The Effectiveness of Information-Motivation-Behavioral Skills Model on Self-Care Practices in Early Pregnancy to Prevent Gestational Diabetes Mellitus in Iranian Overweight and Obese Women: A Randomized Controlled Trial.

BACKGROUND: Gestational diabetes mellitus (GDM) is one of the most common metabolic dysfunction in pregnancy and as overweight and obesity are of the major risk factors. The aim of this study was to determine the effect of Information-Motivation and Behavioral skills (IMB) model-based counseling on preventing GDM in overweight and obese pregnant women. METHODS: This randomized controlled trial study was conducted on 137 pregnant women in two groups; education and counseling IMB model-based for four sessions (n = 70), and antenatal usual care (AUC) (n = 67). This study was conducted on overweight and obese pregnant women, at the 12 to 16 weeks' gestation and recruited from the Prenatal Clinic of Rohani Hospital in north of Iran. Blood glucose was measured before and 8 weeks after the intervention. Descriptive and inferential statistics including mean, frequency, t-test, chi-square and ANCOVA were used. RESULTS: The prevalence of GDM was lower in the intervention group than the control group (10% and 29.9%, respectively, RR = 0.33, CI 95% (0.15- 0.74) p = .004) as well as mean fasting blood glucose (Cohen's d = 0.28, p = .07), and glucose tolerance test at the first and second hour (d = 0.41 and Cohen's d = 0.73, respectively, p < .01). CONCLUSIONS: A lifestyle intervention in early pregnancy by IMB counseling in overweight and obese pregnant women can be effective in decrease GDM.

Design, implementation and evaluation of a virtual clinical training protocol for midwifery internship in a gynecology course during COVID-19 pandemic: A semi-experimental study.

BACKGROUND: Over the past year, the occurrence of COVID-19 pandemic has challenged clinical education for health care students, due to the possibility of exposure to the virus and increased spread of the disease. Clinical training of midwifery students in gynecologic problems, based on the Iran midwifery education curriculum, was also disrupted during this pandemic. OBJECTIVES: This study was aimed at designing, implementing and evaluating a virtual clinical training protocol for midwifery internship in a Gynecology course. DESIGN: A semi-experimental study. SETTINGS: Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran. PARTICIPANTS: Forty-seven midwifery interns in Gynecology course were recruited during two semesters in 2020. METHODS: Five steps based on the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model were taken, which included 1) educational and skills needs assessment, 2) design, 3) development via focused group interviews and brainstorming with the presence of the midwifery department members in three sessions, 4) implementation including pretest and posttest, webinar, uploading the information of virtual patients, questions and correct answers, and 5) evaluation including knowledge assessment by a designed questionnaire and skills evaluation by the modified-Mini-CEX checklist. Data were analyzed using mean, standard deviation and paired t-test. RESULTS: After training, a significant increase (p < 0.001) was observed in scores of knowledge and interview skills, clinical judgment, consultation, efficiency, professionalism, clinical competence and total score of clinical skills. CONCLUSIONS: Training for gynecological diseases through virtual clinic promoted knowledge and clinical skills of midwifery interns. To enhance education, a virtual clinic may be used in crisis situations and in combination with teaching under normal circumstances by strengthening the infrastructure and removing barriers.

Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis.

OBJECTIVES: To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment. DESIGN: Individual participant data meta-analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed. DATA SOURCES: Major electronic databases, from inception to February 2017. ELIGIBILITY CRITERIA: Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education (≥tertiary) or lower education (≤secondary). RISK OF BIAS: Cochrane risk of bias tool was used. DATA SYNTHESIS: Principle measures of effect were OR and regression coefficient. RESULTS: Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B -0.055; 95% CI -0.098 to -0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B -0.053; 95% CI -0.069 to -0.037,p<0.001). Physical activity based interventions did not impact GWG when stratified by education. CONCLUSIONS: Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial.

Use of ginger versus stretching exercises for the treatment of primary dysmenorrhea: a randomized controlled trial.

BACKGROUND: Dysmenorrhea is a common gynecologic problem. In some cases, non-medical treatments are considered to be more effective, with fewer side effects. Ginger and exercise are alternative treatments for dysmenorrhea, but in the present study they were not combined. OBJECTIVE: In this study, the effects of ginger and exercise on primary dysmenorrhea were compared. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This randomized controlled trial was performed in Mazandaran University of Medical Sciences, Iran. Two groups of female students were recruited by simple random allocation. In each group, 61 students with moderate to severe primary dysmenorrhea with regular menstrual cycles and without a history of regular exercise were assessed. The ginger group received 250 mg ginger capsules from the onset of menstruation. In the exercise group, belly and pelvic stretching exercises were performed for 10 min, 3 times per week. MAIN OUTCOME MEASURES: Intensity of pain was assessed according to a visual analogue scale after the first and the second month. RESULTS: Exercise was significantly more effective than ginger for pain relief (31.57 ± 16.03 vs 38.19 ± 20.47, P = 0.02), severity of dysmenorrhea (63.9% vs 44.3% mild dysmenorrhea, P = 0.02) and decrease in menstrual duration (6.08 ± 1.22 vs 6.67 ± 1.24, P = 0.006), in the second cycle. CONCLUSION: Stretching exercises, as a safe and low-cost treatment, are more effective than ginger for pain relief in primary dysmenorrhea. TRIAL REGISTRATION: The trial was registered in www.IRCT.ir with No. 201203118822N2.

Comparison of the Effect of Stretching Exercises and Mefenamic Acid on the Reduction of Pain and Menstruation Characteristics in Primary Dysmenorrhea: A Randomized Clinical Trial.

OBJECTIVES: Dysmenorrhea is a common gynecologic disorder. Although non-steroidal anti-inflammatory drugs are commonly used, due to their side effects and lack of response in some individuals, other approaches such as exercise have been considered. This study compared the effect of stretching exercises and mefenamic acid on the reduction of pain and menstruation characteristics in primary dysmenorrhea. METHODS: In this randomized clinical trial, 122 female students with moderate to severe dysmenorrhea were assessed and were placed in either the exercise or mefenamic acid group. The exercise program was performed for 15 minutes, three times a week and included a five-minute warm up and six belly and pelvic stretching exercises for 10 minutes. The mefenamic acid group received 250 mg capsules every eight hours from the onset of menstruation until pain relief. Both interventions were performed during two consecutive menstrual cycles. Pain intensity was measured using a 10 cm visual analog scale. RESULTS: The mean pain intensity was significantly higher in the exercise group only in the first cycle (p = 0.058). In the second cycle, the mean difference in pain reduction in the exercise group was higher than the mefenamic group compared to the start of the study (p = 0.056) and the first cycle (p = 0.007). There was no significant difference in the severity and duration of pain between the groups (p > 0.050). CONCLUSIONS: Stretching exercises were as effective as mefenamic acid in the treatment of primary dysmenorrhea. Our results suggest that the effect of exercise on relieving menstruation pain increases over time.

Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials.

CONTEXT: Interventions targeting maternal obesity are a healthcare and public health priority. OBJECTIVE: The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy. DATA SOURCES: A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration. STUDY SELECTION: Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified. DATA SYNTHESIS: There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain. CONCLUSION: This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice.

The effect of mefenamic acid and ginger on pain relief in primary dysmenorrhea: a randomized clinical trial.

PURPOSE: The aim of the study was to compare the effect of mefenamic acid and ginger on pain management in primary dysmenorrhea. METHODS: One hundred and twenty-two female students with moderate to severe primary dysmenorrhea were randomly allocated to the ginger and mefenamic groups in a randomized clinical trial. The mefenamic group received 250 mg capsules every 8 h, and the ginger group received 250 mg capsules (zintoma) every 6 h from the onset of menstruation until pain relief lasted 2 cycles. The intensity of pain was assessed by the visual analog scale. Data were analyzed by descriptive statistics, t test, Chi-square, Fisher exact test and repeated measurement. RESULTS: The pain intensity in the mefenamic and ginger group was 39.01 ± 17.77 and 43.49 ± 19.99, respectively, in the first month, and 33.75 ± 17.71 and 38.19 ± 20.47, respectively, in the second month (p > 0.05). The severity of dysmenorrhea, pain duration, cycle duration and bleeding volume was not significantly different between groups during the study. The menstrual days were more in the ginger group in the first (p = 0.01) and second cycle (p = 0.04). Repeated measurement showed a significant difference in pain intensity within the groups by time, but not between groups. CONCLUSION: Ginger is as effective as mefenamic acid on pain relief in primary dysmenorrhea. Ginger does not have adverse effects and is an alternative treatment for primary dysmenorrhea.

The effect of 8 weeks aerobic exercise on insulin resistance in type 2 diabetes: a randomized clinical trial.

Diabetes complications are the main reasons behind morbidity and mortality preventable by healthy diet and physical activity. There are few studies about the effect of aerobic exercises on insulin resistance in human. Also various training protocols are associated with different results. Since approaches to decrease insulin resistance may be followed by more effectiveness treatment, this study assessed the effect of aerobic exercise on insulin resistance in type 2 diabetes mellitus. In this randomized clinical trial, 53 type 2 diabetic women were randomly divided into two groups as exercise (n=27) and control (n=26).The exercise protocol included warm-up by stretching and flexibility exercises for 10 m, followed by walking for 30 m with maximum intensity 60% increase in heart rate and then stretching in the seated position for 10 m, 3 times a week for 8 weeks. Resistance to insulin was assessed using Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Significant differences have been observed in insulin resistance, fasting glucose and plasma insulin between the groups after 8 weeks. There were significant differences in waist and hip circumference, BMI, plasma insulin and insulin resistance within the groups over time. In addition, the changes in waist and hip circumference, FBS, plasma insulin and insulin resistance had significant interaction with the time between the groups. The current exercise protocol has been effective in lowering plasma glucose (p = 0.05), insulin levels (p = 0.000) and insulin resistance (p = 0.02). It seems that aerobic exercises training promote the effectiveness of medical treatment in type 2 diabetes mellitus.