Current Women's Health Reviews - Volume 15, Issue 4, 2019

Background: Although, some clinical trials investigated the maternal and neonatal effect of fentanyl as a premedication before induction of general anesthesia in cesarean section, to the best of our knowledge, there is no systematic review to summarize these results. Objectives: The present systematic review and meta-analysis evaluated the maternal and neonatal effect of intravenous fentanyl as a premedication before induction of general anesthesia in cesarean section. Methods: The databases of Pubmed, Embase, Scopus and Cochrane library were searched till July 2017 to identify randomized clinical trials which evaluated the effects of intravenous fentanyl as a premedication before induction of general anesthesia compared with placebo on neonate first and fifth minute Apgar score and maternal heart rate and mean arterial pressure (MAP) in cesarean section. Standard Mean difference (SMD) was calculated and I-square statistic test was used for heterogeneity analysis. Results: The present systematic review and meta-analysis consisted of three clinical trials including 180 women in labor. Considering the results of meta-analysis, there is no significant differences between fentanyl and placebo in the case of Apgar score at 1 minute; however, the Apgar score of 5 minutes was significantly lower in fentanyl group compared with placebo (SMD -0.68, 95%CI: - 0.98, -0.38, p<0.001). In the term of maternal hemodynamics, the heart rate (SMD -0.43, 95%CI: - 0.72, -0.13, p=0.004) and MAP (SMD -0.78, 95% CI: -1.09, -0.48, p<0.001) in fentanyl group were significantly lower compared with placebo group. Conclusion: The present meta-analysis showed that using intravenous fentanyl as a premedication before induction of general anesthesia had adverse effects on neonate Apgar score. However, it had positive effects on preventing adverse consequences of intubation on maternal hemodynamics.

Objective: Infertility has a severe impact on quality of life and mental health. This condition could be exacerbated by the existence of comorbid medical disease, like endometriosis. The aim of this critical narrative review is the examination of the state of the art about the quality of life and mental health in infertile women with endometriosis. Methods: We performed a rigorous and systematic search for studies on multiple electronic databases. A total of 6 papers were included in the review and were subjected to interpretative and critical narrative synthesis. Results and Discussion: Major findings are resumed in the following points: (a) infertile women with endometriosis when compared to infertile ones without endometriosis show higher depression, stress perception, and anxiety, and lower general quality of life; (b) quality of life specifically related to infertility is similar among women with and without endometriosis and seems to be related to personality and beliefs factors; (c) giving birth to a child is related to better mental quality of life; (d) during assisted reproductive treatment (ART) stimulation, infertile women with endometriosis have a decrease of dysmenorrhea and dyspareunia; (e) satisfaction of ART is related to the number of attempts, treatment accomplishment and pregnancy test outcomes. Clinical implications of these findings and suggestions for future researches were discussed. Conclusion: Concluding, it is crucial to assess the psychological factors related to endometriosis and infertility to reduce the impact of these diseases on quality of life and mental health, provide adequate support to these patients, improve their satisfaction and increase the change to get pregnant.

Background: The incidence of diabetes mellitus has significantly increased in the last two decades. Gestational diabetes mellitus, GDM, is a complication that affects both pregnant women and newborn babies. Pregnant women that are diagnosed with GDM are 7 times more likely to be diagnosed with type II diabetes mellitus. In addition, infants born by GDM mothers are at higher risk of developing diabetes mellitus in the future. Objective: The study aims to review the literature on the diet control in pregnant women with gestational diabetes mellitus. Results: Controlling blood sugar within the normal range during pregnancy can decrease negative pregnancy outcomes. However, most pregnant women with GDM cannot control their blood sugar within the normal range because of a lack of knowledge and skill in selecting appropriate foods. They also often experience inconsistency in their diet control behavior Most pregnant women worry about gaining too much weight, and most pregnant women with GDM have to learn how to choose their food properly in terms of both nutrients and quantity in order to control their blood sugar levels within the normal range. Conclusion: Diet control during pregnancy is one way to prevent the negative consequences of GDM for both mothers and infants. The food proportion for pregnant women with gestational diabetes is CHO: PRO: FAT = 50: 20:30 and also to consume an appropriate amount of vitamins and minerals and water each day.

Objective: To provide a review of the literature with regards to the diagnosis and management of eating disorders in pregnancy. Methods: Available literature was reviewed and summarized to discuss the epidemiology, diagnosis, natural history of the illness, and treatment. Results: Eating disorders are common mental health conditions in reproductive-aged women, including pregnant women. Anorexia nervosa, bulimia nervosa, and binge eating disorder are the most commonly diagnosed, with a mixed clinical picture existing due to the fluidity between these conditions. Pregnancy can often act as a trigger for eating disorders given the focus on weight gain and the stressors associated with the changing physical appearance of pregnancy. There are significant maternal and fetal risks associated with eating disorders in pregnancy including an elevated risk of cesarean delivery, postpartum depression, preterm delivery, and perinatal mortality. Treatment of eating disorders should involve a multidisciplinary team of providers with close monitoring in pregnancy and the postpartum period with honest discussions on handling weight gain and triggering restrictions associated with pregnancy. Conclusion: Pregnancy is a high-risk time for women with eating disorders given the significant maternal and fetal risks of their illness.

Background: Gestational Diabetes Mellitus (GDM) has a serious impact on maternal health as well as on the health of the infant. This is also very closely related to adverse outcomes in pregnancy. A mother suffering from gestational diabetes mellitus (GDM) has high incidences of showing significant risks to the fetus health, growth and development. As the incidences of GDM are increasing day by day, therefore, maternal health, age and obesity parameters are of major concern for reflecting GDM during their pregnancy conditions. It has been studied and investigated that IR (Insulin Resistance) is a common pathway in GDM and T2DM (Type 2 Diabetes Mellitus). Objective: To explore the effect of Cajanus cajan in treating gestational diabetes mellitus (GDM) in Wistar rats. Methods: The study was conducted on 30 female rats which were caged along with male rats. We obtained 26 pregnant rats which were weighed. The pregnant rats in the control group, intervention group, and GDM group were equally randomized. When the pregnancy was verified, the Intervention and the GDM (Gestational Diabetes Mellitus) group were given 45 mg/kg streptozotocin by the peritoneal injection for inducing GDM while the control group was given an equal volume of the citrate buffer. When the model was established accurately then the intervention group was administered orally with the extracts of leaves of Cajanus cajan chloroform extract (270mg/kg), Methanol extract (270mg/kg) and Ethyl acetate extract (270mg/kg). Whereas the other groups were administered with water and diet. The blood samples were collected and the fetal rats along with placental weight were recorded on the 19th day of the pregnancy. The serum glucose levels, serum insulin levels, and lipid levels were recorded in pregnant rats before the delivery. Results: The rats were weighed before and after delivery, fetal weight was recorded, placental weight of the GDM group was found to be lower than the control group as well as the intervention groups. Treating with (Chloroform extract, Methanol extract, Ethyl acetate extract (270mg/kg) different extracts of Cajanus cajan leaf in the intervention groups the lipid levels of the intervention group significantly increased in case of the Methanolic extract whereas the other extracts were also effective. The levels of antioxidant enzymes of the GDM group in pancreas and liver tissue were lower in intervention groups as compared to control and GDM group whereas the antioxidant enzyme levels in the liver and pancreas were equivalent to the control group. The results showed that the ethyl acetate and methanol extracts of the Cajanus cajan leaves might have bioactive and hypoglycemic nature. Further research is required for the complete evaluation of the active compound in various animal models to justify the nature of the compound. Conclusion: Cajanus cajan leaf extract suppresses oxidative stress and insulin resistance, therefore, improves the blood glucose levels in GDM rats.

Background: Based on the available evidence, diet alone cannot fulfill maternal and fetal nutritional demands during pregnancy. Therefore, taking dietary supplements are recommended during pregnancy worldwide. Maternal socio-demographic characteristics can affect dietary supplements consumption during pregnancy. Little information is available with regard to the dietary supplement consumption in Iranian pregnant women. Objective: This cross-sectional study was conducted to determine the prevalence of dietary supplement use in Iranian pregnant woman. Methods: 250 pregnant women in their third trimester of pregnancy attending the obstetric clinic affiliated to Hamadan University of Medical Sciences between February and August 2018 were asked to complete a questionnaire. Information including socio-demographic and other related characteristics of precipitants and use of any dietary supplements during their current pregnancy was collected. Chi-square test and independent sample t-test were used to determine the association between variables. Results: The results showed that dietary supplement use among Iranian pregnant women was relatively high (69%). Folic acid was the most common supplement used by the participants (66%) followed by multivitamin (52%) and Iron (48.6%). However, only 26.4% of pregnant women reported consumption of folic acid prior to pregnancy. The consumption of dietary supplements was directly associated with the age (P=0.003), level of education (P<0.001), family income (P=0.03), and the history of miscarriage (P=0.047). Conclusion: Although dietary supplement use among Iranian pregnant women was relatively high, pregnant women with poor socio-economic status do not consume required dietary supplements. Thus, vulnerable groups can benefit from educational and financial supports during pregnancy.

Background: Screening of lower genital tract infection (LGTI) in mid-trimester prevents preterm birth (PTB). There is no consensus on best screening methods for LGTI-symptoms, speculum findings, a point of care tests or high vaginal swab microscopy. Aim: To know diagnostic accuracy of screening of lower genital tract infection (LGTI) in midtrimester by clinical symptom/signs and point of care tests (viz Amsel’s criteria) as against the gold standard microscopic tests using gram stain. Settings and Design: Prospective observational study in a tertiary care hospital over two years. The study population included 228 antenatal women between 18th-24th weeks. Materials and Methods: Symptoms of vaginal discharge were noted. Speculum examination was performed on all, to detect the type of discharge. High vaginal swabs were collected, subjected to the point of care tests (Amsel’s criteria) as well as gram staining. Microscopy (Eg: Nugent’s criteria) was taken as the gold standard, to which other methods were compared. Results: Thirty women (13.5%) were symptomatic. Among 198 that were asymptomatic, 91(45.92%) had LGTI. Speculum examination showed discharge in 221 (96.9%), but gram staining showed LGTI in only 104 (45.61%), among whom 45 (19.7%) had partial Bacterial vaginosis (BV), 14(6.1%) had full BV, and 40(17.5%) had candidiasis. The commonest discharge was homogenous thin white, suggestive of BV but 51% among them had normal vaginal flora (NVF); whereas 27% of those labelled physiological discharge were positive for BV. The appearance of discharge and gram stain thus did not correlate well. Amsel’s criteria had poor diagnostic accuracy compared to Nugent’s, although negative predictive value were high. Conclusion: There is a high prevalence of LGTI, especially BV among asymptomatic pregnant women at mid-trimester, best detected with a routine high vaginal swab and gram staining rather than relying on symptoms/speculum findings/point of care tests. Such testing may guide appropriate treatment for reducing the risk of PTB.

Background and Objective: Few studies have focused on the epidemiology of perimenopausal syndrome, and its prevalence in African women is concerningly high. This study investigated selected biochemical parameters, hormonal changes, and possible metabolic syndrome (MetS) in perimenopausal and premenopausal women among Igbo women in Enugu, Southeast of Nigeria. Methods: This study was conducted between March 2018 and November 2018. A total of 200 apparently healthy women, comprising 120 perimenopausal women (mean age 50 years) and 80 premenopausal women (mean age 35 years), living in Enugu, were randomly recruited for this study. Anthropometric indices (blood pressure, waist circumference, weight, and height) of these women were measured. Fasting blood samples were collected and used for measurement of luteinizing hormone (LH), estradiol (E2), follicle stimulating hormone (FSH), fasting plasma glucose (FPG), and lipid profile using standard methods. MetS in the perimenopausal and premenopausal women was observed using three different criteria: the National Cholesterol Education Program- Adult Treatment Panel 111 (NCEP-ATP 111), the World Health Organization (WHO), and International Diabetes Federation (IDF). Student’s t-test and Chi-square were used to compare continuous and categorical variables. Results: There were significantly (p<0.05) higher values of blood pressure (systolic and diastolic), FPG, waist circumference, LH, FSH, total cholesterol, and LDL-C, but significantly (p<0.05) lower values of estradiol in perimenopausal women as compared to premenopausal women. The incidence of MetS was higher in perimenopausal women as compared to premenopausal women in all the three criteria studied. Interpretation and Conclusion: Perimenopausal women have a higher risk for the development of metabolic syndrome-associated diseases than premenopausal women.

Background: Mother-infant bonding has tremendous implications for the child's future development. The difficulties that some mothers have in establishing an emotional bond with their newborns often referred to as impaired bonding or bonding failure are an essential focus in the postpartum period. Therefore, it is important to identify predictive factors for bonding failure and to intervene at an early stage for the better mental health care of mothers as well as infant. Objective: To determine the effect of various modes of delivery on the mother-infant bonding. Methods: Prospective observational study performed on low-risk singleton pregnancy who delivered at term. Mother-to-Infant Bonding Scale (MIBS; Taylor et al., 2005), a validated self-report test was used to measure mother's feelings towards her baby within three days of delivery and at the end of six weeks postpartum period. Total score ranges from 0 to 24. A total MIBS score of ≥ 2 is established as cut-off indicating “poor bonding”. MIBS score of 0 and 1 is considered as “good bonding”. The mean bonding score among the 3 groups was compared. Results: Elective cesarean delivery group had 112 participants, 115 were Emergency cesarean group and 107 were vaginal delivery group. Immediately after the delivery (MIBS 1), the proportion of women with poor bonding among Emergency cesarean group was 34.8% when compared to proportion of women with poor bonding among Elective cesarean (11.6%) and Vaginal delivery (13%). This was statistically significant (p-value 0.01). When we followed up these mothers at 6 weeks post-partum checkup, the MIBS scoring (MIBS-2) consistently improved among the three groups. However, proportion of women with poor bonding still remained high at 16.5% among the Emergency cesarean group. Conclusion: Mode of delivery has a significant impact on MIBS. In this study, unplanned cesarean delivery was associated with a high incidence of poor mother to infant bonding. Poor bonding was commoner in this group even at 6 weeks post-partum, compared to those undergoing a successful vaginal delivery and a planned elective cesarean delivery.

Background: Breast cancer is the most commonly diagnosed malignancy and the leading cause of death among women throughout the world. The incidence of breast cancer has been increasing in Iran and the disease has been the most prevalently registered cancer in the country during the past decade. Objective: Therefore, this study aimed to investigate the effects of motivational interviewing (MI) on awareness, attitude, and practice of breast self-examination (BSE) in high-risk women. Methods: This randomized clinical trial recruited 60 rural women at higher risk of breast cancer in Babol, Iran in 2016. Thirty women from two randomly selected villages were assigned to the MI group. Two other villages were also randomly selected and 30 of their female residents were allocated to the control group. Eligible people were first identified by referring to the villages’ health centers. The participants were recruited using a table of random numbers and their informed consent was obtained. In the MI group, five 90-minutes weekly sessions of MI were held. Conventional training was conducted in the control group. All subjects completed a researcher-made questionnaire at baseline (before the intervention), at the end of the study, and three months later. Data were analyzed using repeated measures analysis of variance, and Bonferroni, Friedman, Wilcoxon, and chi-square tests. Results: In the MI group, there were significant increases in women's mean scores of awareness in the first and second follow-ups compared to the baseline. Moreover, the mean score of attitude toward BSE in the MI group increased at the end of the study (P<0.001). The positive performance of the participants was significantly different between the MI and control groups at the end of the study (86.7% vs. 16.7%; P<0.001) and three months later (83.3% vs. 13.3%; P<0.001). Conclusion: MI can be used alongside conventional trainings to promote and motivate screening behaviors.