مجله زنان مامائی و نازائی ایران
سال بیست و سوم شماره 10 (دی 1399)

The diagnosis of gestational diabetes mellitus (GDM) by HbA1c is up to 6.5%, but some studies have declared that the value of 5.7-6.4 % is associated with higher risk of GDM. This study was performed with aim to determine the validity of HbA1c=5.7-6.4% in the prediction of gestational diabetes and to estimate the outcomes of pregnancy.

This co-group study was conducted on 950 pregnant women in Arash Hospital at 2018. All high risk pregnant single tone women aged 18-35 years pregnancies under 20 weeks were included. At first visit, HbA1c test and OGTT 75 g test were performed as gold standard, if the test was negative; test was again performed at 24-28 weeks of gestation. The incidence of diabetes and pregnancy outcomes including: the incidence of preeclampsia, cesarean section, abortion, macrosomia, shoulder dystocia, intrauterine death, fetal growth retardation were compared in cases with HbA1c = 5.7-6.4 and less than 5.6%. Data were analyzed by Stata software (version 13) and student t-test for quantitative variables and Chi-square test for qualitative variables. Univariate and multivariate logistic regression was used to determine the association between HbA1c and variables. P<0.05 was considered statistically significant.

The prevalence of diabetes was 39.2% and at the cut-off point of 5.7%, the highest classification of gestational diabetes was observed. At this point, the sensitivity and specificity were 41.33 and 15.92, respectively. The rate of macrosomia was significantly lower in women with HbA1c<5.6 compared to the women with HbA1c= 6.4 – 5. 7 % (p <0.001); however, the rate of cesarean section was significantly higher in this group (p = 0.02). The rate of preterm delivery (p = 0.9), pre-eclampsia (p = 0.2) and shoulder dystocia (p = 1) were not statistically different between the two groups.

HBA1C measurement in the first half of pregnancy does not have a high sensitivity for the prediction of gestational diabetes, but it has high specificity.

Pregnancy itself is a stressful event that can be affected by the current outbreak of COVID-19. It is important to pay attention to the factors that reduce the anxiety caused by COVID-19 epidemics in pregnant women. Therefore, this study was performed with aim to determine the relationship between social support and anxiety caused by the epidemic of COVID-19 in pregnant women.

This cross-sectional, correlational study was performed on 200 pregnant women in 2020. Sampling tools included a demographic and midwifery information questionnaire, Perceived Social Support-Family questionnaire (pss-fa), and a questionnaire for anxiety in Pregnant Women caused by COVID-19 epidemic. Data were analyzed by SPSS software (version 16) and Pearson correlation coefficient, ANOVA and independent t-test, and single-variable linear regression. P<0.05 was considered statistically significant.

The prevalence of anxiety caused by COVID-19 epidemics was significantly different in the weak, moderate, and strong social support subgroups (P<0.001). The results of correlation test showed significant inverse relationship between anxiety caused by COVID-19 and the level of social support received by pregnant women (Pearson correlation coefficient=-0.211, p=0.003); this means that increasing the level of social support from the family reduces the level of anxiety caused by COVID-19 epidemics in pregnant women.

Considering the inverse relationship between the rate of anxiety caused by COVID-19 epidemic and the level of social support received by pregnant women, it seems that supportive measures by the family and those around them are essential.

Chlamydia trachomatis in men can be a cause of infertility which sometimes is not considered in the infertility criteria; on the other hand, this infection has adverse effects on the morphology of semen. Regarding to the unknown prevalence and destructive effects of this infection on semen, this study was performed with aim to investigate the prevalence of Chlamydia trachomatis infection and its effect on semen of infertile men referred to infertility clinics in Tabriz.

In this descriptive study, which was performed during 2015 with the participation of 268 infertile men referred to infertility clinics affiliated to Tabriz University of Medical Sciences, the prevalence of Chlamydia trachomatis infection in men and its effect on semen were investigated. Data were compared by SPSS software (version 20) and t-test. P<0.05 was considered statistically significant.

The prevalence of Chlamydia trachomatis infection in infertile men was 35.82%; the morphological results of semen analysis showed that the number (P=0.009), progressive movement (P=0.026), morphology (P=0.001) and viability (P=0.003) of men sperm with chlamydia trachomatis infection was significantly lower than men without infection, while volume (P=0.012), in situ movement (P=0.009), sperm immobility (P=0.008) was significantly higher in men with infection than men without infection.

Incidence of Chlamydia trachomatis infection was higher than normal in the present study and this infection has led to destructive effects on semen morphology.

Satisfactory sexual relations promote women's health and quality of life. Some medicinal Plants can have an effect on sexual satisfaction due to the presence of certain compounds. This study was performed with aim to investigate the effect of herbal composition (Oak Gall, pomegranate peel and Fenugreek Seed) on female sexual satisfaction.

This double-blind randomized clinical trial study was performed as parallel in 2020 on 60 women aged 15-45 years referred to Ardabil Comprehensive Health Centers. Subjects were divided into two groups of herbal vaginal suppositories (n=30) and placebo (n=30), and both groups used the suppository 2 days a week for 1 month. Data collection tools were Larson Questionnaire and Orgasm Questions (FSFI). Data were analyzed by SPSS software (version 23) and paired t-test, independent t-test, Chi-square and analysis of covariance. P<0.05 was considered statistically significant.

Before treatment, there was no significant difference between the two groups in terms of orgasm scores and level of sexual satisfaction (p <0.05). After treatment, orgasm scores were significantly higher in the group consuming herbal suppositories than the control group (p <0.001), but the two groups did not have a significant difference in terms of sexual satisfaction (p = 0.14).

The use of herbal compounds (Oak Gall, pomegranate peel, Fenugreek Seeds) can improve orgasm. Further studies in this field are recommended to ensure the effect of this herbal compound on sexual satisfaction.

Along with lifestyle changes, weight gain in pregnant women is increasing, which can lead to the problems such as high blood pressure, preterm delivery, cesarean section, and even maternal and child death. This study was performed with aim to evaluate the effect of walking on weight gain and blood pressure in overweight pregnant women.

 This randomized controlled clinical trial study was performed on 30 overweight pregnant women with gestational age of 20-27 weeks in Nahavand city in 2019. Participants were divided into two groups of intervention (n=15) and control (n=15). The exercise protocol of the intervention group consisted of 12 weeks of walking program with 45% to 60% of the maximum heart rate for 20 to 40 minutes. Data were analyzed by SPSS software (version 22) and Shapiro-Wilk, Loon and covariance analysis. P ˂ 0.05 was considered statistically significant.

The intervention group experienced less weight gain after 12 weeks of walking exercise than the control group (P ˂ 0.001). Walking exercise had a significant effect on systolic (P=0.015) and diastolic (P=0.015) blood pressure in pregnant women of the intervention group.

12 weeks of walking had a significant effect on the optimal weight gain of overweight pregnant women and maintain their blood pressure in the normal range.

Hysterectomy, as one of the most common gynecological surgeries, has a negative effect on the psychological dimension of women. This study was performed with aim to compare postmenopausal and non-menopausal women who underwent hysterectomy in terms of posttraumatic stress.  

This analytical-cross-sectional study was performed on 154 postmenopausal and non-menopausal women who underwent hysterectomy in Hazrat Zeinab and Shahid Dr. Faghihi hospitals in Shiraz from August to the end of January 2019. The posttraumatic stress date was collected through Weiss & Marmar questionnaire. Data were also analyzed by SPSS software (version 16) and descriptive statistics and inferential statistics tests of independent t-test and paired t-test. P<0.05 was considered statistically significant.

Mean Post-Traumatic Stress (PTS) score increased one week after the operation and decreased two months after the operation (p= 0.179). The score of stress was lower in the menopausal group (4.99±6.02) than the non-menopausal group (6.49 ± 7.72). Also, there was no significant difference between the mean PTS score of postmenopausal and non- menopausal two months after the surgery (p >0.05).

Although hysterectomy increases stress in postmenopausal and non-menopausal groups with significant differences in the non- menopausal group, but after two months, the PTS score significantly decreased. More attention from midwives and clinic staff on mental health is essential.

Genetic polymorphisms are one of the possible causes of recurrent abortion with unknown cause. This study was performed with aim to investigate the association and frequency of rs2249863 and rs1233334 polymorphisms of the upstream region of HLA-G gene with the recurrent spontaneous abortion in women from Northwest of Iran.

This case-control study was performed on 160 women from Northwest of Iran referring to the Madar infertility clinic of Tabriz between 2018 and 2019. Among them, 80 women with a history of recurrent spontaneous abortion (at least 2 abortions) were considered as case group and 80 women with at least one child and without any history of miscarriage as control group. After collecting blood samples, genome DNA was extracted and the polymorphisms were evaluated by PCR and sequencing technique. Data were analyzed using SPSS software (version 22) and Fisher test. P <0.05 was considered statistically significant.    

The frequencies of allele G and genotype GG in the rs2249863 polymorphism were significantly different between the case and control groups (P<0.05). In the rs1233334 polymorphism, although the frequencies of allele C and genotype CC were different between the case and control groups, but the differences were not statistically significant (P>0.05). Moreover, haplotype analysis identified the CG as the commonest haplotype that its frequency was significantly different between the case and control groups (P<0.05).

The rs2249863 polymorphism and CG haplotype of the rs2249863 and rs1233334 polymorphisms are associated with the recurrent spontaneous abortion in the studied population and they could be considered as potential risk factors for the disease.

Fibroblast growth factor 21 (FGF21) increases lipolysis and fatty acid oxidation. The effect of different volumes of resistance training on FGF21 is not well defined. Therefore, the aim of this study was to compare the effects of high and low volume of resistance trainings on serum level of FGF-21, body composition and mobility in sedentary obese older women.

Thirty sedentary obese elderly women (age 64.57±4.50 years, body mass index 32.34±2.69 kg/m2, and body fat percent 40.93±2.11) who were resident in Mashhad participated in this quasi-experimental study. The subjects were randomly assigned into three equal groups of control, low volume resistance training (LVRT), and high volume resistance training (HVRT). The subjects performed LVRT (one-set) and HVRT (three-set) protocols twice weekly for 12 weeks. Anthropometric and biochemical evaluations were carried out one week before the first session and 48 hours after the last session. In addition, 30-second chair stand, arm curl, two minutes step and eight foot up-and-go tests were evaluated. Dependent t-test and analysis of covariance were used to examine the intra- and inter-group differences, respectively.

Following training, the body fat percentage was significantly lower in HVRT group than LVRT group (P=0.001). In contrast, the results in 30-second chair stand (P=0.001) and arm curl (P=0.001) were significantly higher in HVRT group than LVRT group. However, there were no significant differences between two groups of HVRT and LVRT in weight (P=0.999), body mass index (P=0.999), FGF21 (P=0.999), two minutes step (P=0.072), and eight foot up-and-go (P=0.231) at the end of the protocols.

These results demonstrate that three-set resistance training resulted in greater improvements in body composition and mobility than single-set resistance training in obese elderly women.

Severe interval training is an effective way to improve cognitive function, cardiovascular health and body weight reduction; so far, the combined effect of this type of exercise with omega-3 supplementation in overweight girls has not been studied. Therefore, this study was performed with aim to evaluate the effect of two weeks of sprint interval training (SIT) combined with omega-3 consumption on serum levels of Irisin, BDNF and Lipid profile in overweight girls.

This randomized clinical trial study was performed in 2019 on 15 students of Lorestan university with BMI>25 kg/m2. Subjects were divided into two groups: training-placebo and training-supplement. Subjects participated in a 2-week SIT protocol (3 sessions per week). The participants in the training-supplement group received an omega-3 tablet (1000 mg) and training-placebo group received glucose tablet (1 gram) each day for two weeks. Serum levels of irisin, BDNF and lipid profile were measured at fasting 24 hours before and after the training protocol. Data were analyzed by SPSS software (version 25) and paired t-test and covariance test. P<0.05 was considered statistically significant.

The results of the study showed a significant increase in serum levels of irisin and BDNF in both groups (p<0.05). However, in the training-supplement group, serum levels of LDL and cholesterol also decreased (p<0.05). Also, the results of covariance test showed no significant difference between the two groups in all variables (p˃0.05).

Sprint interval training for two weeks with and without omega 3 consumption increases serum levels of irisin and BDNF in overweight girls, and omega-3 consumption combined with this type of training, also reduces serum levels of LDL and cholesterol.

Prolonged labor leads to adverse birth outcomes. Thermotherapy is a new non-pharmacological method to reduce duration of labor. Hot water bags and infrared are the methods of thermotherapy. Due to the different mechanism of these two methods and lack of study regarding their comparison, this study was conducted with aim to compare the effect of infrared belt and hot water bag on the duration of the first stage of labor in primiparous women.

This parallel three-group randomized clinical trial was conducted on 150 primiparous women referred to Mashhad Um Al-Benin Hospital in 2019. At first stage of labor, two 20-minute cycles of thermotherapy was performed in the intervention groups by the infrared belt and hot water bag at dilation of 4-5 cm and of 6-7 cm of the cervix. The control group received routine care. Duration of the first stage was assessed from the beginning of 4-5 cm dilation per minute. Data were analyzed by SPSS software (version 25) and Kruskal-Wallis test and one-way analysis of variance. p < 0.05 was considered statistically significant.

Mean duration of the first stage of labor was significantly different in the three groups (p <0.001). Mean duration of the first stage of delivery was significantly less in the infrared belt group than the hot water bag group (p <0.001). The infrared belt and hot water bag had no adverse effect on FHR, Apgar score and PPH.

The use of infrared belt is an effective way to reduce the duration of the first stage of labor. This method can be used as a complementary method and a non-pharmaceutical treatment method for management of labor.

During recent decades, laser therapy has been one of the most popular methods in treatment of hirsutism in women with polycystic ovary syndrome (PCOS). This study was performed with aim to determine the therapeutic effect of laser on hirsutism in women with PCOS as a systematic review.

The search process of experimental and semi-experimental studies (Persian and English language) was performed in databases including PubMed, Scopus, Web of Science, Cochrane library, Magiran, SID, and IranDoc up to July 2020. The search was performed using the keywords of polycystic ovary syndrome, hirsutism, laser, treatment, hair, and the related latin keywords. The main outcomes were the effect of interventions on hair loss, hair loss duration, the duration of new hair growth, and the side effects of laser treatment.

After the advanced search, 11 articles (638 participants) had inclusion criteria. The skin type of the participants was based on Fitzpatrick scale. The majority of studies used the Alexandrite laser device. The duration of treatment in the studies was a maximum of 6 months with treatment intervals of 4 to 6 weeks. The main outcomes of this study included: significant reduction in the number of hairs and the intensity of excess hair, an increase in the mean growth time of new hair, energy levels in the range of 10 to 50 j/cm2 and duration of 20-50 milliseconds. The complications included hyperpigmentation, erythema, and pain.

The findings indicated the impact of light-based technologies on different types of outcomes associated with the treatment of hirsutism in women with PCOS, but due to the limitations, there is no consensus on the most appropriate type of laser, fluorescence, and the number of treatment sessions. Greater clinical trial studies are needed to develop the clinical guidelines.

The black widow spider is known in the Mediterranean region as L.tredecimguttatus species that in Khorasan is known with its local name as “Dalmak”.  The venom of this spider contains excitatory neurotoxins called alpha-latroteins. Black widow spider bite cases are rare during pregnancy, and few studies have been performed in this regard, the symptoms of a bite during pregnancy are not different from those of non-pregnant women, and causing acute fetal complications are unlikely. In this study, a case of a black widow spider bite was reported in a pregnant woman.

The reported case is a 29-year-old woman (Gravid 2(with 6-week gestational age who was unaware of her pregnancy and complained of abdominal pain and right lower extremity burning from the night before referring to Ghaem Hospital Emergency Department, Mashhad. The patient was examined, and after rule out of the possibility of ectopic pregnancy and other differential diagnoses, the patient was treated with maintenance therapy with the diagnosis of black widow spider bites, and after two days of hospitalization, she was discharged with good general condition, good vital signs and complete relief of abdominal pain.

Black widow spider bites can mimic symptoms similar to acute abdominal surgery, ectopic pregnancy, or other diagnoses, In the early months of pregnancy, it can be very difficult to diagnose the cause of the symptoms. In addition, black widow spider bites during pregnancy can mimic the symptoms of cholecystitis or appendicitis, which can be diagnosed by careful examination of the patient and obtaining a proper history.