Current Women's Health Reviews - Volume 19, Issue 1, 2023

Background: Cervical cancer (CC) is one of the treatable forms of cancer that can be prevented in its long precancerous conditions and good screening programs. Aims: Using directed content analysis, the present study, as qualitative research, aimed to investigate married women’s perspectives on screening for CC based on the protection motivation theory (PMT). Methods: To this end, a total number of 20 married women, considering maximum variation in sampling in terms of age and level of education, were interviewed. Therefore, an in-depth semistructured interview was used for data collection until saturation was reached. The PMT was also applied as the main framework to develop the interview items. Results: Eight categories, namely, intention, fear, perceived susceptibility, perceived severity, response efficacy, self-efficacy, response cost, and social support, were identified based on data classification. The majority of the participants intended to have a Pap smear. Moreover, they believed that if women knew more about screening for cervical cancer, they would definitely do so. Most of the participants, 60 %, had a high level of perceived susceptibility, and 100 % of them had self-efficacy related to doing a Pap smear. Almost all the interviewees acknowledged the effectiveness of a Pap smear and its consequences, but 80 % of the participants reported that they could not follow regular tests due to response cost despite their self-efficacy and knowledge about the effectiveness and the benefits of this type of screening. All the study participants also put more emphasis on the role of social support to push them to get a Pap smear. Conclusion: The cost of a Pap smear and social support should be considered when encouraging married women to participate in screening programs.

Polycystic ovarian syndrome (PCOS) is characterized by a wide range of metabolic and endocrine abnormalities, which can be quite complex in the diagnosis and treatment. The pathogenesis of PCOS is unclear. Therefore, symptoms of this condition differ from person to person, and it becomes difficult to treat PCOS. So far, many pharmacological interventions such as antilipidemic, ovulatory stimulants, and oral contraceptives have been used alone or in combination for the treatment of PCOS and have not been significantly effective. Precision medicine could be of importance in the treatment of PCOS, and the use of artificial intelligence could be beneficial in understanding the pathogenesis and management of this condition. Biotechnological interventions using small mRNA have been explored for this condition. Moreover, it is also hypothesized that the gut microbiota has a key role in regulating hormones through the gut-brain axis. Herbal remedies have also been used, but it is limited due to improper standardization. The treatment of PCOS is based on providing symptomatic relief and limiting the perpetuation of this condition. Understanding the use of different interventions is important to bring out better clinical outcomes.

Pre-eclampsia (PE) is one of the major pregnancy complications, affecting up to 10 % of all pregnancies in some regions of the world. The clinical diagnosis, characterised by hypertension and proteinuria often late during pregnancy, with the added inability to treat (other than delivery), can lead to significant morbidity and mortality in both mother and unborn foetus. Moreover, as yet, only low dose aspirin administration is accepted as a preventive measure for PE. This puts more pressure to identify diagnostic and prognostic biomarkers of PE from blood or urine for the non-invasive screening of pregnant women before pregnancy becomes complicated. Over the years, a number of DNA and protein molecules, such as cell-free DNA, VEGF, sFLT1, PlGF, PP-13, ADMA, and several other biomarkers, have been linked to specific pathophysiological observations and proposed as predictive markers for PE. However, their reliability and reproducibility have been put to the test by numerous studies. The aim of this review is to cover the key clinical and biochemical features of pregnancies complicated by PE and evaluate the robustness of data gathered from various studies in order to better understand the link between the proposed biomarkers and the development of PE so as to better quantify their relevance in diagnostic or prognostic applications. The overall goal is to use such biomarkers for earlier detection, better molecular monitoring, and, where possible, lessening of symptoms, hopefully leading to a reduction in the yearly PE-related deaths worldwide.

Cancer is known as a disease with a high morbidity and mortality rate. There are several short-term and long-term complications of cancer, leading to poor quality of life. Cancer in advanced stage and malignant tumors requiring a multisystem involvement makes the treatment challenging. The diverse health impact of cancer requires a multidisciplinary approach for treatment. The oncology pharmacy has facilitated a revolutionary approach for preparing and training specialised pharmacists to deal with a variety of health challenges faced by cancer patients. Oncology pharmacists or oncopharmacists are the experts in designing drug therapy and individualizing it in accordance with the requirements. The conventional and novel role of pharmacists in clinical pharmacy practice is documented to positively impact the health of cancer patients, including cancer survivors. Hence, this review tries to summarize the potential role of oncopharmacists.

Objective: Diet may have an impact on gestational diabetes mellitus (GDM) development; nevertheless, controvertible studies have been published. The aim of this study was to provide evidence from analytical studies on the relationship between diet and GDM development. Methods: Following the PRISMA guidelines, ISI Web of Knowledge, PubMed, Google Scholar, Scopus, Embase, and the Cochrane library were searched for articles published in the English language from Jan 2005 to Dec 2020. We included observational studies, assessed their risk of bias, and extracted data on association between diet status and GDM development. Keywords were selected based on the Mesh terms, which included gestational diabetes mellitus“, “GDM”, “diet,” “nutrition,” “food,” “dietary pattern which was combined by "OR" and "AND" Boolean operators. Two reviewers (SHA and PM) independently reviewed abstracts and full-text articles and extracted data. Results: Among the 5 articles included, 4 were case-control and one was a cross-sectional study. Studies have shown that diets with a high intake of saturated fatty acids (more than 10% of total daily fat intake) and trans fatty acids (more than 1% of total daily fat intake) before and during pregnancy significantly increase the risk of gestational diabetes mellitus. Conclusion: High intake of saturated fat and trans fat before and during pregnancy can disturb glucose metabolism and increase the risk of GDM, although all of the studies recommend more widespread observational and clinical trials studies to identify the exact relationship between high saturated and trans fatty acids intake and GDM.

Background: COVID-19 infection was declared pandemic infection on March 11, 2020 by the World Health Organisation. Pregnant women have a high propensity to acquire this infection due to their altered physiological and immunological function. Objective: To know the overall incidence of COVID positive obstetric patients and assess the presence of any co-morbidity or obstetric complications as well as maternal and perinatal outcomes at our institute. Methods: This retrospective observational study was conducted at the Saraswathi Institute of medical sciences (SIMS), Hapur Uttar Pradesh, India from April 2020 to December 2020. All Covid positive obstetric patients, antenatal and postnatal upto 6weeks postpartum were included from the hospital records. Their socio-demographic characters, period of gestation at the time of admission, presenting symptoms, any medical or obstetric complications as well as maternal and perinatal outcome were studied in the form of the severity of symptoms, ICU admissions, requirement of mechanical ventilatory support and NICU admissions. Results: Total 95 obstetric patients were admitted, out of which 83 (87.36 %) were antenatal and 12 (12.63 %) were postnatal. Sixteen patients delivered at SIMS, out of which 9 (56.25 %) had cesarean delivery and 7 (43.75 %) had vaginal delivery and 9 had preterm deliveries (56.25 %). Among the 12 postnatal patients, 5 (41.66 %) undergone cesarean delivery and 7 (58.33 %) had vaginal delivery. Twenty (21.05 %) patients needed ICU admission and 3 (3.15 %) patients required ventilatory support. There were 2 (2.10 %) maternal deaths and 2 (2.10 %) neonatal deaths. Conclusion: The course of COVID-19 obstetric patients was mild in majority of cases, however, increased rates of pregnancy complications and caesarean delivery was observed.

Background: Childbirth is an important event in a woman’s life. Adverse childbirth experiences may lead to negative psychological reactions and disturb the mother’s mental health during the postpartum period. Objective: This prospective study aimed to assess the relationship between experiences of antepartum intervention and post-traumatic stress symptoms in mothers following childbirth. Methods: The study sample comprised 176 Iranian women, who were under assessment for 8 weeks postpartum. Current Post-Traumatic Stress Disorder symptoms (PTSD) were assessed through the Impact of Events Scale-Revised (IES-R) questionnaire. Data were analyzed using SPSS software (Version 19.0), and the adjusted odds ratios (ODs) were estimated by binary logistic regression. Results: Based on the obtained results, 38.3% (N = 62) of the women appeared to be at risk of developing PTSD symptoms. The mean ± SD score of PTSD symptoms was obtained at 22.51 ± 12.04 (0-65). The results showed that women in the PTSD group underwent more obstetric interventions (P = 0.002) and experienced more childbirth pain (P = 0.048), compared to women without PTSD, during childbirth. Insertion of sublingual or vaginal prostaglandin tablets, experiencing episiotomy incision, perineal/labial/vaginal sutures, and artificial rupture of amniotic membranes correlated significantly with PTSD symptoms (P < 0.05). The results of binary logistic regression analysis confirmed that the rate of obstetric interventions was the significant predictor of PTSD after childbirth (OD = 1.284; P = 0.008). Conclusion: The findings of the present study indicate that the enhanced understanding of healthcare providers of obstetric intervention consequences may prevent postpartum PTSD through the provision of physiological delivery and supportive care during labor.

Background: Post-abortion insertion of an intrauterine device (IUD) is recommended for the prevention of repetitive voluntary termination of pregnancy (VTOP) in women who choose to have a reliable contraceptive method. Aim: This study aimed to analyze the incidence of IUD dislocation and its factors in patients who had an IUD immediately inserted after VTOP. Methods: In this retrospective study, 288 consequent patients who came to our hospital for VTOP between August 1st, 2018 to August 26th, 2019, and had given signed consent for immediate IUD insertion were taken as the study group. The demographic characteristics, obstetric history, and gestational age at the time of the procedure were obtained from the patient records. On the 10th day of post-abortion, the localization of the IUD was evaluated by speculum examination and transvaginal ultrasonography. The effects of obstetric history and gestational age at the time of termination on IUD dislocation rates were analyzed statistically. Results: The overall incidence of IUD dislocation was 16.3 % at the 10th-day follow-up visit. The incidence of IUD dislocation was similar in patients with gestational age< 5w, 5-7w, and 7-10w (21 %, 14.5 %, and 13 %, respectively, p=0.36). However, the incidence increased with high gravity and parity. The gravity, parity, number of vaginal deliveries, and cesarean section were higher in patients with an IUD dislocation than the ones with an IUD in place. Conclusion: The IUD insertion after voluntary legal termination of pregnancy is suitable for all gestational ages. A high number of previous pregnancies and deliveries are risk factors for IUD expulsion after immediate IUD insertion.

Background: Inconsistent results were found regarding the relationship between human blood oxytocin (OXT) levels and psychiatric and sexual dysfunction (SD) in several studies. Objective: The present study aimed to determine the relationship between OXT levels and sexual function and depression. Methods: It was a cross-sectional study involving 84 non-pregnant healthy married women at childbearing age. Beck Depression Inventory and Female Sexual Function Index (FSFI) were used to collect the data, and human oxytocin ELISA kit was used to determine serum OXT level. The independent t-test and Pearson correlation coefficient were used to determine the relationship between variables. Results: Average age of the participants was 36.1 (6.91) in this study and the range of their age was 19-49. The mean serum OXT level was 192.70 (139.71)pg/ml. The mean total score of FSFI and depression were 21.54 (5.18) and 12.42 (11.20) from the attainable score of 2-36 and 0-63, respectively. The associations between serum OXT level and FSFI overall score (r=0.066, P=0.548) and depression score (r=0.137, P=0.215) were not found to be significant. No statistically significant differences were found between the two groups of women with and without SD (P=0.155) and women with and without depression (P=0.110) in terms of serum OXT levels. Conclusion: The results of this study did not indicate a significant relationship between serum OXT levels and depression and sexual function. As there was no significant relationship between the oxytocin concentrations and measured outcomes, conducting further studies with a better study design and a larger sample size is recommended.

Background: Female genital cosmetic surgery (FGCS) consists of a set of design approaches to recover or strengthen the vulva. These cosmetic procedures are conducted to relieve functionality problems such as vaginal looseness and sexual dissatisfaction. The external genital tract is shaped cosmetically. Its results could be better judged through understanding the direct experience of women who underwent surgery. Therefore, this study aimed to explain the experiences of women regarding FGCS through phenomenological methods. Methods: In a phenomenological study with purposive sampling, semistructured in-depth interviews were conducted on women who experienced FGCS. Then, the interviews were entered into the Word software and were analyzed by the Colaizzi 7-step method. To ensure the correctness of the data, the Guba’s criteria were used. Data were analyzed using MAXQDA software version 10. Results: The results showed that 15 women aged between 23 and 49 years old and with a mean age of 34 years old, mostly married and housewives as well as with diploma educational levels, participated in the study. Three themes and eight subthemes were excluded from the analysis of participants’ interviews. Participants presented their experiences on their sexual function after FGCS as sexual satisfaction, high-quality life, and willingness for surgery. Conclusion: The studies showed those women’s experiences with FGCS were positive, resulting in sexual satisfaction and higher quality of life. Therefore, the assessment of women to perform cosmetic surgery should be prioritized, and the women should be supported to make a decision regarding such surgery.

Background: There is contradictory evidence about the relationship between female circumcision and sexual function and satisfaction, which may be rooted in cultural and social beliefs and the different types of genital mutilation/circumcision (GM/C). Objective: The present study aimed to compare the sexual satisfaction among Iranian Kurdish women with and without GM/C. Methods: This cross-sectional study was conducted on 310 women with and without GM/C aged 18-45 years, referred to the health centers of Mahabad, Iran, in 2020, using the convenience sampling method. After completing the informed consent form by the participants, the demographic and obstetric characteristics and Larson sexual satisfaction questionnaires were completed. The collected data were analyzed using SPSS21 software, and Chi-square and ANCOVA tests were used. Results: The mean (SD) score of sexual satisfaction was 87.10 (6.15) and 86.99 (4.44) among women with and without GM/C, respectively. After controlling the effect of confounding variables, no significant difference was observed between the two groups. The majority of women in both groups (91.6% in women with type I genital mutilation and 92.9% in women without GM/C) had moderate sexual satisfaction and there was no significant difference between the two groups in terms of sexual satisfaction levels. Conclusion: The results indicated no correlation between sexual satisfaction and type I female genital mutilation, which may be due to the limited area of genital injury, and the individual and social acceptance of this practice. A similar study design in other populations with different types of female genital mutilation is recommended.

Background and Objectives: Preconception care involves health promotion, screening, and interventions for women and men to reduce the risk factors with the potential effect on their future pregnancies; the present research is aimed at investigating the effect of planned behavior theory on the knowledge, attitude, subjective norms, perceived behavior, self-control, intention, and practices of preconception care. Methods: This is a controlled randomized trial study to examine the impacts on the intentions and conductance of the preconception care among the women referring to a marriage consulting center. To this end, 110 women referring to the marriage counseling centers of Asad Abad city in Iran were selected and then divided into two groups. The educational sessions were held twice a week in four 60-minute sessions for the intervention group, while the control group received no intervention. Wilcoxon and Mann-Whitney and ϰ² were employed for data analysis at the significance level of 0.05. The reliability of the tools was evaluated using Cronbach Alpha. Findings: The results indicated a significant difference between the two groups in terms of awareness (14.27 ± 1.53 vs. 5.32 ± 2.95), attitudes (45.89 ± 3.52 vs. 36.36 ± 6.77), subjective norms (30.01 ± 3.34 vs. 26.38 ± 4.10), and perceived behavioral control (23.10 ± 2.06 vs. 18.87 ± 4.61) for the intervention and control groups, respectively (P = 0.001). Also, 89% of the intervention group (vs. 4% of the controls) tried to make the record for preconception care. Conclusion: The theory of planned behavior can effectively improve awareness, attitude, and perceived behavioral control in women. This theory also improved the behavioral intention of women toward preconception care. The midwives and physicians are recommended to use this educational method in health centers to motivate the women to take preconception counseling with the help of health providers.

Background: Optimal nutrition for adolescent girls is critical for growth, development, and long-term health. Dietary diversity is a crucial component of feeding strategies. In resourcepoor countries, undiversified diets and low-quality monotonous diet feeding habits are frequent. This leads to poor nutritional status, particularly micronutrient deficiencies, which has an impact on adolescent females' current and future lives, as well as their kids. However, data on the magnitude of dietary diversity and associated determinants among adolescent girls in resource-poor settings such as Ethiopia, which include the research area, is sparse. Methods: A community-based cross-sectional study design was conducted among 603 adolescent girls from randomly selected adolescent girls in Ethiopia using a multistage sampling method. The data were collected through face-to-face interviews by using a pretested structured questionnaire and entered into Epi-data 4.2.0.0 version and exported to SPSS version 20 for analyses. Multicollinearity between independent variables and model goodness fit test was checked. Bivariable and multivariable logistic regression analysis were used to determine the degree of relationship between independent and dependent variables. At a p-value of less than 0.05, the odds ratio was declared, along with the 95 percent confidence interval and the level of statistical significance. Results: The prevalence of dietary diversity among adolescent girls was 43.8% (95% CI: 39.7%- 48.0%). having secondary and above level of education and primary education, [AOR = 4.0, 95% CI: (1.89-8.32)], being in food secure households [AOR = 6.99, 95% CI: (4.34-11.23)], skipping practice of meals [AOR = 0.54, 95% CI: (0.33-0.88)], currently being on the menstruation [AOR = 0.42, 95% CI: (0.26-0.66)] and having good knowledge about nutrition [AOR = 2.20, 95% CI: (1.32-3.56)] were significantly associated with dietary diversity among adolescent girls. Conclusion: The prevalence of dietary diversity among adolescent girls was low in the study area. Therefore, attention should be given to fathers with no formal education, and efforts should be made to improve household food security, adolescent girls knowledge about nutrition, and minimize skipping of meals to increase adolescent girls dietary diversity and to break the vicious cycles of malnutrition.