مجله زنان مامائی و نازائی ایران
سال هفدهم شماره 128 (هفته دوم دی 1393)

polycystic ovary syndrome is the common cause of infertility due to anovulation، and insulin resistance، increasing high body mass Index and waist: hip ratio (WHR) are known risk factors in poor outcome of infertility treatment and also clinical response to metformin. This study was performed with aim to assess the effect of metformin on prediction of treatment outcomes of IUI in insulin – resistant and non-resistant infertile women with polycystic ovarian syndrome (PCOS) and the effect of resistant to insulin، BMI and WHR on them. This non randomized clinical trial study was performed on 74 infertile women with PCOS who were candidate for IUI referred to infertility clinic of Mirza Koochackan Hospital of Tehran between 2011 and 2012. The patients were divided in two groups of Insulin Resistance and nonresistance according to the results of GTT (Glucose Tolerance Test) and Insulin level hormone test and were divided to four groups according to BMI. All patients received metformin 500mg، three times daily، six weeks before the IUI cycle and both groups subsequently underwent treatment with drugs of ovulation induction for IUI. Data were analyzed with T-test and ANOVA test. P from 74 studied women، 34 cases were insulin resistance and 37 nonresistance. Treatment with metformin caused more ovulation rate، mean follicular size، positive result of pregnancy test، clinical pregnancy and adverse effects in Insulin resistance group، but these differences were not significant (P>0. 05). But، two groups showed a significant difference in BMI and WHR ratio (P=0. 02). 11 cases (29. 7%) in resistance group and 9 (24. 3%) in nonresistance group become pregnant، but this difference was not significant (P>0. 05). In four indexes، two groups were not statistically significant in terms of IUI results and pregnancy incidence (P=0. 05). But، in over weigh patients (BMI=25-30) in both groups، more pregnancy rate was observed. Metformin can be administered for all PCOS patient regardless of Insulin resistant and nonresistance. Also BMI is a better predictor for the rate of response to treatment with metformin.

Iron deficiency anemia in pregnancy has adverse effects on pregnant women، fetus and neonate. With regard to the high prevalence of iron deficiency anemia، this study was performed with the aim to evaluate the frequency of iron deficiency anemia in pregnant women at the beginning and end of pregnancy and also its effect on the mother، fetus and infant. This cross-sectional study was performed on 546 pregnant women who referred to all clinics and clinics of gynecologists in Semnan from 2007 to 2010. CBC and serum ferritin were performed for all the patients. Hemoglobin level less than 11gr/dL accompanied by mild to severe reduced iron stores was defined as iron deficiency anemia. Test results and demographic data were recorded in the questionnaire and the Fisher exact test، chi-square and t-test at 5% significance level were used for data analysis. iron deficiency anemia was observed at the beginning of pregnancy in 169 women (31%) and at 36th week of pregnancy in 86 (27. 2%). statistically significant relation was found between iron deficiency anemia At the beginning of pregnancy with maternal parity (P<0. 001)، infection during pregnancy (P=0. 009)، and IUFD (P=0. 002)، but at 36th week of pregnancy، none of the variables had significant relation (P>0. 05). Weight of preterm (P=0. 008) and term neonates (P=0. 001) was lower in iron deficiency anemic patients at the beginning of pregnancy. Iron deficiency anemia has high prevalence in Semnan and has noticeable adverse effects on pregnancy outcomes، so it is suggested to introduce diagnostic and therapeutic protocols based on regional policies in accordance with the prevalence of iron deficiency anemia in order to take necessary steps towards improvement of maternal and neonatal health.

Pregnancy is from the most risky period of women''s life and nutrition during this period will affect the health of the mother and fetus. This study was performed aimed to compare the effectiveness of nutrition training by group discussion method and using multi-media package on the nutritional status of pregnant women. This quasi-experimental study with a control group was performed on 174 pregnant women in health centers of Mashhad and Gonabad. Multimedia package was designed using Autoplay software (version 8. 2). The pretest of output of the test subjects were studied. Then، nutrition training was performed by group discussion method and multimedia packages. Finally، a month after the intervention، posttest of output was completed. Data analysis was performed using Dietplan software (version 6) and SPSS software (version 20) and one-way ANOVA and paired t-test. P Variables niacin (P=0/04)، vitamin B6 (P=0/04)، vitamin D (P=0/01)، B12 (P=0/03) in a closed multimedia pre- and post-intervention difference were statistically significant. Folate (P=0/04) vitamin c (P = 0/03)، carotene (P=0/006) and fiber (P = 0/03) in group discussions before and after the intervention group had a statistically significant difference. Compared to the methods used، the mean scores were higher in group discussion about the multimedia package. The two methods of group discussion and multimedia package significantly improve the nutritional status of pregnant women than pre-intervention compared to the control group. Comparison of two methods of teaching showed that group discussion method was more effective than multi-media package method.