Inulin-type fructans with different degrees of polymerization improve insulin resistance, metabolic parameters, and hormonal status in overweight and obese women with polycystic ovary syndrome: A randomized double-blind, placebo-controlled clinical trial

Polycystic ovary syndrome (PCOS) is associated with reproductive disorders and adverse cardiometabolic risk factors that can negatively impact the general health of women. Inulin-type fructans (ITFs) are proposed to beneficially affect risk factors associated with metabolic disorders. Whether ITFs can help with the management of PCOS by modifying insulin resistance (IR) and androgen levels has not yet been explored. The aim of this study was to investigate the effects of ITFs with different degrees of polymerization on insulin resistance, blood lipids, anthropometric measures, and hormonal status in overweight and obese women with PCOS. In a randomized double-blind placebo-controlled trial, seventy-five women with PCOS aged 18-40 years old were randomly assigned to receive 10 g/day of high-performance inulin (HPI) or oligofructose-enriched inulin (OEI) or maltodextrin for 12 weeks. Biochemical and clinical outcomes were measured at baseline and after the intervention. Participants in the HPI and OEI groups experienced improvements in waist circumference, total testosterone, free androgen index, sex hormone-binding globulin, and triglycerides compared to the placebo group. Also, the number of women with irregular menses or oligomenorrhoea decreased significantly in both ITF groups. Participants in the HPI group reported lower body mass, fasting insulin, and HOMA-IR, as well as a higher quantitative insulin sensitivity check index. ITF supplementation, especially with long-chain ITFs, when given for 12 weeks may improve metabolic outcomes, androgen status and clinical manifestations in women with PCOS.

The uterocervical angle-cervical length ratio: A promising predictor of preterm birth?

OBJECTIVE

To predict spontaneous preterm birth (sPTB) (labor before 37 weeks of pregnancy) in low-risk singleton pregnancies during the second trimester, using ultrasound markers: uterocervical angle (UCA) and cervical length (CL).

METHODS

In a prospective observational cohort study, we followed primigravid women with singleton pregnancies without known risk factors for sPTB from 16+0- 23+6 weeks of pregnancy until birth. Transvaginal ultrasonography on admission revealed the UCA and CL, and maternal history was obtained from submitted patient profiles. Logistic regression models disclosed significant predictive variables, and receiver operating curves (ROCs) demonstrated optimal cut-offs and test accuracy indices. Predictive functions of variables were compared using positive and negative likelihood ratios.

RESULTS

In a sample of 357 participants, 41 (11.5%) experienced sPTB. UCA and CL were significantly associated with sPTB when adjusting for other variables (adjusted odds ratio: UCA 1.05, 95% confidence interval [CI] 1.02-1.07 and CL 0.82, 95% CI 0.75-0.90). Optimal cut-offs were estimated to be 106° and 33 mm for UCA and CL, respectively. We devised the novel index UCA/CL with an area under the ROC of 0.781 (95% CI 0.734-0.823), cut-off = 3.09°/mm, and improved likelihood ratios (positive: 3.18, 2.47, and 4.22; negative: 0.63, 0.52, and 0.51 for UCA, CL, and UCA/CL, respectively).

CONCLUSION

The second-trimester UCA/CL was found to be a promising index to predict sPTB in low-risk singleton pregnancies. Further multicenter studies may generalize this conclusion to other gestational ages or risk groups and make it more comprehensive by considering other risk factors.

Evaluation of the Relationship between Pregnancy-Associated Plasma Protein A (PAPP-A) and Pregnancy Outcomes

Background

In the current study, we aimed to evaluate the association between pregnancy-related plasma protein-A (PAPP-A) levels measured in the first trimester and pregnancy outcomes.

Materials and Methods

This is a descriptive-analytical study that was performed in 2019--2021 on 1061 pregnant women in their first trimester. Demographic and basic information of all women were collected. These data included age, weight, parity, and date of delivery. Then the quantity of PAPP-A was recorded in three groups including less than 0.5 MOM, 0.5 to 2.5 MOM, and more than 2.5 MOM.

Results

Data of 1061 women were analyzed. 900 women (84.8%) had term delivery and 155 women (14.6%) had pre-term deliveries. PAPP-A levels were normal in 83.4% of women. BMI and number of pregnancies had significant relationships with PAPP-A (p < 0.001, P = 0.03 respectively). The mean BMI in mothers with PAPP-A higher than 2.5 was significantly more than mothers with normal or lower PAPP-A levels (26.2 ± 31, P = 0.04). The frequency of term labor in mothers with normal PAPP-A was higher than other mothers (86.3%, P = 0.04). The frequency of preeclampsia in recent pregnancies in mothers with normal PAPP-A was significantly lower than other mothers (p < 0.001) and the frequency of abortions in recent pregnancies in mothers with PAPP-A less than 0.5 was significantly higher than mothers with normal or elevated PAPP-A (p < 0.001).

Conclusion

Mothers with low PAPP-A levels are more likely to have poor pregnancy outcomes such as abortion, pre-term labor, and preeclampsia.

Cytomegalovirus Specific Cell-Mediated Immunity Status in Women with Preeclampsia: A Case-Control Study

Background

Preeclampsia, a pregnancy-specific complication, has been associated with cytomegalovirus (CMV) infection in observational studies. CMV-specific T cell response plays a major role in viremia clearance. We explored whether CMV-specific cell-mediated immunity (CMI) status is associated with preeclampsia in pregnant women.

Materials and Methods

CMV-specific CMI was assessed using CMV-QuantiFERON (QF-CMV) assay in plasma serum of 35 women with preeclampsia as well as 35 normal pregnant controls, retrospectively. Participants were matched for gestational age in a 1:1 ratio. The proportion of reactive results, the mean value of interferon-gamma (IFN-γ) level produced in mitogen and antigen tubes were compared between the cases and controls through Chi-square and Wilcoxon rank-sum tests, respectively. The odds ratio and confidence interval were calculated as well.

Results

No significant differences observed between demographic characteristics of the case and control groups. The QF-CMV assay turned reactive (QF-CMV [ + ]) Women with preeclampsia had lower mean IFN-γ levels in antigen tube compared with normal pregnant controls. There were no statistically significant differences in the value of mitogen tube between case and controls women with suppressed CMV-CMI were 6.3 times more likely to have preeclampsia. This result even strengthened after adjustment for age, gestational age, and gravidity.

Conclusions

Our findings support an association between suppressed CMV-specific CMI and preeclampsia.

Effects of inulin-type fructans with different degrees of polymerization on inflammation, oxidative stress and endothelial dysfunction in women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial

OBJECTIVE

Polycystic ovary syndrome (PCOS) is associated with several cardiovascular risk factors. Prebiotics were proposed to beneficially affect risk factors associated with metabolic disorders. The aim of this study was to investigate and compare the effects of inulin-type fructans (ITFs), as well-studied prebiotics, with different degrees of polymerization, on markers of inflammation, oxidative stress and endothelial dysfunction in PCOS patients.

DESIGN

A randomized, double-blind, placebo-controlled trial.

PATIENTS

Seventy-five PCOS women were randomly assigned to receive 10 g/day of either high-performance inulin (HPI) or oligofructose-enriched inulin (OEI) or placebo for 12 weeks.

MEASUREMENTS

Biochemical indices and blood pressure levelswere assessed before and after the intervention.

RESULTS

In the intent-to-treat analysis, high-sensitive C-reactive protein (hs-CRP) decreased in HPI and OEI groups, over the 12 weeks, and the changes were significant in the HPI group, compared to placebo (changes from baseline in the HPI group: -0.11 vs. placebo group: 0.004 mg/L [conversion factor to SI units (nmol/L): 9/5238]; p = .007). Serum levels of nitric oxide (NO) increased, and endothelin-1 and total oxidant status decreased in HPI and OEI groups, at the end of the trial; however, these changes were not significantly compared to placebo (p = .07, .36 and .22, respectively). No differences in systolic and diastolic blood pressure were found. Per-protocol analysis (n = 68) yielded consistent results for all endpoints, with the exception that the significant effect of ITFs on serum hs-CRP levels in the unadjusted ITT analysis became nonsignificant in the per-protocol analysis (p = .06).

CONCLUSION

A 12-week supplementation with long-chain ITFs had favourable effects on inflammatory status among PCOS patients.

Prophylactic hypogastric arterial ligation before cesarean hysterectomy for controlling complications in pregnant women with placenta adherent abnormality: A randomized controlled clinical trial

BACKGROUND

Placenta adherent abnormality (PAA) is abnormal attachment of the placenta to the myometrium. This abnormal placenta binding has severe clinical consequences for the mother and the fetus. We investigated the outcomes of hypogastric arterial ligation (HAL) before hysterectomy compared to hysterectomy alone in pregnant women with PAA.

MATERIALS AND METHODS

In this randomized controlled clinical trial, 70 patients were randomly allocated to HAL along with hysterectomy and hysterectomy alone groups (35 in each Group). The total amount of intraoperative blood loss, the need for intraoperative blood products transfusion, frequency of deep vein thrombosis, duration of surgery, duration of hospitalization, and visceral trauma were compared between 2 Groups.

RESULTS

Finally, 64 patients completed the study protocol with mean age of 33.84 ± 4.25 years. The study groups were comparable in terms of basic baseline demographic and clinical characteristics. Visceral trauma was less frequently occurred in HAL group compared to hysterectomy alone (0% vs. 15.6%; P = 0.02). Intraoperative blood loss (1525 ± 536.41 cc vs. 2075 ± 889.36 cc; P = 0.001) and were significantly lower in HAL group compared to hysterectomy alone. Duration of operation (179.06 ± 36.28 vs. 197.66 ± 39.47; P = 0.05) and hospitalization (4.97 ± 2.20 vs. 6.10 ± 2.39; P = 0.03) also were significantly lower in HAL group.

CONCLUSION

Our findings suggest that prophylactic HAL has a protective effect on the reduction of blood loss and less visceral trauma in pregnant women with PAA.

Predictive Value of Middle Cerebral Artery to Umbilical Artery Pulsatility Index Ratio for Neonatal Outcomes in Hypertensive Disorders of Pregnancy

Background

Hypertension may lead to notifying adverse perinatal events that should be diagnosed and managed precisely. This study aims to investigate the values of cerebroplacental ration for the prediction of adverse perinatal events in hypertensive disorders of pregnancy.

Materials and Methods

The current descriptive-comparative study has been conducted on 100 singleton pregnant women with the diagnosis of preeclampsia or pregnancy-induced hypertension. The Cerebroplacental ratio (CPR) was measured for the included population and divided into normal and abnormal ranges of >1 and ≤1. The adverse perinatal outcomes, including abnormal 5 min APGAR, low birth weight, perinatal death, neonatal intensive care unit (NICU) admission, academia, seizure, emergency cesarean delivery, and Tchirikov index as the general manifestation of adverse perinatal outcomes were compared between the groups. The specificity, sensitivity, positive predictive value, negative predictive value (NPV), and accuracy were measured for the adverse perinatal outcomes.

Results

The two groups were remarkably different in terms of 5 min APGAR, low birth weight, cesarean section delivery, and Tchirikov index (P < 0.05). The specificity of CPR for prediction of small-for-gestational age, poor APGAR, requirement of assisted respiration, academia, Tchirikov score and NICU admission was 93.1%, 93.1%, 67.1%, 91.8%, 71.2%, and 63%, and its sensitivity was 26%, 14.8%, 51.8%, 14.8%, 51.8%, and 37%, respectively.

Conclusion

CPR seems to be an appropriate means for the prediction of adverse perinatal outcomes with diversity in the prediction values of different determinants of adverse perinatal outcomes; however, in general, it had sensitivity, specificity, PP, NPV, and accuracy of 51.8%, 71.2%, 40%, 80%, and 66%, respectively.

Association between dietary inflammatory potential and risk of developing gestational diabetes: a prospective cohort study

Background

Limited and inconsistent data are available regarding the relationship between the dietary inflammatory potential (DIP) and risk of gestational diabetes mellitus (GDM).

Objective

The present prospective study aimed to evaluate the association between DIP score during the first trimester of pregnancy and risk of developing GDM among Iranian women.

Methods

In this prospective cohort study, 812 pregnant women aged 20–40 years, who were in their first trimester, were recruited and followed up until week 24–28 of gestation. Dietary intakes of study subjects were examined using an interviewer-administered validated 117-item semi-quantitative food frequency questionnaire (FFQ). DIP score was calculated from 29 available food parameters based on earlier literature. The results of a fasting plasma glucose concentration and a 50-g, 1-h oral glucose tolerance test, between the 24th and 28th week of gestation, were used to diagnose GDM. The risk of developing GDM across quartiles of DIP score was estimated using Cox regression in several models.

Results

At study baseline, mean (SD) age and BMI of study participants were 29.4 (±4.84) y and 25.14 (±4.08) kg/m², respectively. No significant association was found between DIP score and risk of GDM in the crude model (RR: 1.01; 95% CIs: 0.71–1.45). When we adjusted for age the association did not alter (RR: 1.04; 95% CIs: 0.72–1.48). Even after further adjustment for maternal weight gain we failed to find a significant association between DIP score and risk of GDM (RR: 0.97; 95% CIs: 0.66–1.41).

Conclusion

We found no significant association between DIP and risk of developing GDM. Further longitudinal studies among other populations are needed to elucidate the association between DIP score and GDM.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00705-5.

The association between dietary glycemic index and load and risk of gestational diabetes mellitus: A prospective study

AIMS

This study aimed to investigate the association between dietary GI and GL and risk of GDM in a group of pregnant women in Iran.

METHODS

A number of 812 pregnant women were recruited in their first trimester in a prospective study. A validated 117-item semi-quantitative food frequency questionnaire was used to assess usual dietary intakes of participants at study baseline. Dietary GI and GL were calculated based on earlier publications. GDM was diagnosed based on the results of a fasting plasma glucose concentration and a 50-g, 1-h oral glucose tolerance test at 24-28 weeks of gestation. Cox proportional hazards model was used to compute relative risks (RRs) and 95% confidence intervals (CI) for GDM.

RESULTS

Mean ± SD of age and BMI of study participants was 29.4 ± 4.84 y and 25.14 ± 4.08 kg/m², respectively at study baseline. Mean ± SD of dietary GI was 58 ± 7 and that of dietary GL was 176 ± 42. Overall, 28.4% (n = 231) of study population developed GDM at weeks 24-28 of pregnancy. After adjustment for potential confounding variables, we found that women in the highest tertile of dietary GL were 43% more likely to develop GDM than those in the lowest tertile (95% CI: 1.01, 2.00; P-trend = 0.03). However, no significant association was seen between dietary GI (RR for the highest tertile compared to the lowest: 0.85; 95% CI: 0.61, 1.20; P-trend = 0.37), and risk of GDM.

CONCLUSIONS

We found that women with the highest dietary GL were at a greater risk of developing GDM during pregnancy. No significant association was seen between dietary GI and risk of GDM.

Association of Maternal Serum Vitamin D Level with Risk of Pregnancy-Related Complications and Neonatal Anthropometric Measures: A Prospective Observational Study

Background

Body of evidence is increasing about the importance of Vitamin D (VD) for normal development of the fetus and for maternal health. As limited data are available regarding the association between maternal VD level and pregnancy-related complications and neonatal anthropometric measures, the present study aimed to evaluate the neonatal anthropometric measures including weight, high, and head circumference and pregnancy-related complications such as preeclampsia, blood pressure, gestational diabetes mellitus, and nausea and vomiting in pregnancy with 25(OH)VD level.

Methods

The current prospective observational study was conducted among 812 Iranian pregnant women during the first trimester in Isfahan, Iran. Needed data were collected using validated questionnaires and biochemical examinations.

Results

Overall, this study demonstrated an inverse significant association between VD level and chance of having low-weight infant in the adjusted model (odds ratio [OR]: 0.03, 95% confidence interval [CI]: 0.004-0.26, P < 0.001) in the first VD assessment. The same results were obtained in the second VD assessment (OR: 0.08, 95% CI: 0.01-0.40, P < 0.01). However, such associations were not seen about other neonatal measures and pregnancy-related complications.

Conclusions

We found that low maternal VD level might be associated with risk of low-weight infant. Such findings could be considered to implement informative interventional programs to control newborn adverse outcomes. Further studies are required to confirm these findings.

Evaluation of Changes in Levels of Hyperandrogenism, Hirsutism and Menstrual Regulation After a Period of Aquatic High Intensity Interval Training in Women with Polycystic Ovary Syndrome

Background

Polycystic ovary syndrome (PCOS) is a polygenic endocrine disorder in women of reproductive ages which will lead to infertility. This study is aimed to determine changes in levels of hyperandrogenism, hirsutism and menstrual regulation after a period of aquatic high intensity interval training (AHIIT) in women with PCOS.

Methods

Thirty patients with PCOS having age between 20 and 35 and body mass index (BMI) ≥30 kg/m² in obstetrics and gynaecology clinics in Isfahan were selected based on Rotterdam Diagnostic Criteria. They were randomly divided into experimental (AHIIT + metformin, N = 15) and control groups (metformin, N = 15). The exercises were done for 12 weeks, three sessions of 20 minutes. Metformin (1500 mg) was taken daily for 3 consecutive days for 12 weeks. Kolmogorov-Smirnov test, t-test, Covariance and Wilcoxon were applied (P value < 0.05).

Results

After 12 weeks, no significant difference was observed in waist-to-hip ratio (WHR), but in AHIIT, the BMI and fat mass significantly decreased and levels of follicle-stimulating hormone (FSH), free testosterone (FT) and sex hormone binding globulin (SHBG) increased compared to control group (P < 0.05). While levels of improvement of total testosterone (TT), dehydroepiandrosterone sulphate (DHEAS), FT, luteinising hormone (LH) and free androgen index (FAI) were not significant between the two groups (P > 0.05). Furthermore, there was a significant decrease in homeostatic assessment of insulin resistance (HOMA-IR) and hirsutism severity in experimental group (P < 0.05). In both groups, the order of menstrual cycles improved significantly (P < 0.05).

Conclusions

Doing AHIIT besides drug therapy can be effective for PCOS patients.

Association between major dietary patterns and polycystic ovary syndrome: evidence from a case-control study

Polycystic ovary syndrome (PCOS) is a multifactorial endocrine disorder in women. Change in lifestyle, especially dietary pattern, might have a role in the prevalence of PCOS. The limited number of studies has made it difficult to draw any conclusion about the relationship of dietary patterns with PCOS. This study aimed to investigate the association between dietary patterns and PCOS. A case-control study was performed on 225 patients newly diagnosed with PCOS and 345 healthy women in Isfahan, Iran. The presence of PCOS was confirmed by expert gynecologists based on Rotterdam criteria. Usual dietary intake was assessed by a 168-item food frequency questionnaire. Dietary patterns were identified by principal component analysis. Three major dietary patterns including Western, plant-based, and mixed were identified that explained 53.93% of the variance in food intake. The top tertile of the Western dietary pattern significantly increased the odds of PCOS (odds ratio (OR), 2.03; 95% confidence interval (CI), 1.12–3.67), both before and after adjustments for covariates. After adjustments for potential confounders, the highest tertile of the plant-based dietary pattern was related to higher odds of PCOS than the lowest tertile (OR, 2.32; 95% CI, 1.23–4.37). In addition, those in the second tertile of the mixed dietary pattern were 66% less likely to have PCOS compared with those in the lowest tertile (OR, 0.34; 95% CI, 0.18–0.61). In conclusion, we found that Western and plant-based dietary patterns were associated with an increased risk of PCOS. Also, moderate adherence to the mixed dietary pattern was associated with a reduced risk of PCOS. Additional studies with a longitudinal design are required to confirm our findings.

The Association Between Major Dietary Patterns and Pregnancy-related Complications

BACKGROUND

Most pregnancy-related complications are associated with increased risks of adverse outcomes for mother and her infant. Although, relations between diet and pregnancy's complications indicate that there may be some benefits of nutritional factors to prevent such disorders, there are rare studies regarding the associations of dietary patterns and mentioned complications. So, the aim of the present study was to determine the relationship between dietary patterns and risk of pregnancy-related complications.

METHODS

The current prospective observational study was based on the data collected from 812 pregnant women. Dietary data was collected using a validated semi-quantitative food frequency questionnaire.

RESULTS

Three major dietary patterns identified according to the results from the factor loading matrix were: (i) 'western dietary pattern'; (ii) 'traditional dietary pattern'; (iii) 'healthy dietary pattern'. Overall, this study demonstrated a marginal significant inverse association between high adherence to healthy dietary pattern and chance of having pre-eclampsia. Also, a high chance of pre-eclampsia was observed among women with the most adherence to western dietary pattern.

CONCLUSION

We found that dietary patterns might be associated with the risk of pregnancy-related complications. Further studies are required to confirm these findings.

Comparison of risk factors and pregnancy outcomes of gestational diabetes mellitus diagnosed during early and late pregnancy

OBJECTIVE

To compare risk factors and pregnancy outcomes of gestational diabetes mellitus (GDM) diagnosed during early and late pregnancy.

DESIGN

Prospective population-based cohort study.

SETTING

Community health care centers of Isfahan, Iran.

PARTICIPANTS AND MEASUREMENTS

1000 pregnant women who were eligible and consented to participate underwent fasting plasma glucose testing at the first prenatal visit (6-14 weeks). The women free from GDM or overt diabetes were screened at 24-28 weeks of gestation using a 75-g, 2-hour oral glucose tolerance test. The diagnosis of GDM was reached through the International Association of the Diabetes and Pregnancy Study Groups. Early-onset GDM was defined as the diagnosis of GDM at the first prenatal visit. Late-onset GDM was defined as the diagnosis of GDM later at 24-28 weeks.

FINDINGS

Prevalence of GDM was 10% (95% CI: 8.1-11.9) at the first prenatal visit. GDM incidence was 9.3% (95% CI: 7.4-11.2) at 24-28 weeks of gestation. Family history of diabetes, and previous gestational diabetes and maternal age were the independent risk factors for GDM during early and late diagnosis. GDM was associated with increased risk of macrosomia, large for gestational age, and cesarean section in both periods while, neonates of women with early-onset GDM were more likely to have an apgar score at 1-min < 7, and neonatal respiratory distress syndrome and were more admitted to the neonatal intensive care unit.

KEY CONCLUSION AND IMPLICATION FOR PRACTICE

Despite early screening and current practice management, early-onset GDM was associated with poorer pregnancy outcomes compared to the late-onset group. Women with early-onset GDM would benefit from more strict surveillance and management strategies to improve pregnancy outcomes. Further studies are needed to evaluate the efficacy of alternative management approaches in these high risk women.

Comparative study on the influence of three delivery positions on pain intensity during the second stage of labor

BACKGROUND

Labor is a physiologic process, and consideration of labor pain and relieving that is among the major components of maternal care. Application of some labor position can lay the fetus better in pelvic canal direction. The present study aimed to investigate the effect of laying the mother in three labor positions on the pain severity in the second, third, and fourth stages of labor.

MATERIALS AND METHODS

This is a clinical trial conducted on 96 primiparous pregnant women randomly selected through convenient sampling from those who were hospitalized in the hospitals of Isfahan and Jahrom. Women with a gestational age of 37-42 weeks, singleton pregnancy, who had passed the first labor stage through physiologic process, and with cephalic presentation were selected. The subjects were randomly allocated to be in the groups of lithotomy, sitting, and squatting positions. Pain severity in the second, third, and fourth labor stages was measured with visual analog scale (VAS) as well as McGill present pain intensity (PPI). The data were collected through interviews and observations with the help of VAS. The data were analyzed by Chi-square and Kruskal-Wallis statistical tests.

RESULTS

In the latent phase of the second labor stage, mean pain severity in lithotomy (2.27) and squatting positions (2.48) was significantly less than the mean pain severity in sitting (5.33) position (P = 0.001). Pain severity in the active phase of the second and third labor stages was significantly less in squatting position (6.14) group compared to the other two groups (7.59 and 7.41 in sitting and lithotomy positions, respectively) (P = 0.024). Pain severity in the fourth labor stage showed no significant difference in all three groups.

CONCLUSIONS

Application of various labor positions as one of the non-medicational methods to reduce pain in the second and third stages of labor leads to labor pain reduction.

Comparison of CRP and ALK-P serum levels in prediction of preterm delivery

Background:

Preterm birth, defined as birth occurring before 37 weeks of gestation, is a common complication of pregnancy and may lead to death or long-term disability in newborns. Accurate diagnosis is, therefore, crucial for identifying those women undergoing preterm labor who are at greatest risk of preterm delivery. This may allow transport to a regional obstetrical center and permit time for corticosteroid therapy. Recent study recommends several markers such as CRP (C-reactive protein) and ALK-P (alkaline phosphatase) to predict preterm delivery.

Materials and Methods:

We select a total of 300 pregnant women that had symptoms of premature birth. All of them were under treatment with tocolytic and serum sample were taken to assess the level of CRP-ALKp. Cervix length and the time of response to tocolytic were measured. 110 pregnant of them had preterm labor. 110 patient that had a term labor selected as a control group.

Results:

Qualitative evaluation of efficacy CRP level on preterm delivery showed a significant relationship with 27 as a cut of point of CRP (P < 0.00001 –OR = 7.5). Investigate of effect of ALK-P level on preterm delivery refers to a significant relationship with 399 as a cut of point of ALKP (P < 0.00001 –OR = 5). Inquire of efficacy of CRP level and ALK-P level on preterm delivery demonstrate a significant relationship (P < 0.0001 1OR = 9).

Conclusions:

Maternal concentrations of CRP and ALKP and cervix length can be used as appropriate biomarker for predicting preterm labor and response to tocolytic therapy in pregnant women.

Maternal plasma nitric oxide metabolites and cervical length assessment in predicting the tocolytic therapy in preterm labor in Isfahan

Background:

Preterm labor (PTL) is the main challenge in prenatal health care, leads to high rate of mortality and increases cost of health services. To evaluate the preterm delivery (PTD)-related risk factors, we decided to measure nitrite oxide metabolites and cervical length (CL) as the diagnostic and predictive tools for PTD in women and response to tocolytic therapy.

Materials and Methods:

In this case–control study, sixty women of 18–35 years with first pregnancy during the 24–34 gestational weeks with PTL in case group admitted to the delivery section of Beheshti Hospital, Isfahan, Iran were included. Sixty women in control group have the same specifications. NO and CL level were assessed, and the collected data were analyzed by SPSS software, version 20 and MedCalc software, version 15.1.

Results:

The two groups were similar regarding maternal and gestational age (P > 0.05). Lower level of NO was observed in PTL women with a mean of 35.30 ± 8.27 μmol/L compared to the normal gestation group with a mean of 39.05 ± 10.17 μmol/L (P = 0.035). In addition, the diagnostic accuracy of both PTL-predicting factors was determined (NO ≤31, sensitivity 99.7%, specificity 82.5% and CL ≤22, sensitivity 80%, specificity 99.9%).

Conclusion:

As the previous investigations stated, it can be claimed that NO might be the reliable marker for predicting the PTL, and administration of NO synthesis could be a candidate for the future therapeutic target.

Improved Assay for Quantifying a Redox Form of Angiotensinogen as a Biomarker for Pre-Eclampsia: A Case-Control Study

Objective

Angiotensinogen exists in two distinct redox forms in plasma, the oxidized sulfhydryl-bridge form and the reduced, unbridged, free thiol form. The oxidized form of angiotensinogen compared to the free thiol form preferentially interacts with renin resulting in increased generation of angiotensin. The predictive potential of the ratio of free-thiol to oxidized angiotensinogen in the plasma for pre-eclampsia was first suggested by the Read group in ref 10. We propose an improved method for determining the ratio and validate the method in a larger cohort of pregnant women.

Methods

Plasma samples from 115 individuals with pre-eclampsia and from 55 healthy pregnant control subjects were collected sequentially over a 2 year period. Using two distinct enzyme-linked immunosorbent assays (ELISAs) the plasma levels of total and free thiol angiotensinogen were quantified. The oxidized angiotensinogen plasma level is derived by subtracting the level of free thiol, reduced angiotensinogen from the total angiotensinogen levels in the plasma.

Results

The relative proportion of free thiol angiotensinogen, expressed as a percentage of that observed with an in-house standard, is significantly decreased in pre-eclamptic patients (70.85% ± 29.49%) (mean ± SD) as compared to healthy pregnant controls (92.98 ± 24.93%) (mean ± SD) p ≤ 0.0001. The levels of total angiotensinogen did not differ between the two groups.

Conclusion

Patients with pre-eclampsia had substantially lower levels of free thiol angiotensinogen compared to healthy pregnant controls, whilst maintaining similar total angiotensinogen levels in the plasma. Hence, elevated levels of plasma oxidized angiotensinogen may be a contributing factor to hypertension in the setting of pre-eclampsia.

Effect of auriculotherapy on menstrual irregularities in single girls with polycystic ovarian syndrome and aged 18-35 years in Isfahan in 2012

BACKGROUND

Polycystic ovarian syndrome is one of the most common endocrine disorders with a prevalence of 5-10% in women. This syndrome is one of the major causes for menstrual disorders and is treated by medicational and non-medicational methods. This study aimed to define the effect of auriculotherapy on menstruation disorders in girls with polycystic ovarian syndrome.

MATERIALS AND METHODS

This is a clinical trial conducted on 60 single girls aged 18-35 years with clinical, laboratory, and sonography signs. The subjects were randomly assigned to two groups of auriculotherapy and medication, which underwent treatment for 2 and 3 months, respectively. Clinical signs were investigated in three steps in both groups. Data were collected through observation, laboratory tests, and sonography, and were analyzed by SPSS version 15.

RESULTS

In 60 subjects, Chi-square test showed a significant difference in menstruation disorders in both groups 1 month after the start of intervention (P = 0.001); but 2 months after the start of intervention (P = 0.11) and immediately after the end of the intervention (P = 0.16), the difference was not significant. Three months after the end of the intervention, this variable showed a significant difference (P = 0.02).

CONCLUSIONS

Medicational treatment and auriculotherapy are both effective on menstruation disorders, but auriculotherapy is more effective on reduction of menstruation disorders, compared to medicational therapy.

Effect of the presence of support person and routine intervention for women during childbirth in Isfahan, Iran: A randomized controlled trial

Background:

The aim of this study was to examine the effects of the presence of continuous support person and routine interventions during labor and delivery in Isfahan, Iran.

Materials and Methods:

One hundred pregnant women in spontaneous labor were assessed in four groups: Group 1; received routine intervention with a support person, Group 2; received routine intervention without support person, Group 3; received support person without routine intervention, Group 4; did not receive routine intervention or a support person. Sociodemographic, antenatal characteristics, length of stage of labor, instrumental delivery, the cervical laceration, perineal tear, labor pain, satisfaction and Apgar score collected and analyzed.

Results:

Based on the results there was no significant difference in regard to maternal age, BMI, maternal education and working statutes among the studied groups (P-value >0.05). Also, 1 and 5-min Apgar <7, cervical lacerations and instrumental delivery among studied groups were similar (P-value >0.05). Length of first and second stage of labor, perineal tear, satisfaction score and pain before and after labor were significant among studied groups (P-value <0.05).

Conclusions:

Presence of a support person and routine intervention during labor did not effect on incidence of cervical lacerations, instrumental delivery and Apgar <7. Labor pain and women's dissatisfaction, and number women with third and fourth degree of perineal tear among women who received routine intervention were increased compare to others. Interventions makes decreased the length of first and second stage of labor. In totally, the presence of a support person during labor in Iranian women decrease length of labor and improved labor outcomes.

The use of maternal C-reactive protein in the predicting of preterm labor and tocolytic therapy in preterm labor women

Background:

Levels of a number of some biomarkers have been associated with spontaneous preterm birth. This study was aimed to evaluate the relation between C-reactive protein (CRP) with preterm labor and response to tocolytic therapy.

Materials and Methods:

Seventy five pregnant women with symptoms of preterm labor (cases) in compare with 75 term women (controls) were enrolled. Baseline data and CRP was recorded. So, cases were under treatment tocolysis with the use of magnesium sulfate, and then they were followed till delivery time to assess the response to the treatment.

Results:

Sixteen patients with symptoms of preterm labor did not response to the treatment and delivered prematurely and 59 women response to tocolytic treatment and delivered at term. The curve constructed cut-off value for >3.6 (AUC, 0.683; SE, 0.041; P < 0.0001) for CRP, indicating a significant relationship with preterm labor. Also, there was significant relationship between CRP level with response to the treatment in cut-off >1.8 (AUC, 0.738; SE, 0.076; P = 0.001) for CRP.

Conclusions:

Maternal concentrations of CRP can be used as appropriate biomarker for predicting preterm labor and response to tocolytic therapy in pregnant women.

Maternal serum interleukin 6 and 8 and C-reactive protein in predicting the tocolytic therapy in preterm labor

BACKGROUND

This study aimed to evaluate the relation between C-reactive protein (CRP), interleukin (IL) 6 and 8 with the response to tocolytic therapy.

MATERIALS AND METHODS

A total of 75 singleton pregnant women between 18 and 35 years old, and with symptoms of preterm labor were hospitalized in "Shahid Beheshti" hospital in Isfahan, Iran. Tocolysis in patients was performed first with infusion of 4 g of magnesium sulfate 20% and then 2 g per hour continued. Next, they were followed till delivery time to assess the response to the treatment. Baseline data and serum levels of IL-6 and IL-8 and CRP were all recorded.

RESULTS

A total of 16 patients with symptoms of preterm labor did not respond to the treatment and delivered prematurely and 59 women responded to tocolytic treatment and delivered at term. There was a significant relationship between serum IL-6, IL-8 and CRP levels with response to the treatment in cut-off > 45 for IL-6 [area under the curve [(AUC), 0.894; SE, 0.042; P-value < 0.0001, >171 for IL-8 (AUC, 0.864; SE, 0.059; P-value < 0.0001)] and >1.8 for CRP (AUC, 0.738; SE, 0.076; P-value = 0.001). Also, pairwise comparison of receiver operating characteristic curves between CRP, IL-6, and IL-8 showed that there were no significant differences between areas for IL-6 with IL-8 (P-value = 0.46); IL-6 with CRP (P-value = 0.086); and IL-8 with CRP (P-value = 0.18).

CONCLUSION

Maternal serum concentrations of IL-6 and IL-8 and CRP can be used as appropriate biomarkers for predicting the response to tocolytic therapy in pregnant women and there were no significant differences between these markers in predicting tocolytic therapy.

The Relationship between Intake of Dairy Products and Polycystic Ovary Syndrome in Women Who Referred to Isfahan University of Medical Science Clinics in 2013

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive women. Nearly 10% of young women in this period involved. Although factors such as Insulin Resistance, hyper insulinemia, obesity and dietary are suggested to be associated with PCOS, cause of PCOS is not completely understood. Dairy products (a key component of the usual diet) of participants can also affect the factors of this disease and may have beneficial effects on treatment of PCOS. However, research in this area is scarce. The purpose of this study was to evaluate the relationship between dairy products consumption and PCOS.

METHODS

This descriptive cross-sectional study of 400 women was conducted in Shahid Beheshti Hospital of Isfahan University of Medical Science, Iran. Dietary intake was evaluated by validated food frequency questionnaire. Other variables such as ovarian disease, inherited predisposition, age at menarche, physical activity and history of other diseases were evaluated using questionnaire. Data analysis was performed by a logistic regression test using SPSS software version 15 Predictive analytics software and solutions.

RESULTS

There were a significant association between PCOS and ovarian disease (P < 0.001), age (P < 0.001) and using medication (P = 0.001). Body mass index (BMI) was inversely associated with PCOS, but it was not significant (P = 0.068). There was a significant direct relationship between milk consumption and risk of PCOS after adjusting for confounding factors (P = 0.028).

CONCLUSIONS

The findings of this study indicated that ovarian disease and medication use is directly linked to PCOS. Dairy consumption was not significantly correlated with PCOS. However, after adjustment for confounders, there was an direct relationship between milk consumption and risk of PCOS.

Maternal serum cytokines in the prediction of preterm labor and response to tocolytic therapy in preterm labor women

Background:

One of the most important challenges in health care system is prevention of preterm birth. The present study was aimed to investigate the relation between interleukins 6 and 8 (IL-6 and IL-8) with preterm labor and response to tocolytic therapy.

Materials and Methods:

In the year 2012, 75 women with the symptoms of preterm labor (cases) in compare with 75 term women (controls) were randomly selected and evaluated. Baseline data and serum levels of IL-6 and IL-8 (using immunoassay method) recorded. Hence, tocolysis in women in case group was performed with the use of magnesium sulfate and then they were followed until delivery time to assess the response to treatment.

Results:

In case group, 59 women response to tocolytic treatment and delivered at term but 16 of them delivered prematurely. The curve constructed cut-off value for IL-6 was >37.9 (area under the curve [AUC], 0.674; standard error [SE], 0.043; P < 0.0001), and > 9.5 for IL-8 (AUC, 0.773; SE, 0.038; P < 0.0001), indicating a significant relationship with preterm labor. Furthermore, there was a significant relationship between serum IL-6 and IL-8 levels with the response to the treatment in cut-off >45 for IL-6 (AUC, 0.894; SE, 0.042; P < 0.0001) and >171 for IL-8 (AUC, 0.864; SE, 0.059; P < 0.0001).

Conclusion:

In summary, our results suggest that the assessment of maternal serum concentrations of IL-6 and IL-8 can be used as appropriate biomarkers for predicting preterm labor and response to tocolytic therapy in these women. However, further studies needs to be done.

Nutritional status in patients with ulcerative colitis in Isfahan, Iran

Background:

Malnutrition is common among patients with inflammatory bowel disease. The present study aimed to investigate the nutritional status of ulcerative colitis (UC) patients in Isfahan, Iran.

Materials and Methods:

In this descriptive analytical cross-sectional study, between Dec 2011 and Jun 2012, 99 patients with UC were randomly selected and evaluated. Age, sex, duration of disease, body mass index (BMI) and laboratory parameters recorded for all patients. Nutritional risk index (NRI) was calculated and its association with patients’ variables was assessed with regard to UC disease severity.

Results:

Twelve patients out of 99 patients had mild UC and 87 patients had moderate to severe UC. Based on the NRI, 90.9% were not malnourished and 9.1% were at moderate to severe risk for malnutrition. Among laboratory parameters only, serum potassium level in patients with moderate to severe UC was significantly higher than those with mild UC (P = 0.017). Other laboratory parameters were similar between patients stratified by US status. Patients age s significantly correlate with serum vitamin D, immunoglobulin a (IgA) and potassium level (P > 0.05), also duration of disease was significantly correlate with Phosphorus (P = 0.024) among laboratory parameters.

Conclusion:

In studied UC patients, malnutrition risk was based on degree of disease severity. Patients with moderate to severe UC were more at risk for malnutrition compared to the patients with mild UC. Furthermore, among laboratory parameters only serum potassium level was higher among patients with moderate to severe UC compared to others.

Prevalence and risk factors of hepatitis B and C viruses among hemodialysis patients in Isfahan, Iran

BACKGROUND

The aim of this study was to assess the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) and their associated risk factors among hemodialysis patients in Isfahan, Iran in 2011.

MATERIALS AND METHODS

In this cross-sectional study, a total of 499 chronic hemodialysis patients from eight governmental hemodialysis centers were tested. Demographic information, time duration on hemodialysis, history of blood transfusion, and the number of transfused blood units as risk factors to HBV and HCV infections were calculated. The status of HBsAg and anti-HCV was assessed by serological testing.

RESULTS

The overall prevalence of HBV-positive and HCV-positive among study population was 1.2% and 5.2%, respectively. Age, sex, and time duration on hemodialysis were not statistically significant in HBV- and HCV-patients compared with other hemodialysis patients (P > 0.05). History of blood transfusion and the number of transfused blood units in HBV infected patients were similar to other patients (P > 0.05). The main risk factors in hemodialysis patients infected by HCV were history of blood transfusion and the number of transfused blood units (P < 0.0001).

CONCLUSION

In conclusion, the prevalence of HBV and HCV infections in hemodialysis centers in Isfahan is lower than in some other cities of Iran. History of blood transfusion and the number of blood units transfused might be a risk factor for HCV gaining. However, further studies are needed to assess the role of other demographic and clinical risk factors in these patients.

Comparison of remifentanil: Entonox with Entonox alone in labor analgesia

Background:

We designed a study to evaluate the effectiveness of continuous low dose infusion of remifentanil adding to self-administration of entonox administered for pain relief during the active phase of first stage of labor.

Materials and Methods:

Thirty healthy term pregnant women recruited in our randomized double-blind, cross over study. They received the study medicines during two 30-min periods with a 15-min wash-out sequence after each period. Fifteen parturient used remifentanil as a single bolus dose followed by constant low dose infusion and self-administration of entonox (group R) during the first period and entonox and saline (group P) during the second period, while the remainder of the parturient used the drugs in a reverse order. Pain and Ramsay score, maternal and fetal hemodynamic, and ventilation were assessed during each intervention.

Results:

In this study, mean pain severity scores were 8 ± 0.9 before and 5.4 ± 1.7 after intervention in group P, and 7.8 ± 0.1, 3.5 ± 1.3 in group R, respectively. Mean pain severity difference was 2.6 ± 1.5 in group P, while 4.3 ± 1.5 in group R; so, use of entonox and remifentanil can decrease labor pain two times more in comparison with entonox/placebo (normal saline). However, hemodynamic and ventilation parameter in remifentanil/entonox period were same as in entonox/placebo period. No statistical differences were seen in mean Ramsay score between group R and P. There was no episode of maternal bradycardia, hypotension, or hypoxemia.

Conclusion:

Not only adding low dose infusion of remifentanil to self-administration of entonox was notable in labor pain reduction, it did n’t make more parturient and neonatal side-effects.

The estimation of direct medical costs of treating patients with chronic hepatitis B and C in iran

BACKGROUND

The objective of this study is to estimate the average diagnosis and treatment costs of chronic hepatitis B and C, with respect to different therapeutic strategies in Iran.

METHODS

This is a descriptive, analytical, and cross-sectional study carried out on patients with hepatitis B and C, who were referred to the Liver Disease Research Center for Prevention and Treatment of Hepatitis, Isfahan University of Medical Sciences, in 2011. We have estimated the direct medical costs including doctors' fees, cost of para-clinical tests, medical treatments, and liver biopsy, in different treatment strategies.

FINDINGS

The results of this study showed that the total cost of diagnostic services for hepatitis B virus (HBV) and hepatitis C virus (HCV) patients, with state medical tariffs, was US$ 1499.07 and US$ 2084.89, respectively. The patients' profiles showed that there were currently seven therapeutic strategies available to treat HBV patients. The total cost of treatment strategies varied significantly from US$ 73 to US$ 8256. There were also four main strategies for HCV patients, each of these could be applied in two periods of time. The total cost of these treatment strategies showed a high discrepancy from US$ 242 to US$ 8256.

CONCLUSION

The results confirmed that the total direct medical cost for an HBV patient in Iran exceeded US$ 5.5 Milliard in 2011. The results implied that the market price of direct medical cost of HBV and HCV patients in Iran is much higher than the estimated state costs. These costs would likely be saved or reduced by effective disease management and early prevention.

Crown-rump length discordance in twins in the first trimester and its correlation with perinatal complications

BACKGROUND

A difference more than 15-40% in birth weight of twins can predict perinatal complications. As significant difference in twins growth has a very important effect on pregnancy and perinatal complications, this study aimed to evaluate crown-rump length discordance (ΔCRL) in the first trimester of pregnancy and its correlation with perinatal complications.

METHODS

A total number of 118 women in the first trimester of twin pregnancy underwent ultrasound examination to measure ΔCRL. Then, at the time of delivery, perinatal complications in twins were recorded and the correlation between ΔCRL and perinatal complications were evaluated.

RESULTS

Among 118 studied mothers with twin pregnancy, ΔCRL was normal (< 11%) in 96 cases (81.4%) and high (≥ 11%) in 22 cases (18.6%). Birth weight discordance was normal (< 20%) in 103 cases (87.3%) and above normal (≥ 20%) in 15 cases (12.7%). The results revealed a significant correlation between higher frequency of small for gestational age (SGA) and high ΔCRL (more than 11%) (p = 0.01).

CONCLUSIONS

Our study concluded that SGA has a significant relationship with high ΔCRL (> 11%).

Effects of silybum marianum on patients with chronic hepatitis C

BACKGROUND

Silymarin derived from silybum marianum (milk thistle), a flowering member of the daisy family, may benefit liver function in people infected with the hepatitis C virus. The aims of this pilot study were to assess the efficacy and safety of silymarin on serum hepatitis C virus (HCV) RNA, serum aminotransferases (ALT, AST) levels, liver fibrosis and well-being in patients with chronic hepatitis C (CHC).

METHODS

This prospective self-controlled trial study was conducted from March to September 2006 at Department of Gastroenterology, Isfahan University of Medical Sciences, Isfahan, Iran. 55 patients with HCV (10 female and 45 male) with a mean age of 31.8 ± 6.4 years (10-67 years) were participated in the study. Patients received 24 weeks of silymarin (630 mg/day). Baseline virological biochemical, liver fibrosis (by a serum fibrosis markers, including YKL-40 and Hyaluronic acid), and SF-36 questionnaire were performed with biochemical tests repeated at the end of the treatment period.

RESULTS

There was statistically difference in mean of ALT (108.7 ± 86.6 vs 70.3 ± 57.7) before and after the treatment (p < 0.001). The means of AST were 99.4 ± 139.7 and 59.7 ± 64.32 before and after the treatment with statistically differences (p = 0.004). After the treatment, nine patients were found with negative HCV-RNA (p = 0.004) and statistically significant improvement in results of liver fibrosis markers were found only in fibrosis group (p = 0.015). Quality of life was improved significantly (p < 0.001).

CONCLUSIONS

This study indicated that in patients with CHC performing silymarin (650 mg/day) for 6 months, improved serum HCV-RNA titer, serum aminotransferases (ALT, AST), hepatic fibrosis and patient's quality of life. More future studies are warranted.

The comparative examination of the effect of two oxytocin administration methods of labor induction on labor duration stages

BACKGROUND

Oxytocin is the most consumed medication in modern midwifery. The consumption of oxytocin in inducing and strengthening delivery in delivery wards requires an efficient method for making use of this medication with maximum effect and minimum side effects. In this regard, this study has been conducted aiming at comparing the effect of two methods of prescribing oxytocin in inducing delivery on the duration of stages.

METHODS

The present study is of a clinical trial kind with three-blinded parties which was conducted in 2010 on 120 research volunteers who had the inclusion criteria. The samples were randomly assigned into two groups of control and experiment. The data collection means consisted of a questionnaire and a checklist. In order to analyze the data, the SPSS software, version 17, Student T-test and Chi-square test were used.

RESULTS

There was no statistically significant difference between two groups regarding the duration of the first and the first stages and the active phase. The duration of the third stage of delivery was shorter than the group which had stopped using oxytocin at the active phase. There has been no significant difference between the mean of oxytocin dosage from the initiation of the delivery induction till the active phase. The mean of oxytocin dosage has been significantly different between two groups during all stages of delivery so much so that this rate has been lower in the experiment group.

CONCLUSIONS

The results of the data analysis show that the continuation of oxytocin after the active phase not only does not have any advantage regarding the shortening of duration of stages and its cutting but also it leads to a decrease in the consumption dosage of oxytocin in the active phase and the second stage of delivery and on the other hand leads to a decrease in the side effects of the medication on mother and infant.