Current Women's Health Reviews - Volume 19, Issue 3, 2023

Background: Oral health during pregnancy is essential regarding its long-term and shortterm effects on maternal and child health. Objective: This study aimed to investigate the strategies and methods used in oral health promotion interventions during pregnancy. Also, it is tried to determine the extent to which environmental barriers and socio-economic factors, in addition to individual factors, have been considered in the design of these interventions. Methods: The data were extracted from Pub-Med, Web of Science, and Scopus databases by searching the published papers before November 2019. The search terms consisted of pregnancy, oral health promotion, health education, and preventive health services, resulting in 2772 records. The inclusion criteria were pregnant women as a target group; study design with randomized (controlled) trials; implementing a minimum of one health promotion intervention; and studying the outcomes including knowledge, attitudes, dental cleaning behaviors, and clinical examinations. On the other hand, the articles only focused on the infant’s oral health were excluded. Results: A total of 20 articles were included in this study. The subject of most reviewed studies was the individual-level interventions using various methods, including lectures, role-playing, group discussion, one-on-one counseling, skill-based education, commercials on the video-sharing website, and using social networks. Few studies (n = 4) provided screening and referring to dental services, prophylaxis, nonsurgical therapy, and initial periodontal treatment. Only one study focused on socio- economic factors, including cost and location of dental services and involvement of prenatal care providers. Conclusion: According to ecological approaches, maintenance of outcomes needs addressing multilevel determinants. However, based on the results, a few oral health interventions during pregnancy included environmental/policy-level factors in addition to individual factors. Hence, interventions with different strategies that consider multiple determinants are needed.

Background: Adolescent pregnancy is considered a global health problem, and adolescent mothers need to receive comprehensive support during labor and delivery. Objective: The present study aimed to evaluate the effect of doula companions on the childbirth experience of adolescent mothers. Methods: This trial study was conducted on 54 primigravid women under the age of 19 years referred to the Taleghani educational-treatment center affiliated with Tabriz University of Medical Sciences, Iran, from April to September, 2020. Participants were randomly assigned to the intervention (doula accompaniment) and control groups through block randomization using Random Allocation Software with block sizes of 4 and 6. The data were collected using the demographic and obstetric characteristics, Support and Control in Birth Questionnaire, Labor Agentry Scale, and the information in the labor progress record. The data were analyzed using SPSS 24. Independent t-test and ANCOVA were used. Results: The mean score of support and control in birth was 121 ± 14.55 in the intervention group and 96.44 ± 15.8 in the control group (p <0.001). After intervention and adjusting the effect of support and control in birth, no significant difference in childbirth experience was observed between the two groups (AMD: 1.40, 95% CI: -2.25 to 5.07, p = 0.44). Conclusion: Considering the effectiveness of the doula companion in improving the support and control in the birth of adolescent mothers, it is suggested to consider the doula support during labor and childbirth as one of the interventions to improve the quality of maternal health care among adolescents.

Background: Reflexology is a non-invasive, inexpensive, and simple technique that can be employed for pregnant women. Objective: This study aimed to determine the effects of reflexology on anxiety during labor (primary outcome) and its side effects (secondary outcome). Methods: In this systematic review, the Cochrane Library, PubMed, Google Scholar, Scopus, Web of Science, SID, Science Direct, and ProQuest databases were searched systematically and without time constraints until 20 April 2021. The quality of the selected articles was assessed using Cochrane Handbook and the meta-analysis was performed utilizing RevMan 5.3. Heterogeneity was evaluated by the I2 statistic and as there was heterogeneity between the studies, subgroup analysis was carried out based on the control group. Since the anxiety assessment tools in the included studies were identical, the mean difference (MD) was reported. The quality of the evidence was assessed using the GRADE approach. Results: Six studies that included 643 pregnant women were investigated in this systematic review. The results of the meta-analysis using five of the studies revealed that reflexology significantly lowered the mean scores for maternal anxiety compared to routine care or simple massage (MD: -11.34; 95% CI: -16.28 to -6.40). None of the studies reported any specific side effects after reflexology treatment. Conclusion: Reflexology can decrease maternal anxiety during labor. However, given the small number of studies and the high or unclear bias risk in most of them, no definitive conclusions can be drawn, and it is recommended that further research with stronger methodologies be conducted on this subject.

Coronavirus disease (COVID-19) is probably the biggest international crisis in Worldwar- 2. Health care workers are any country’s biggest asset at the time of coronavirus pandemic. A pregnant health care worker involved in patient care may face multiple risks for herself and her foetus. This article briefly discusses the problems faced by pregnant health care staff and works out possible solutions for the same. Workplace health protection for herself and her unborn fetus is the right of all pregnant health care workers and a uniform policy ensuring the same is the need of the hour.

Background: Patients' preferences towards their physicians constitute a crucial part of providing patient-centered care. Gender preference of patients towards gynecologists/obstetricians is controversial. Objective: The authors aimed to develop and validate a scale that specifically assesses the gender preferences of patients toward physicians in the obstetrics and gynecology field. Materials and Methods: This epidemiological cross-sectional study was conducted on 1192 participants in Lebanon. The questionnaire used consisted of two parts; the first part was related to sociodemographic questions and obstetrics and gynecology specialists’ overview, and the second part was divided into males' and females' perceptions of gynecologists. The newly developed GPGO scale, consisting of 13 items, was only intended for females. Statistical analysis was performed to test the internal reliability, convergent validity, and construct validity. Overall, there were 1192 respondents, 890 females and 302 males. In this study, we only included females’ responses. Results: Tests of assumptions of sample adequacy showed communalities higher than 0.3. Factor analysis of the 13 items in the GPGO scale revealed two main components. Items were adequately loaded into each component. The scale’s Cronbach alpha indicated internal reliability to be good (0.861); component 1 had acceptable internal reliability (Cronbach alpha = 0.745), while component 2 had high internal reliability (Cronbach alpha = 0.846). Pearson correlation coefficients were 0.877 (p<0.0001) and 0.898 (p<0.0001), respectively. Therefore, the scale showed adequate convergent validity. Conclusion: The resulting GPGO scale, which assesses the preference of patients towards gynecologists and obstetricians, is validated for use in females aged 18 years old and higher. The scale can be used in future studies for comparison or prospective follow-up.

The renin-angiotensin system (RAS) is a signaling pathway that acts as a major regulator in human physiology. To sidestep the major intimidations of low blood volume and low blood pressure, the diverse actions of Ang II/ACE/AT1R can be viewed as a useful response in maintaining homeostasis. The deleterious action of the Ang II/ACE/AT1R axis is endogenously counterbalanced by ACE 2/Ang 1-7/MasR. Yet, over activation of the Ang II/ACE/AT1R axis may lead to hypertension. Preeclampsia is characterized by hypertension with proteinuria or end-organ dysfunction after 20 weeks of gestation. The early-onset sort is more genuine and capable of high maternal and fetal dismalness and mortality rates than the late-onset sort of preeclampsia. Various theories for the pathogenesis of preeclampsia are, the exact underlying molecular mechanisms remain unclear but are likely to be multifactorial. Later studies of RAS in preeclampsia have highlighted the need for thorough research on this topic. There is an increase in the levels of circulating angiotensinogen during the first 20 weeks of gestation. At the beginning of the pregnancy, there is an increment of prorenin by 4 - 5 times. Renin synthesis in preeclampsia is suppressed. PE pregnant women have higher levels of prorenin receptor expression in their placental tissue than normal pregnant women. AT1 receptor autoantibodies are also observed. Ang II is raised in normal pregnancies as a result of higher levels of angiotensinogen and renin. Preeclampsia causes a decrease in angiotensin-(1-7) levels. Aldosterone is also relatively low in pregnancies complicated by preeclampsia.

Objectives: Preeclampsia (P.E) and Eclampsia are hypertensive disorders of pregnancy that complicate 2-8 % of pregnancies globally. Hypertensive disorders of pregnancy constitute one of the leading causes of maternal and perinatal mortality worldwide. The incidence of Preeclampsia in Lebanon was estimated at 2.84%. This study aimed primarily to evaluate the knowledge and practices of Lebanese obstetricians and secondary to identify the factors associated with these scales. Methods: A cross-sectional study was conducted between September and December 2020 in obstetricians’ clinics of different healthcare institutions. Data was collected using a questionnaire based on the recommendations of the National Institute for Health and Care Excellence (NICE) guidelines and the American College of Obstetricians and Gynecologists (ACOG) preeclampsia 2020 guidelines. In private clinics, the investigator visited the medical doctor. Each doctor agreed to participate in the research, signed the consent form, and filled out the distributed questionnaire without any intervention from the investigators. In the hospitals, the questionnaires were distributed to the Obstetrics and Gynecology Department. Results: In this study, 95 doctors were recruited. The practice score of more than half of the 95 doctors (54.7%) is low. The mean of their knowledge score (14.5) is higher than the mean of their practice score (8.5). Almost all doctors have a high knowledge score (96.8%), but more than half of them have poor practice scores (54.7%). A linear regression showed that the knowledge score decreased for doctors who live in Bekaa. A second linear regression showed that the practice score decreased for doctors who live in Bekaa (p=0.001). However, training on preeclampsia (p<0.001) increased the practice score. A third linear regression showed that the total score decreased for doctors living in Bekaa (p<0.001). However, having a board certificate (p=0.03) and training in preeclampsia (p=0.008) increased the total score. Conclusion: Different continuous medical education activities should be available widely and mandatory for all working doctors to improve their knowledge and practice towards preeclampsia. Preeclampsia can be fatal and every single maternal life should count.

Background and Objective: Cesarean section (CS) is one of the most common obstetric procedures performed worldwide, and new research indicates that the frequency of CS is increasing. Maternal-fetal morbidity and death due to CS is a serious public health problems worldwide. Our study aimed to assess the impact of multiple cesarean sections (CSs) on mother-fetal morbidity. Methods: This cross-sectional study was performed on 165 women who underwent multiple repeated CSs in our clinic and met the criteria of inclusion by evaluating their records. All women were divided into 3 groups according to the number of CSs: 2nd (n = 111), 3rd (n = 44), and 4th/5th (n = 10). Maternal-neonatal outcomes; blood transfusion needs, adhesions, APGAR scores, and respiratory difficulties were investigated retrospectively. Results: Our results revealed that adhesion (60.6 %) was the most frequent maternal complication. The prevalence of thick adhesions decreased with the number of cesarean sections performed (70, 25, and 5 cases for the previous 2nd, 3rd, and 4 or more CS, respectively). There was no statistically significant difference between the groups in terms of adhesions, uterine rupture, bladder injury, endometritis, and wound infection. NICU admission (14.5 %), Low birth weight (3.6 %), and IUGR (3.03 %) were among the unfavorable fetal outcomes. There was a significant difference among the three studied groups regarding APGAR score, maternal age, and hospital stay, while a nonsignificance was found in birth weight and maternal adhesion. Conclusion: Our findings support our hypothesis that the likelihood of maternal complications rises as the number of CSs rises. The manner and time of delivery have a greater impact on infant outcome than the number of CSs. There is no clear absolute barrier for the number of CSs. However, 4 or more cesarean births were recognized as the essential level for the majority of outcomes. The number of CSs must be decreased to reduce the associated issues.

Background: Choriocarcinoma and other placental tumors are rare, and metastasis to the gastrointestinal, especially the small bowel, is extremely rare. Furthermore, about 5% of all metastasis belongs to the GI tract. Case Presentation: We reported an 18 -year-old patient with severe GI bleeding. Serum BHCG level was 57322 mIU/mL. CT angiography and Pelvic MRI suggested a metastatic arteriovenous malformation to the small bowel. In surgery, we detected the AVM from the right side of the uterus to the ileum, and pathological findings confirmed the choriocarcinoma with metastatic AVM to the ileum. Conclusion: Chemotherapy started after surgery, and the patient was asymptomatic on follow-up after 14 months. The results showed that GTN was a differential diagnosis when patients are referred with these signs and symptoms.

Objective: Non-puerperal uterine inversion is a rare occurrence. The common etiology for this condition is uterine sarcoma, endometrial carcinoma, and myoma. Case Presentation: This case is a 44-year-old woman with a protruding malodorous vaginal mass, abdominal pain, and urinary retention. Total hysterectomy with bilateral salpingectomy was performed. Conclusion: Diagnosis of uterine inversion might be difficult and requires a high index of suspicion.

Background: Fear of childbirth is a common problem in pregnant women, which usually results in increased request for Cesarean section deliveries. The present study was conducted to evaluate the effect of education based on the theory of planned behavior on fear of childbirth and choosing vaginal delivery among pregnant women. Methods: One hundred pregnant women at 20-36 weeks’ gestation who were covered by the health centers of Aleshtar, Iran were selected using simple random sampling. After pretest using two valid and reliable questionnaires (one researcher-made questionnaire and the Childbirth Attitudes Questionnaire (CAQ)), the samples were randomly allocated to intervention and control groups. The intervention group attended four educational sessions. Then, after the intervention, the above questionnaires were administered in both groups once again. Data were analyzed using one-way analysis of variance, t test, chi-square test, Mann-Whitney test, and Wilcoxon test. Results: There was no significant difference in the constructs of the theory between the two groups before the intervention while significant differences were observed in the scores of knowledge , attitude, and perceived behavioral control (P = 0.001), intention to choose vaginal delivery (P = 0.004), and vaginal delivery (P = 0.001) between the two groups. Conclusions: Education based on the theory of planned behavior could significantly affect the fear of childbirth and increase the vaginal delivery rate.

Background: Sex without a condom poses the highest risk of sexually transmitted infections among (STIs) female sex workers (FSWs). Objectives: This systematic review and meta-analysis was conducted to summarize the evidence related to barriers to condom use among FSWs. Methods: We searched Web of Science, PubMed, and Scopus using keywords, such as “condom use” and “sex worker” and the related synonyms. The pooled effect size was expressed as odds ratios (ORs) with 95% CIs using a random-effects model. Results: Of the 5,854 studies obtained in the initial search, 35 with a sample size of 14,218 met the eligibility criteria and were included in the final analysis. Three factors identified in studies, i.e., marital status (OR = 1.15; 95%CI [0.74, 1.50]), alcohol consumption (OR = 1.22; 95%CI [0.84, 1.59]), and STIs knowledge (OR = 1.07; 95%CI [0.54, 1.59]), were not significantly associated with not using condom among FSWs. Also, 7 factors identified in studies, i.e., history of violence (OR = 1.84; 95%CI [1.36, 2.31]), history of sexual abuse (OR = 1.87; 95%CI [1.36, 2.38]), history of STIs (OR = 1.54; 95%CI [1.10, 1.97]), HIV risk perception (OR = 1.81; 95% CI [1.58, 2.05]), knowledge of condom use (OR = 1.53; 95%CI [1.15, 1.91]), drug use (OR = 1.62; 95%CI [1.10, 2.14]), and condom use self-efficacy (OR = 1.75; 95%CI [1.52, 1.98]), were significantly associated with not using condom among FSWs. Conclusion: Many factors affect condom use among FSWs. However, in this study, the history of sexual abuse, history of violence, and HIV risk perception were identified as the main barriers to condom use among FSWs.

Background: Preconception care (PCC) is one of the most important components of healthcare services for women of reproductive age. Focusing on improving preconception health can lead to improved reproductive outcomes, healthier pregnancies, and healthier babies. Aims: The aim of the study was to determine the predictive factors of receiving PCC in pregnant women of Qazvin. Methods: The present cross-sectional study was conducted from March 2018 to September 2019. Participants included 350 pregnant women in their 6-14 weeks of gestation, who had been referred to a selected comprehensive health center (CHC) for their initial prenatal visits. A two-stage cluster sampling was used to access the samples with maximum socioeconomic and cultural diversity. Data were collected using a questionnaire on demographics, fertility, and factors that affect access to PCC; a questionnaire on perceived social support; and a general self-efficacy questionnaire. Data were analyzed using uni-variable and multivariable logistic regression methods with SPSS software version 25. Results: In the present study, 57.5% of the participants had received PCC. More than 75% of them received this care less than a year ago at a CHC. In the final model, wanted pregnancy (OR= 11.68), awareness of PCC (OR= 8.86), and history of ART for current pregnancy (OR= 7.18) were the strongest predictors for PCC reception. Conclusion: Women of reproductive age appear to benefit strongly from PCC services when they have planned their pregnancy and are aware of PCC services. Therefore, information related to the opportunities and potential outcomes of PCC should be made publicly available. In addition, healthcare providers should focus more on providing patients with information about preconception counseling.

Background and Objective: Diabetes in pregnancy can lead to severe neonatal and maternal adverse events. Moreover, there is an increase in GDM prevalence. Therefore, we aimed to compare insulin detemir (IDet) with the neutral protamine Hagedorn (NPH) in diabetic pregnant women. Methods: We searched four electronic databases until August 2021: PubMed, Scopus, Web of Science, and Cochrane. We included randomized controlled studies that compared IDet with NPH in diabetic pregnant women. We extracted both maternal and neonatal outcomes, and used RevMan software to conduct the analysis. Results: Five studies were included. The analysis showed a significantly lower risk of hypoglycemic events during pregnancy in the IDet group than the NPH group [RR = 0.6, 95% CI [0.43, 0.84], p = 0.003], and a higher gestational age (GA) at delivery in the IDet group than the NPH group [MD = 0.28, 95% [0.02, 0.55], p = 0.03]. On the other hand, the analysis revealed non-significant differences between IDet and NPH in terms of birth weight, congenital anomalies, neonatal hypoglycemia, preterm delivery, and others. Conclusion: Insulin detemir (IDet) was preferred over neutral protamine Hagedorn (NPH) in terms of showing lower rates of hypoglycemic events during pregnancy and a higher gestational age at delivery. Meanwhile, there were non-significant variations between them with respect to neonatal outcomes, such as weight at birth, congenital anomalies, or neonatal hypoglycemia.

Postbiotics are known as preparations comprising inert microorganisms and/or their ingredients that activate health profits on the host. They stimulate the intestine microbiome, support gut immune activity, and prevent pathogenic microorganism duplication. Although postbiotics are a type of probiotic waste, they can apply some beneficial effects on human health, such as antiobesity, antioxidant, immunomodulatory, and anti-carcinogenic. Accordingly, many studies suggested a conclusive effect of postbiotics on polycystic ovary syndrome (PCOS) in women and depressive symptomatology. The aim of our study was to provide an updated review of these subjects. We conducted a systematic search of the literature in multiple databases, such as Web of Science, Google Scholar, Science Direct, and PubMed based on some keywords. In the current review, we have focused on better understanding of postbiotics on consumers’ health providing a base for future investigation.

Background: Healthy and satisfying sex life is one of the important elements of well-being and quality of life in women. Objectives: This study aimed to investigate the effect of sexual counseling on self-efficacy, assertive sexual communication, self-awareness, sexual attitude, awareness of sexually transmitted diseases, and HIV in addicted women in mandatory drug treatment camps. Material and Methods: The present study was conducted on 68 women in two groups (intervention = 34, control = 34). The intervention group received the counseling program. The control group received routine services from the rehabilitation center. Results: The results showed that in the intervention group, 31 (100) before the intervention and 26 (86.7) 4 weeks after intervention (p = 0.05), had heard the name of STDs (p = 0.28). Moreover, 12 (38.7) participants in the intervention group and 12 (38.7) in the control group could name 4 symptoms of STDs in women 4 weeks after intervention (p = 0.001). Additionally, the sexual attitude was 44.64 ± 4.21 and 45.38 ± 4.09 in the intervention group and 40.66 ± 4.50 and 39.93 ± 4.71 in the control group 4 and 8 weeks after the intervention, respectively. (p = 0.01). Moreover, the obtained results showed that the mean score of sexual knowledge was 40.25 ± 3.62, 41.74 ± 3.44 and 36.36 ± 5.37 in the intervention group 4 and 8 weeks after the intervention, showing a significant difference (p = 0.02). Conclusion: The findings of this study showed that sexual knowledge, sexual attitude and selfefficacy, and sexual assertiveness could be improved through interventions based on skills and empowerment. In addition, by presenting knowledge on STDs, condom use for safe sex in addicted women can be increased.