Effect of gestational diabetes mellitus on lipid profile: A systematic review and meta-analysis.

Gestational diabetes mellitus (GDM) can have adverse effects on pregnancy. GDM is associated with changes in the lipid profile of pregnant women. Finding out the early ways to diagnose GDM can prevent the adverse outcomes. This meta-analysis study aimed to determine the effect of GDM on lipid profile. PubMed, ProQuest, Web of Science, Scopus, Science Direct, Google Scholar, and ClinicalTrial were systematically searched for published articles relating to GDM until 2021 according to PRISMA guidelines. Newcastle Ottawa scale was used to assess the quality of the studies. Thirty-three studies with a sample size of 23,792 met the criteria for entering the meta-analysis. Pooled standardized mean difference (SMD) for total cholesterol (TC) and triglyceride (TG) was 0.23 mg/dL (95% CI: 0.11-0.34) and 1.14 mg/dL (95% CI: 0.91-1.38), respectively. The mean of TC and TG in people with GDM was higher than that in normal pregnant women. A similar pattern was observed for the very low-density lipoprotein (VLDL) and TG/high-density lipoprotein (HDL) ratio, with pooled SMD of 0.99 mg (95% CI: 0.71-1.27) and 0.65 mg (95% CI: 0.36-0.94), respectively. Pooled SMD for HDL was -0.35 mg/dL (95% CI: -0.54 to -0.16), women with GDM had a mean HDL lower than normal pregnant women. Although pooled SMD was higher for low-density lipoprotein (LDL) in the GDM group, this difference was not significant (0.14 [95% CI: -0.04 to 0.32]). Of all the lipid profiles, the largest difference between the GDM and control groups was observed in TG (SMD: 1.14). Elevated serum TG had the strongest effect on GDM. Higher levels of TC, LDL, VLDL, and TG/HDL ratio, and lower level of HDL were exhibited in GDM group. So, these markers can be considered as a reliable marker in the diagnosis of GDM.

Neonatal outcome among pregnant women with COVID-19: a systematic review and meta-analysis.

BACKGROUND: COVID-19 has raised many concerns about the possible side effects of pregnancy. There is currently no conclusive evidence of the vertical transmission of COVID-19. Accordingly, this paper is a Systematic Review and Meta-Analysis investigated neonatal outcomes among pregnant women with COVID-19. METHODS: PubMed, Web of Science (WoS), EMBASE, ProQuest, Scopus, and Google Scholar were searched up to November 2020. The Cochran's Q-test and I2 statistic were applied to assess heterogeneity, a random-effects model was used to estimate the pooled estimate of the mean, and a meta-regression method was utilized to investigate the factors affecting heterogeneity between studies. RESULTS: Of 1132 studies, 23 were included in the analysis (sample size: 749 for neonates and 820 for mothers). Most of these studies (n = 13) were conducted in China. The pooled estimate for the mean of birth weight, APGAR score in min 1 and 5 was 3084.97 g (95% CI: 2993.66-3176.29), 8.76 (95% CI: 8.27-9.25), and 9.44 (95% CI: 9.18-9.70), respectively. Also, the pooled prevalence of premature birth, shortness of breath, and neonatal death was 17.80% (95% CI: 12.47-23.13), 8.43% (95% CI: 4.50-12.37), and 7.73% (95% CI: 2.00-13.47), respectively. The meta-regression results indicated that the mother's age, disease duration, and sample size had no significant effect on heterogeneity between studies (p-value all of them was >.05). Finally, 15 studies (65.22%) reported that vertical transmission did not occur. CONCLUSION: The COVID-19 infection can have adverse outcomes for the newborn. Despite the positive test of neonates, the vertical transmission of COVID-19 from the infected mother to the fetus has not yet been conclusively proven; thus, further research is needed.

A Systematic Review on Use of Medicinal Plants for Male Infertility Treatment.

Objective: Male infertility is involved in about half of the casess of infertility and the only sole reason for infertility in 20%-30% of the cases. Following the recent interest in the use of medicinal plants, scientists have sought to clarify their effects on male fertility. This review aimed to summarize the results of studies available to determine the effectiveness, safety and mechanism of herbal treatments in the improvement of male fertility. Materials and methods: Medline/PubMed, Scopus, Science Direct, and the Cochrane Central Register of Controlled Trials (Central) databases were searched for randomized controlled trials (RCTs) published during 2000-2020. Studies were only included if they adhered to the CONSORT checklist. The methodological quality of the selected studies was assessed using the Cochrane risk of bias tool. Results: Finally, 20 studies recruiting a total of 1519 individuals were reviewed. These studies compared the effects of eleven different medicinal plants, i.e. ginseng, saffron, Nigella sativa, palm pollen, ADOFON, TOPALAF, sesame, and Mucuna pruriens, on male fertility with those of placebo. All studies (except one) confirmed the beneficial effects of medicinal plants on the improvement of sperm and reproductive parameters and thus male infertility. Conclusion: The existing RCTs indicated the positive effects of medicinal plants on male fertility. Therefore, in order to develop a novel approach to the treatment of male infertility, further clinical trials are warranted to determine the maximum dosage and duration of treatment with herbal medicines and evaluate any potential side effects of such interventions.

Iranian midwives' awareness and performance of respectful maternity care during labor and childbirth.

INTRODUCTION: Midwives' perceptions of Respectful Maternity Care (RMC) play an important role in promoting quality of care. This study aimed to explore the awareness and performance of Iranian midwives of RMC during childbirth. METHODS: A cross-sectional study was carried out from November to December 2020 to evaluate 130 midwives' awareness and performance of RMC during childbirth at four public hospitals in Urmia province, Iran. Participants were midwives who were working in the labor unit and had at least one year of work experience. The Midwives' Knowledge and Practice Scale on Respectful Maternity Care was used to assess midwives' awareness and performance. The quality assessment of questionnaires was based on the mean for each item. A multivariate linear regression approach was developed to evaluate the relationship between midwives' age, academic education level plus occupational information and their awareness and performance of RMC. RESULTS: This study revealed that Iranian midwives had good awareness but fair performance of RMC. The mean scores of the overall awareness and performance of RMC were 36.07±10.13 and 75.47±35.4, respectively. Midwives' performance on two domains was fair including 'Giving emotional support' and 'Providing safe care'. The results of multivariate linear regression analysis showed a significant negative relationship between job satisfaction and midwives' performance on RMC. Also work experience plus a Master's degree in midwifery had positive significant effects on midwives' awareness along with performance on RMC (p<0.05). CONCLUSIONS: Promoting respectful maternity care requires essential interpersonal and communication skills and supportive attitudes from midwives.

Role of interleukin-6 (IL-6) in predicting gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is the most common pregnancy-associated metabolic disorder that is steadily increasing worldwide. Early diagnosis of pregnant women susceptible to GDM is the first step for deploying effective preventive treatment to reduce maternal, fetal, and neonatal complications. The diagnostic process of GDM is still controversial and interleukin-6 (IL-6) is one of the most recent markers used for the diagnosis of GDM. In this study, we aimed to systematically review the role of IL-6 in the diagnosis of GDM. In this systematic review, Google Scholar, Scopus, PubMed, ISI Web of Science, ProQuest, and MEDLINE databases were searched using the following keywords: GDM, screening, and IL-6, with the time interval 2009-2020. The quality of articles was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Twenty-four articles with desired quality that met the inclusion criteria were selected and reviewed further. Sixteen studies showed a statistically significant association, while 8 studies did not report any relationship between IL-6 levels and GDM. Based on the results of these studies, assessing the serum IL-6 levels can be investigated a newly established diagnostic biomarker for GDM. Therefore, through early diagnosis of susceptible women, effective measures can be implemented to reduce its complications.

Diagnostic accuracy of maternal serum multiple marker screening for early detection of gestational diabetes mellitus in the absence of a gold standard test.

BACKGROUND: Gestational diabetes mellitus (GDM) is associated with adverse diabetic complications for both mother and child during pregnancy. The common Gold Standard (GS) for diagnosis of GDM is 75 g oral glucose tolerance test (OGTT) during 24-28 gestational weeks which seems a little late for any proper intervention. This study aimed to employ the Bayesian latent class models (LCMs) for estimating the early diagnostic power of combination of serum multiple marker in detecting GDM during 14-17 weeks of gestation. METHODS: Data from a sample of 523 pregnant women who participated in gestational diabetes screening tests at health centers affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran from 2017 to 2018 were used. The beta-human chorionic gonadotropin (ß-hCG), unconjugated estriol (uE3), and alfa-fetoprotein (AFP) values were extracted from case records for all participants. The Bayesian LCMs were applied for estimating sensitivity, specificity, and area under receiver operating characteristic curve (AUC) of combining the three biomarkers' results in the absence of GS, adjusting for maternal age and body mass index. RESULTS: The mean (standard deviation) maternal age of the participants was 28.76 (±5.33) years. Additionally, the mean (standard deviation) BMI was 24.57 (±3.22) kg/m2. According to the Bayesian model, the cSensitivity, cSpecificity, and cAUC for the optimal composite diagnostic test were estimated as 94% (95% credible interval (CrI) [0.91-0.99]), 86% (95% CrI [0.80-0.92]), and 0.92 (95% CrI [0.87-0.98]), respectively. CONCLUSIONS: Overall, the findings revealed that the combination of uE3, AFP, and ß-hCG results might be considered as an acceptable predictor for detecting GDM with a rather high level of accuracy in the early second trimester of pregnancy without a GS.

Role of C-reactive Protein(CRP) or high-sensitivity CRP in predicting gestational diabetes Mellitus:Systematic review.

BACKGROUND AND AIMS: Gestational Diabetes Mellitus (GDM) is the most common disorder during pregnancy in 8-18% of pregnancies. Due to maternal and neonatal morbidity and mortality, early diagnosis and appropriate treatment have always been of interest to researchers. One of the recent cases for early diagnosis of GDM is the size of the C-reactive protein (CRP). The purpose of this review study was to investigate the role of CRP or its high sensitivity type in predicting GDM. METHODS: Systematic searching of MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar, and ProQuest databases between 2009 and 2019 using keywords 'Gestational Diabetes Mellitus','Screening', 'C-reactive protein',' High sensitivity CRP'was performed. The quality of articles was also assessed using the STROBE checklist. RESULTS: After a thorough search of the mentioned databases, 31 articles with the desired quality were finally selected. Most of studies showed significant relationship between CRP or high-sensitivity CRP(hs-CRP) level with GDMbutthe relationship was not significant in fewstudies. CONCLUSIONS: Blood levels of CRP or hs-CRP could be used as a potential indicator for GDM, but more studies are needed.

Characterization and haplotype study of 6 novel STR markers related to the KCNQ1 gene in heterogeneous cardiovascular disorders in the Iranian population

Background/aim: The KCNQ1 gene has a significant role in long QT syndrome, Jervell and Lange-Nielsen syndrome, familial atrial fibrillation, and short QT syndrome. Analyzing such heterogeneous disorders, six novel short tandem repeat (STR) markers around the KCNQ1 gene were found and evaluated in a healthy population, and other statistical traits of the markers were detected. Materials and methods: Using Tandem Repeats Finder (TRF) and Sequence-Based Estimation of Repeat Variability (SERV) software, STR markers were detected with valid tetra- and pentanucleotide repeats. The markers were investigated for a total of 60 unrelated Iranian healthy individuals and analyzed using GenAlEx 6.502 and Cervus 3.0.7. Results: A total of 77 haplotypes was detected, of which 25 haplotypes were unique and the others occurred at least two times. The number of haplotypes per locus ranged from 7 to 18 with the highest frequency of 69.2%, and the observed heterozygosity was calculated as 0.589. The power of discrimination ranged from 0.70 to 0.96. Five of the markers meet Hardy­Weinberg equilibrium. Conclusion: A novel panel of STR markers was described with high allele heterozygosity and segregation in every locus, which may lead to faster and more credible recognition of the disease-inducing KCNQ1 gene and allow it to be used for human identity testing and prenatal diagnosis.

Identification of a Novel KCNQ1 Frameshift Mutation and Review of the Literature among Iranian Long QT Families

Background: Long QT syndrome (LQTS) is characterized by the prolongation of QT interval, which results in syncope and sudden cardiac death in young people. KCNQ1 is the most common gene responsible for this syndrome. Methods: Molecular investigation was performed by DNA Sanger sequencing in Iranian families with a history of syncope. In silico examinations were performed for predicting the pathogenicity of the novel variant. Results: A novel homozygous KCNQ1 frameshift mutation, c.1426_1429delATGC (M476Pfs*4), was identified, and then the current literatures of five patients were reviewed regarding the LQTS. Conclusion: The novel frameshift mutation has been reported for the first time among the Iranian population. Our finding along with the case series study of LQTS patients illustrates the importance of genetic and case series in precise detection of the frequency of LQTS carriers.

Detection of a new KCNQ1 frameshift mutation associated with Jervell and Lange-Nielsen syndrome in 2 Iranian families.

Jervell-Lange Nielsen syndrome (JLNS) with autosomal recessive inheritance is a congenital cardiovascular disorder characterized by prolongation of QT interval on the ECG and deafness. We have performed molecular investigation by haplotype analysis and DNA Sanger sequencing in 2 unrelated Iranian families with a history of syncope. Mutational screening of KCNQ1 gene revealed the novel homozygous frameshift mutation c.733-734delGG (p.G245Rfs*39) in 2 obviously unrelated cases of JLNS which is probably a founder mutation in Iran. The novel mutation detected in this study is the first time reported among Iranian population and will be beneficial in the tribe and region-specific cascade screening of LQTS in Iran.

Novel frameshift mutation in the KCNQ1 gene responsible for Jervell and Lange-Nielsen syndrome.

OBJECTIVES: Jervell and Lange-Nielsen syndrome is an autosomal recessive disorder caused by mutations in KCNQ1 or KCNE1 genes. The disease is characterized by sensorineural hearing loss and long QT syndrome. MATERIALS AND METHODS: Here we present a 3.5-year-old female patient, an offspring of consanguineous marriage, who had a history of recurrent syncope and congenital sensorineural deafness. The patient and the family members were screened for mutations in KCNQ1 gene by linkage analysis and DNA sequencing. RESULTS: DNA sequencing showed a c.1532_1534delG (p. A512Pfs*81) mutation in the KCNQ1 gene in homozygous form. The results of short tandem repeat (STR) markers showed that the disease in the family is linked to the KCNQ1 gene. The mutation was confirmed in the parents in heterozygous form. CONCLUSION: This is the first report of this variant in KCNQ1 gene in an Iranian family. The data of this study could be used for early diagnosis of the condition in the family and genetic counseling.

Molecular Characterization of δ-Thalassemia in Iran.

δ-Thalassemia (δ-thal) (OMIM #142000) resulting from mutations on the HBD gene usually has no clinical consequences. However, it may cause the misdiagnosis of ß-thalassemia (ß-thal) carriers by lowering the Hb A2 level to the normal range. Therefore, a study for δ-thal should be considered as a step in the detection of at-risk couple in our region. The aim of the present study was to characterize the mutations of the HBD gene in ß-thal carriers with normal Hb A2 levels, and also in normal individuals with Hb A2 of less than 2.0%. Four ß-thal carriers with normal Hb A2 and 39 individuals with Hb A2 of less than 2.0% were enrolled. Genomic DNA was extracted by the salting out method and the HBD gene was investigated by polymerase chain reaction (PCR) and direct DNA sequencing. Hb A2-Yialousa (HBD: c.82 G > T) was the most common variant found in the HBD gene, but the following mutations were also found: Hb A2-NYU (HBD: c.39 T > A), Hb A2-Coburg (HBD: c.350 G > A), Hb A2-Etolia (HBD: c.257 T > C), Hb A2-Fitzroy (HBD: c.428 C > A) and the δ-IVS-I-5 (G > T) (HBD: c.92 + 5 G > T). One case was a compound heterozygote for δ-IVS-I-5/Hb A2-Fitzroy. The results of this single center study suggest that the mutations in the HBD gene in the Iranian population are heterogeneous and should be considered in genetic counseling of families.

The carrier frequency of α-globin gene triplication in an Iranian population with normal or borderline hematological parameters.

The -α(3.7) rightward deletion is the most frequent α-globin mutation worldwide, while frequencies of the ααα(anti 3.7) triplication are only sporadically known. Carriers of the ααα(anti 3.7) triplication show no clinical symptoms or significant hematological changes, but co-inheritance with ß-thalassemia (ß-thal) has been reported to worsen the clinical and hematological features of the patient as well as the trait. We have screened the α-globin gene rearrangements of 280 individuals with normal hematological indices and 117 persons with borderline hematological parameters. We used multiplex polymerase chain reaction (m-PCR) and multiplex ligation-dependent probe amplification (MLPA) technology to detect triplications and quadruplications. Only the ααα(anti 3.7) triplication was observed. The carrier frequency in the first group was 2.14% and in the second group 1.7%. No phenotype aggravation was noticed in two carriers of ß-thal and the ααα(anti 3.7) triplication, while a mild ß-thalassemia intermedia (ß-TI) was observed in a ß-thal carrier with six α-globin genes. Due to the high consanguinity in the country, homozygosity for the ααα(anti 3.7) triplication and for other rearrangements can be expected. Therefore, an accurate determination of the frequencies and a routine control for these mutations is essential for a correct genotype-phenotype prediction during genetic counseling for ß-thal.

First report on the co-inheritance of beta-globin IVS-I-5 (G-->C) thalassemia with delta globin CD12 {Asn-->Lys (AAT-->AAA)}HbA2-NYU in Iran.

BACKGROUND: Co-inheritance of ß- and δ-globin mutations in Iran is not uncommon. This situation may interfere with correct diagnosis and genetic counseling of α- and ß-thalassemia in screening programs. Here we report the co-inheritance of ß- and δ-globin gene mutations in an individual with microcytosis, hypochromia and a normal hemoglobin A2 (HbA2) level. METHODS: Genomic DNA extraction, amplification refractory mutation system (ARMS) polymerase chain reaction and direct DNA sequencing of δ- and ß-globin genes were exploited for detection of the mutations in these two genes in an individual with low hematological indices and normal HbA2. RESULTS: ARMS-PCR technique revealed the ß(+) IVSI-5 (G to C) mutation and direct DNA sequencing of the δ-globin gene detected a previously reported delta codon 12 (AAT-->AAA) HbA2-NYU. This study reports HbA2-NYU in association with the ß IVSI-5 (G to C) mutation in Iran. DISCUSSION: This report emphasizes that normal HbA2 expression in a ß-goblin carrier is due to mutation in the δ-globin gene and may cause misdiagnosis of thalassemia.

Co-inheritance of hemoglobin D and ß-thalassemia traits in three Iranian families: clinical relevance.

Here we report the result of three cases referred to our lab that had a combination of ß-thalassemia and hemoglobin D (Hb D) traits. These individuals had no symptoms of profound anemia and hematological indices were similar to that of a ß-thalassemia heterozygote. In all three cases, the Hb D level was elevated and no HbA was detected electrophoretically. The electrophoresis pattern suggested that all cases were homozygotes for Hb D. PCR followed by digestion with EcoRI and sequencing of the ß-globin gene confirmed the presence of Cd 121 GAA>CAA in the heterozygous form with another ß-globin mutation. In all cases, the mutations in the ß-globin gene were detected by ARMS PCR technique and they were either IVSII-I or IVSI-5. Hematological studies of the family members showed that thalassemia which caused the mutations and Hb D were in the trans position.

Identification of a novel δ-globin gene mutation in an Iranian family.

δ-Thalassemia (δ-thal) has no clinical symptoms, but its coinheritance with ß-thal may cause misdiagnosis, especially in countries with a high prevalence of ß-thal where prevention programs have been implemented. The molecular basis of most ß-thal syndromes have been defined, while the spectrum of mutations causing δ-thal have not been well characterized. A couple was referred to us for thalassemia molecular screening. Since she had rather low values of Hb A2 and normal Hb F, her δ-globin gene was amplified and directly sequenced. We found two different mutations on her δ-globin genes: HBD: c.92+5G>T/HBD:c.428C>A. The c.92+5G>T mutation has not been previously reported. Two different mutations in trans may explain the reduced Hb A2 level.