Current Women's Health Reviews - Volume 19, Issue 2, 2023

Background: Moderate physical activity (PA) during pregnancy (> 150 min/week) is beneficial to mothers and their growing fetuses. There are no published data on PA during pregnancy in Sudan. Methods: A cross-sectional study was conducted to assess the level of PA among pregnant Sudanese women and to determine its associated factors. Sociodemographic and obstetric variables were gathered through a questionnaire, and PA was assessed by the Pregnancy Physical Activity Questionnaire (PPAQ). The scores were compiled, the participants were classified according to the intensity and type of PA, and logistic regression analysis was performed. Results: Five hundred women with a median (interquartile range) age of 27.0 (9.0) years were enrolled. The majority (88.4%) were housewives, more than half (53.6%) were overweight, and just over a quarter (25.8%) were obese. The sedentary activity was reported by 367 women (73.4%). The most energy (29.54 ± 9.62 metabolic equivalent task h/week; 83.75%) was spent during household and caregiving activities. While there was no association with age, parity, education, gestational age, and PA, overweight (adjusted odds ratios (AOR) = 2.38, 95% confidence interval (CI) = 1.27-4.45) and obesity (AOR = 3.07, 95% CI = 1.56-6.02) were associated with PA. Conclusion: This study demonstrated that the majority of Sudanese pregnant women had a sedentary lifestyle. Most of the energy was spent during household and caregiving activities. Overweight and obese pregnant women were more likely to be physically active. Health education about the importance of prenatal PA is needed in Sudan.

Background: Fetal growth restriction (FGR) is a common alignment that complicates pregnancy, especially for preeclampsia cases; therefore earlier detection is crucial to improve the outcome. Objective: We examine whether the ratio of maternal serum fibrinogen to serum uric acid (ms F/U) can serve as a marker FGR in patients with preeclampsia at 34 weeks. Material and Methods: A cross-sectional study recruited 98 preeclamptic primigravidae at the University Teaching Hospital from June 2018 to June 2019. Patients were sent for laboratory and ultrasound examinations. Maternal parameters include systolic and diastolic blood pressure, serum fibrinogen, and serum uric acid. Ultrasonic fetal parameters include amniotic fluid index AFI, estimated fetal weight EFW, pulsatility index PI, and resistance index RI. Results: Pearson’s correlation between ms F/U ratio and all other feto-maternal variables was significant as P value was <0.0001. The ms F/U ratio showed strong positive correlations with EFW and AFI. The ms F/U ratio showed strong inverse correlations with PI, RI, systolic, diastolic blood pressure, and albumin/creatinine ratio. The strength of association tested by a coefficient of Mallow showed the strongest association between ms F/U versus fetal weight. The highest Odd ratio for FGR was 45, associated with the ms F/U ratio. The cutoff value for ms F/U ratio was 26.08 mg/dL with an estimated sensitivity and specificity of 85% and 96.25%, respectively, with an AUC of 0.82. Conclusion: Strong and significant correlation of ms F/U ratio with feto-maternal parameters at high sensitivity and specificity added to its simplicity, and cost-effectiveness makes ms F/U ratio a reliable marker for earlier FGR to improve the outcome.

Introduction: A partial molar pregnancy is a variation of a molar pregnancy in which an embryo either develops incompletely or with multiple structural anomalies. The aim of this study was to present a rare case of partial molar pregnancy coexisting with a normal diploid fetus. Case Presentation: A 32-year-old woman with gravid 3, Para 2 (2 previous cesarean sections) was referred to Ghaem hospital, an academic hospital of Mashhad University of Medical Sciences, Mashhad, Iran, in 2020 at 34 weeks of gestation due to labor pain. She had an ultrasound-based diagnosis of partial molar pregnancy with the normal female fetus at 30 weeks for the first time. Due to 2 previous cesarean sections and regular uterine contractions, she underwent a cesarean section at 34 weeks and 2 days. A normal female infant with a normal Apgar score was born. The postpartum period was complicated with preeclampsia. The pathological evaluation confirmed partial molar pregnancy. The neonatal Karyotype was 46 XX and the neonatal period was uneventful. Maternal serum β-hCG reached normal after 5 weeks of cesarean. Conclusion: Partial molar pregnancy with the coexisting normal fetus is a rare condition; however, it may complicate the pregnancy outcomes, which affect both mother and fetus. So early diagnosis and close follow-up may prevent catastrophic maternal and fetal complications.

Aim: This study aims to describe the various concerns and treatment strategies associated with the polycystic ovarian syndrome. Polycystic syndrome of ovaries is the most prevalent endocrine problem in adult women and is distinguished by anovulation, excess androgen, and the involvement of ultrasound polycystic ovaries. Hirsutism, obesity, miscarriage, and menstrual irregularities are the signs that are particularly troubling for patients. The hypothesis describes that PCOS is a systemic disease reinforced by recent discoveries amplifying hormones and cytokines in muscle mass tissue. Result and discussion: The treatment strategy should be adapted to the patient's phenotype, problems, and willingness to replicate. Infertility care centers on treatments for activation of ovulation and may include medications, such as metformin, letrozole, clomiphene, and gonadotropin. The application of oral contraception and the adjuvant application of anti-androgens also includes the management of hirsutism. For both treatments of infertility and long-term management, weight loss in obese women with PCOS can be helpful. Conclusion: The literature survey concluded that the proper diagnosis and treatment of PCOS are important; otherwise, it cannot be adequately controlled and can cause many metabolic disorders and other health-related risks.

Background: The current total fertility rate in Bangladesh is now 2.3 births per woman, which is still above the replacement level of 2.1. Objectives: The main objective of this study was to identify potential factors associated with fertility transition in Bangladesh. Methods: This study applied several regression models to find the best-fitted model to determine factors associated with the number of children ever-born in Bangladesh and utilize data from the 2019 Bangladesh Multiple Indicator Cluster Survey. Results: Based on the principles of the AIC, BIC, and Vuong tests, the best-fit model was the Hurdle- Poisson regression model compared to other models. Findings based on the Hurdle Poisson regression result revealed that the number of children increases with the increase of women’s age, but the number of children declines if the education status of women as well as their delayed marriage increases. Women who had secondary or higher education were less likely to have children than illiterate women. Similarly, division, residential area, wealth index, women’s functional difficulties, prenatal care, and migration have significantly influenced the number of children ever born. Conclusion: Based on the findings, the study suggests that fertility can be decreased by improving female education, minimizing early marriage, and eliminating poverty for all ever-married women who were particularly live in rural areas of the Chattogram and Sylhet divisions in Bangladesh. Such steps would be the largest contribution to a future reduction in fertility rates in Bangladesh.

Pre-eclampsia is a type of hypertension that affects several organs during pregnancy. Preeclampsia, on the other hand, does not go away once the baby is born, but it can harm the mother and her children for years. A pre-eclamptic woman is at risk for cerebrovascular disease, cardiovascular disease, renal disease, and metabolic abnormalities later in life if she has pre-eclampsia. In research, children born to pre-eclamptic moms have had a variety of issues. These conditions are associated with cardiovascular, respiratory, neurological, and gastrointestinal issues later in life. The purpose of this study is to learn more about the long-term impact of pre-eclampsia on both mothers and children. Pregnancy and postpartum offer a unique window of opportunity for screening and intervention for both mother and child in the interests of health maintenance and disease prevention.

Objectives: This study aimed to review the literature related to salivary biomarkers used to diagnose breast cancer or predict responses to therapy and its prognosis. Methods: Studies were eligible for inclusion if they had compared salivary diagnostics for breast cancer with the gold standard or other biomarkers. Six databases (PubMed, EMBASE, ScienceDirect, Scopus, Web of Science, and Ovid) and Google Scholar search engine searched for pertinent literature using specific search terms: breast cancer, diagnosis, prognosis saliva, and salivary biomarker. Of the 513 studies screened, 110 were selected for inclusion in this review. Different salivary biomarkers were classified and discussed. Results: Our analysis indicated that the sensitivity and specificity of salivary biomarkers, such as cerb- B2 and sialic acid in BC detection are comparable with serum values. Salivary levels of autoantibodies against MUC1, CA 15-3, and adiponectin had a better correlation with breast cancer than serum levels. Assessment of biomarkers, such as HER-2, helps develop a treatment plan and evaluates response to treatment. Conclusion: Our study confirms that salivary biomarkers are becoming increasingly important in breast cancer diagnosis and treatment planning, as well as in predicting therapeutic response and prognosis. Salivary biomarkers such as c-erb-B2 in association with traditional criteria offer the promise of use as a noninvasive screening method for breast cancer. Additional studies are warranted to determine the most sensitive and specific salivary biomarkers for this purpose.

Background: Fatigue is a common problem in pregnancy and is associated with negative outcomes. Objectives: This study aimed to determine the predictors of fatigue in pregnant women. Methods: This cross-sectional study was conducted on 150 pregnant women with a gestational age of 12-18 weeks visiting the healthcare centers in Mahabad-Iran, 2021. Fatigue was assessed via the modified Multidimensional Assessment of Fatigue (MAF) checklist, depression via the Edinburgh Postnatal Depression Scale (EPDS), stress and anxiety via Depression, Anxiety and Stress Scale-21 (DASS-21), well-being via WHO-5, and positive and negative affect via International Positive and Negative Affect Schedule-Short Form (I-PANAS-SF). The general linear model was used to estimate the degree of the effect of each independent variable (sociodemographic characteristics, depression, stress, anxiety, positive and negative affect, and well-being) on the dependent variable (early pregnancy fatigue). Results: The mean (SD) fatigue score was 21.91 (7.07), within the 0-50 possible range. The majority of pregnant women (87.3%) suffered from fatigue. Based on the Pearson or Spearman correlation analysis, a significant correlation was observed between fatigue and depression (r= 0.334, P<0.001), anxiety (r= 0.327, P<0.001), stress (r=0.329, P< 0.001), well-being (r= -0.279, P<0.001), and negative affect (r= 0.308, P<0.001). Based on the adjusted general linear model, the education, stress and negative affect variables were predictors of fatigue. Conclusion: The education, stress and negative affect predict fatigue in pregnant women, and their identification contributes to the designation of interventions to mitigate fatigue in this group. More studies are required to identify the causes of fatigue during pregnancy.

Background: Pregnancy is a period of physiological and hormonal alterations that can decrease the quality of life (QoL). Women’s subjective perception of QoL is clinically relevant for assessing the effectiveness of interventions and identifying susceptibility to depression. Objectives: This review aims to identify, present, and critically appraise the assessment tools of QoL during pregnancy. Methods: A narrative review of the English-language literature was conducted through the PubMed, CENTRAL, Scopus, and Google Scholar electronic databases. Conclusion: Several generic instruments have been proposed, such as pregnancy-specific and disease- specific questionnaires concerning common diseases during pregnancy. Plasma, salivary and hair cortisol, inflammatory, genetic and epigenetic biomarkers and gut microbiome have also been investigated as potential indicators of maternal anxiety. Their use can quantify the association between pregnancy-specific anxiety and QoL. Application of validated assessment tools of QoL during pregnancy could improve QoL, maternal health interventions, and early identification of susceptibility to maternal depression.

Background: Striae gravidarum, which occurs in most pregnancies, is unpleasant for women, and its treatment is costly. A preventive measure for this condition is applying herbal oils to maintain the skin's elasticity. The current study investigated the effect of a topical combined herbal cream on the occurrence and severity of striae gravidarum in primiparous women. Methods: In this triple-blind randomized clinical trial, 90 primiparous women in their first trimester of pregnancy, attending healthcare centres in Mashhad, Iran, were randomly allocated into two groups of herbal cream and placebo, from which 54 completed the study. The intervention group received 0.3 g of the cream, topically, composed of Calendula (Pot marigold), Anthemis nobilis (Chamomile), Pelargonium Graveolens (Rose Geranium), Theobroma oil (Cocoa Butter) and Soybean, twice a day for three days a week from 14-16 to 27-30 weeks of gestation and the placebo group received a moisturizing cream. At the gestational age of 38-40 weeks, the incidence and severity of striae on the abdominal skin were evaluated using the Atwal numerical scoring system and digital photography. Results: There was a significant difference between the prevalence of striae in the intervention and placebo group (43.3% vs 87.5%) (P<0.0001). Also, a significant difference was seen between the two groups in terms of the severity of the striae (P < 0.001). In the intervention group, the severity of striae in 86.7%, 13.3%, and 0% of the cases was mild, moderate, and severe, respectively, whereas, in the placebo group, it was occurred as mild, moderate, and severe in 37.5%, 58.3%, and 4.2% of the cases. Conclusion: Considering the effect of topically applied herbal cream, it is recommended that health care providers suggest pregnant women to use such herbal creams to avoid striae gravidarum development.

Aims: This study aimed to investigate factors affecting unwanted pregnancy in Hamadan. Background: Various factors affect the occurrence and extent of unwanted pregnancies. Methods: The present case-control study was performed on 901 pregnant women admitted to comprehensive health centers in Hamadan in 2020. The case group included women with unwanted pregnancies and the control group consisted of women who became pregnant in a preplanned manner. Data were collected from the samples using a checklist. Data were analyzed with SPSS24 at a significance level of 5%. Results: This case-control study was conducted on 455 mothers in the case group (with unwanted pregnancies) and 456 samples in the control group. The results of the logistic regression model indicated that the history of abortion, education, stillbirth history, history of contraceptive use, history of unwanted pregnancy, marital satisfaction, emotional relation with the spouse, spouse's opinion about contraception method, age, and the first pregnancy age were the predictors of unwanted pregnancy. Conclusion: To prevent unwanted pregnancies, it is recommended to start the correct training of family planning methods from high school and pursue it continuously after marriage, during pregnancy, and postpartum care.

Background: Hysterectomy is one of the most common gynecological surgeries that affect women's mental health and quality of life. Objective: This study aimed to investigate the correlation between the quality of life and posttraumatic stress in hysterectomized postmenopausal and non-menopausal women. Materials and Methods: This cross-sectional analytical study was conducted from August to December 2019 on hysterectomies postmenopausal and non-menopausal women. There were 77 subjects in each group with a mean age of 52.55 ± 1.098. They were selected via convenience sampling at Hazrat Zeinab (PBUH) and Shahid Dr. Faghihi Hospitals in Shiraz. They were evaluated in a two-month follow-up using the Impact of Event Scale-Revised (Weiss & Marmar, 1997) and WHO Quality of Life-BREF (WHOQOL-BREF) questionnaires. Data were analyzed in SPSS-16 software using descriptive and inferential statistics (independent t-test, paired t-test, and Pearson or Spearman correlation coefficients). Results: Unlike the first stage of the study (before and a week after the surgery, P = 0.289), there was a significant negative relationship in the quality of life and post-traumatic stress between postmenopausal and non-menopausal women (P = 0.001) in the second stage (two months after the surgery). Hysterectomy increased the mean score of post-traumatic stress in postmenopausal and nonmenopausal women after the surgery (P = 0.179), while the quality of life improved and stress decreased two months later (P = 0.0001). Conclusion: Hysterectomy improved the quality of life in postmenopausal and significantly in nonmenopausal women. Hence, due to the correlation and significant negative relationship between post-traumatic stress and quality of life, midwives, families, and society need to pay attention to women’s quality of life.