Narges Sheikhansari

Relationship between pre-pregnancy maternal BMI with spontaneous preterm delivery and birth weight

Abstract The aim of the present study was to find the relationship between pre-pregnancy maternal body mass index (BMI) with spontaneous preterm delivery and birth weight. A prospective cohort study was performed on 576 pregnant women. Maternal BMI was determined at the first prenatal visit between 8–12 weeks’ gestation and considered as the pre-pregnancy maternal weight. The women were then monitored up to delivery. Out of 576 women, 396 completed the study. The demographics of the women in all BMI groups did not differ with regard to age, height, history of abortion and employment. A total of 21 women (5.3%) were underweight; 198 women (50%) were normal weight; 117 women (29.5%) were overweight and 60 (15.2%) were obese. There were no cases of morbidly obese (BMI > 40 kg/m2) women. Obesity in women had a positive correlation with higher gestational age at the time of delivery (r = 0.213, p = 0.015) and a heavier birth weight (r = 0.361, p = 0.008). Low birth weight had a correlation with low maternal BMI (r = 0.157, p = 0.041). Macrosomia was greater in obese women (p = 0.022) and BMI had a positive correlation with macrosomia (r = 0.224, p = 0.034). Preterm delivery showed a negative correlation with maternal BMI (r = –0.124, p = 0.004) and the women with a lower BMI had a greater number of preterm deliveries (p = 0.035).

A comparison between the effects of ginger, pyridoxine (vitamin B6) and placebo for the treatment of the first trimester nausea and vomiting of pregnancy (NVP)

Abstract Introduction: Nausea and vomiting of pregnancy (NVP) are one of the most common complains of the early pregnancy period and are bothersome for pregnant women. Some prefer to use herbal medicine instead of chemical agents. Objective: The purpose of the present study was to compare the effects of ginger, pyridoxine (vitamin B6), and placebo for the treatment of NVP. Method: The study was performed as a triple blind clinical trial on pregnant women suffering mild to moderate NVP between 6 and 16 weeks of pregnancy. In these women ginger, 500 mg twice daily, vitamin B6 40 mg twice daily and placebo twice daily were administered for 4 d. Rhodes questionnaire was used for evaluation of the severity of symptoms. The severity of NVP was evaluated 24 h before entering the study and up to 4 d after using medications and results were compared among the three groups. Results: Seventy-seven women finished the study (28 in the Ginger group, 26 in the B6 group, and 23 in the placebo group). The women of the three groups did not have significant differences according to age, gestational age, parity, and severity of each symptom before treatment and educational status. Total score of Rhodes questionnaire for nausea was decreased significantly in three groups after treatment. (p < .001, p = .012, and p = .03 for ginger, vitamin B6, and placebo, respectively.) Also total score of Rhodes questionnaire for vomiting was decreased in three groups (p = .03 for ginger, p = .02 for B6, and p = .04 for placebo). Ginger and vitamin B6 could reduce the severity of all items of Rhodes questionnaire significantly; however, placebo was significantly effective only on the frequency of nausea, intensity of vomiting and frequency of retching. Ginger and vitamin B6 were more effective than placebo (p = .039 and p = .007, respectively); however, total score of Rhodes did not show significant difference between ginger and vitamin B6 (p = .128). Ginger was more effective for nausea (intensity and distress) and distress of vomit. Conclusion: Ginger is more effective than placebo for the treatment of mild to moderate NVP and is comparable with vitamin B6. Trial registration number and registry website: IRCT2015020320923N1

Evaluation of the value of the first and third trimester maternal mean platelet volume (MPV) for prediction of pre-eclampsia.

INTRODUCTION Pre-eclampsia is one of the most serious complications of pregnancy and one of the major causes of maternal mortality. Thus its prediction is a matter for serious concern. OBJECTIVE The purpose of the present study is to determine the value of mean platelet volume (MPV) measurement in the first and third trimesters of pregnancy for the prediction of pre-eclampsia. METHOD A prospective nested case-control study was performed on pregnant women who were at 9-12weeks of pregnancy. In the first trimester and again in 26-28weeks, MPV was calculated. All eligible women were then monitored to delivery and the MPV of women who were pre-eclamptic was compared with the MPV of normotensive women. RESULTS Pre-eclamptic women were compared with 269 normotensive women. MPV at the first trimester of pre-eclamptic women was significantly higher than normotensive women (10.2±1.06fl VS 9.68±1.09fl, P=0.008). Also, MPV at the third trimester of pregnancy of pre-eclamptic women was more than normotensives (10.16±1.23fl VS 9.62±1.12fl, P=0.009). Area under the curve in receiver operating characteristics (ROC) curve was calculated as 0.64 for the predictive value of MPV at the first and third trimesters of pregnancy, which showed a low value of this test for predicting of pre-eclampsia. CONCLUSION MPV at the first and third trimesters of pregnancy are higher in women who eventually would be pre-eclamptic, but has low predictive value and is not a good predictor of pre-eclampsia.

A comparison between the effects of metformin and N-acetyl cysteine (NAC) on some metabolic and endocrine characteristics of women with polycystic ovary syndrome.

Abstract Objective: To compare N-acetyl cysteine (NAC) and metformin on polycystic ovary syndrome (PCOS). Method: Study was performed as a randomized double-blind clinical trial on women with diagnosis of PCOS without additional complications. In one group, oral NAC 600 mg, three times a day and in the other group, 500 mg oral metformin, three times a day were prescribed. Duration of treatment was 24 weeks, and after finishing this period of treatment, fasting blood glucose (FBS) and insulin, lipid profile and Homeostasis Model Assessment (HOMA) index were measured (all the blood samples were taken while fasting) and were compared in the two groups. Results: Forty-six women in NAC group and 48 women in metformin group finished the study. The two groups did not show significant difference according to age, body mass index (BMI) of more than 30; mean BMI, AUB, FBS, fasting blood insulin, lipid profile and HOMA index before treatment. After 24 weeks of treatment; BMI >30 [17 (35.4%) versus 7 (15.2%), p = 0.033], mean BMI [(28.36 ± 2.27) versus (27.11 ± 3.55), p = 0.44], number of women with the complain of abnormal uterine bleeding (AUB) [24 (50%) versus 13 (28.3%), p = 0.037], FBS [(90.02 ± 6.24) versus (86.61 ± 7.81), p = 0.021], fasting insulin (10.40 ± 2.64 versus 8.89 ± 2.20, p = 0.004), HOMA Index (2.09 ± 0.69 versus 1.71 ± 0.45, p = 0.001), low density lipoprotein (LDL) (141.83 ± 26.98 versus 127.89 ± 28.70, p = 0.017) were less in NAC group. Triglyceride (TG) and total cholesterol did not show significant difference between the two groups after treatment. High-density lipoprotein (HDL) was higher in NAC group. Conclusion: NAC can improve lipid profile and fasting blood sugar (FBS) and fasting blood insulin better than metformin.

Evaluation of the effects of cabergoline (Dostinex) on women with symptomatic myomatous uterus: a randomized trial ☆

OBJECTIVE Myoma is one of the most common benign tumors of uterus and one of the most common causes of vaginal bleeding in women. The purpose of the present study is to evaluate the effect of dopamine receptor agonist cabergoline on the size of myoma and the amount of bleeding in the women with myoma of the uterus. STUDY DESIGN The study was performed as a single blind randomized clinical trial on the women with symptomatic myoma. The women were randomly assigned in 2 groups. In the case group, 0.5mg cabergoline was prescribed weekly for three months, and in the control group, nothing was prescribed and the women only had close observation for symptoms. The reduction in symptoms including pelvic pain and duration and amount of uterine bleeding, and the size of myoma, were compared between the 2 groups. RESULTS 51 women finished the study (26 women in the case group and 25 women in the control group). There was no significant difference between the 2 groups according to age, gravidity, parity, history of abortion, having living children, pretreatment hemoglobin, pain and amount of uterine bleeding, uterine size, and the size of myoma. After treatment, hemoglobin levels had dropped in the control group but not in the case group (p=0.004). On the other hand, pain had also decreased significantly in the case group in comparison with the control group (p=0.001). Also, the amount of menstrual bleeding (p=0.004), uterine size (p=0.001) and the size of the largest myoma (p=0.013) showed significant reduction in the case group. CONCLUSION Cabergoline can decrease the amount of bleeding and pain in the cases of myomatous uterus and can be used for the symptomatic women who want to preserve uterus for a certain period of time.

A comparison between the effects of metformin and megestrol on simple endometrial hyperplasia

Abstract Introduction: Endometrial hyperplasia is one of the most serious causes of severe abnormal bleeding and also can be a precursor of endometrial carcinoma. Objective: The purpose of the present study was to compare the effects of metformin and megestrol on the endometrial hyperplasia. Methods: The study was performed as a randomized clinical trial on 42 cases of histopathologically confirmed simple endometrial hyperplasia without atypia. The eligible women were randomly assigned into two groups. In metformin group, metformin was prescribed, 500 mg twice a day (1000 mg daily), for a duration of 4 weeks, and then, followed by 1500 mg daily, for 8 more weeks. In the megestrol group, megestrol was prescribed 40 mg daily for 12 weeks. At the end of the duration of the treatment, endometrial sampling was performed and the results were compared between the two groups. Results: The women of the two groups did not have significant difference according to age, BMI and gravidity, parity and history of abortion. Overall, 18 women (81.8%) in metformin group and 12 women (60%) in the megestrol group had normal endometrial histology, after 12 weeks of treatment (p = 0.11). Conclusion: Metformin is comparable with megestrol for the treatment of simple endometrial hyperplasia.

Evaluating the effects of copper supplement during pregnancy on premature rupture of membranes and pregnancy outcome

Abstract Objective: To evaluate the effects of copper (Cu) supplementation during pregnancy on the rupture of membranes and pregnancy outcomes. Methods: Study was conducted as a triple-blind randomized clinical trial. In one group, Cu in a dose of 1000 mg per day, and in the other group, placebo was prescribed orally from 16th week of pregnancy. Results: The women of the two groups did not have significant difference according to age, gestational age at recruitment, BMI, and socioeconomic conditions. There was no statistically significant difference between case and control group regarding the incidence of PPROM, PROM, preterm labor, vaginal bleeding during pregnancy, preeclampsia, and the incidence of placenta abruption. There was a 75% and 90% decrease in depressive symptoms in 2nd trimester and 3rd trimester in supplemented group, respectively. Also, there was a 45% and 80% decrease in anxiety symptoms in 2nd trimester and 3rd trimester in the supplemented group, respectively The rate of infection during pregnancy was significantly higher in control group (p = 0.046). There was no difference between the two groups according to neonatal outcomes. Conclusions: Cu supplementation during pregnancy could not influence positively on ROM; however, it could improve some mood status of the women.

Evaluating the effects of administration of 25-hydroxyvitamin D supplement on serum anti-mullerian hormone (AMH) levels in infertile women

Abstract The aim of the study was to evaluate the effects of administration of 25-hydroxyvitamin D [25(OH) D] on serum antimullerian hormone (AMH) levels in infertile women. The study was performed as a non-randomized clinical trial on 30 infertile women who had low serum level of both 25(OH) D and anti-mullerian hormone. Vitamin D was prescribed 50,000 IU weekly for up to three months for all eligible participants. Serum levels of both 25(OH) D and AMH have increased significantly after treatment with 25(OH) D. There was a significant correlation between serum levels of 25(OH) D after treatment with AMH (p = .029, OR = 2.9, CI 95% = 2.7–5.5). Mean AMH level after treatment was higher in women with sufficient 25(OH) D, than women with insufficient 25(OH) D (1.048 ± 0.644 vs. 0.513 ± 0.284 ng/ml), which shows a significant difference (p = .043). Also, after treatment, in women with mean AMH level of >0.7 ng/ml (19 women), mean level of 25(OH) D was higher than in women with mean AMH level of <0.7 ng/ml (11 women) (59.332 ± 21.751 vs. 38.881 ± 17.281 ng/ml, p = .013). This means that higher levels of 25(OH) D are accompanied with higher levels of AMH. In conclusions with administration and increasing the amount of vitamin D serum levels, the serum levels of AMH have increased.

Risk factors in ectopic pregnancy and differences between adults and adolescents, is consanguinity important?

abstract The aim of the study was to determine the risk factors of ectopic pregnancy (EP) and to compare them between women over and under 20 years of age. 308 cases of EP (case group) were compared with 616 cases of normal pregnancy. Smoking [Ad OR =5.7 (CI 95%=2.8–11.6), p < 0.001], previous EP [Ad OR= 11.4 (CI 95%=3–42.4), p = 0.000], previous STD [Ad OR =3.2 (CI 95%=2.1–4.9), p < 0.001], previous use of IUD [Ad OR =4.1 (CI 95%=2.1–8), p < 0.001], history of infertility [Ad OR= 1.8 (CI 95%=1.1–3), p = 0.01], previous caesarean delivery [Ad OR= 1.5 (CI 95%=1.1–2.3), p = 0.03] and consanguinity [Ad OR =2.2 (CI 95%=1.3–3.6), p = 0.002] were considered as risk factors for EP. Prior abortion [p = 0.000], prior STD [p = 0.004], previous caesarean delivery [p = 0.000] and consanguinity [p = 0.04] were more in the >20-year-old group. Negative Rh [p = 0.02], good economic status [p = 0.000] and prior STD [p = 0.03] were more common in Afghan women. However, previous caesarean delivery [p = 0.04] was more in Iranian women. Smoking, previous EP, history of STD, IUD, infertility, previous caesarean delivery and consanguinity are all risk factors for EP.

A comparison between the two methods of magnesium sulfate administration for duration of 12 versus 24 h after delivery in patients with severe preeclampsia.

Abstract Objectives: To compare between the two methods of magnesium sulfate administration for duration of 12 versus 24 h after delivery in patients with severe preeclampsia. Method: The study was performed as a randomized clinical trial on 182 cases of severe preeclampsia. In one group, Mg sulfate (MgSO4) was prescribed for 12 h after delivery and, in the other group, it was prescribed for 24 h after delivery. Both groups were compared for occurrence of convulsion and other adverse effects. Results: The women of the two groups did not have significant difference according to age, BMI, parity and gravidity, gestational age at the time of delivery. Also, systolic blood pressure, diastolic blood pressure, antihypertensive use, previous diabetes and renal disorders, gestational diabetes, and proteinuria were similar in both groups before treatment. One woman had convulsion in the 12-h group and MgSO4 was continued for 24 h in this case. Blood pressure, urine volume, and laboratory indexes did not show significant differences between the two groups before and after treatment. Also, adverse effects were similar in both groups. Pain of the injection site was less in the 12-h group (p = 0.048). Conclusion: Administration of MgSO4 for a duration of 12 h after delivery should be considered somehow as effective as 24 h prescription for preventing convulsion after delivery.