and abnormal duration of menstruation as well as its etiology were compared between the groups. Those with the history of fetal macrosomia [weight >4500g], diabetes, diabetes in previous pregnancies, neonatal morbidity and mortality, recurrent abortion, smoking before or during pregnancy and preterm delivery were excluded from the study. The groups were matched in terms of their age, parity, body mass index, diabetes mellitus in their close relatives and the history of stillbirth or congenital anomalies. Demographic characteristics and duration [in the case and in the control] as well as etiology of abnormal menstruation were similar between the groups [p=0.34]. No significant relation was found between duration of menstruation and GDM. The relationship between duration of menstrual bleeding and gestational diabetes is disputable

effect of exercise on premenstrual syndrome [PMS]

In the light of prevalence of premenstrual syndrome, its effects on women as well as social living qualities and public tendency toward alternative complementary and non-drug treatment, and contradictory reports about the effects of exercise on PMS, this research is conducted on students residing in Shaheed Beheshti University dormitory in 2004. This clinical trial [before and after treatment] was carried out on 35 single students with premenstrual symptoms. The diagnosis of PMS was based on the PMS complications standard multiple choice checklist, which include 30 psycho-somatic items. The subjects were classified into two groups based on their checklist scores. The mild group [scores less than 30], and the moderate to severe one [scores >/= 30]. The subjects carried out the instructed aerobic exercises three times a day, and also 30 minutes of daily walking for two weeks before their menstruation for a period of two months. They were handed out the PMS complication checklist at the beginning of each month so that they could fill it out daily based on "no problem", "mild", "moderate" and "severe" status. The case was considered as improved if the total PMS score was reduced by one in comparison with the start of the study. The status of PMS was investigated at the end of the first and the second months. The PMS and psychotic symptoms score before the study was compared with the end of the first and the second months exercise and evaluated based on Wilcoxon and McNemar tests. Prevalence of PMS in dormitory female students was 22.2% [16.12-28.3, CI: 95%]. The total PMS score was reduced on 29 subjects [82.9%] after two months of exercise [P=0.001]. While 30 cases [85.5%] had improved psychotic symptoms [P=0.001] and 26 subjects [74.4%] had improved physical symptoms [P=0.001]. Exercise resulted in improved physical symptoms including abdominal pain, back pain [P=0.05], breast tenderness [P=0.08], and psychotic symptoms including irritability, impatience, weakness, fatigue, weeping, depression, tendency to remain indoors [P=0.05] and anxiety [P=0.08]. Exercise improves PMS. However, it is recommended that a complete experimental study [including control] be performed to investigate the effects on various exercises on subjects in longer periods of time