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Background: Despite conflicting findings in the current literature regarding the correlation between contraceptives and maternal health consequences, statistical analyses indicate that family planning may decrease the occurrence of such outcomes. Consequently, it is crucial to assess the capability of family planning to mitigate adverse maternal health outcomes. Objectives: This review investigates the effects of modern contraceptive use on maternal health. Search methods: This systematic review is registered on Prospero (CRD42022332783). We searched numerous databases with an upper date limit of February 2022 and no geographical boundaries. Selection criteria: We included observational studies, including cross-sectional, cohort, case-control studies, and non-RCT with a comparison group. We excluded systematic reviews, scoping reviews, narrative reviews, and meta-analyses from the body of this review. Main results: The review included nineteen studies, with five studies reporting a reduction in maternal mortality linked to increased access to family planning resources and contraceptive use. Another three studies examined the impact of contraception on the risk of preeclampsia and our analysis found that preeclampsia risk was lower by approximately 6% among contraceptive users (95% CI 0.82–1.13) compared to non-users. Two studies assessed the effect of hormonal contraceptives on postpartum glucose tolerance and found that low-androgen contraception was associated with a reduced risk of gestational diabetes (OR 0.84, 95% CI 0.58–1.22), while DMPA injection was possibly linked to a higher risk of falling glucose status postpartum (OR 1.42, 95% CI 0.85–2.36). Two studies evaluated high-risk pregnancies and births in contraceptive users versus non-users, with the risk ratio being 30% lower among contraceptive users of any form (95% CI 0.61, 0.80). None of these results were statistically significant except the latter. In terms of adverse maternal health outcomes, certain contraceptives were found to be associated with ectopic pregnancy and pregnancy-related venous thromboembolism through additional analysis. [ABSTRACT FROM AUTHOR]

Background and Objectives: Unintended pregnancy is considered one of the critical indicators of community health as being a risk factor in unsanitary abortions, miscarriage, and insufficient prenatal care. This study aimed to determine the frequency of unintended pregnancy and the related factors in married women. Materials and Methods: The study was conducted on 1013 married women aged 15-49 who were referred to health centers in the South of Tehran. To analyze the data, single and multiple logistic regressions were used. Results: About 50% of participants had already experienced at least one unintended pregnancy. Analysis showed the following predictive factors for unintended pregnancy: being within the age range of 26 to 40 (AOR, 95% CI = 1.91; 1.25-2.90), being over 40 years of age (AOR, 95% CI = 1.96; 1.04-3.71), spouse education level of high-school or lower (AOR, 95% CI = 1.64; 1.11-2.42), first marriage age range of 21 to 30 years (AOR, 95% CI = 0.64; 0.47-0.88), use of the DMPA method as contraception (AOR, 95% CI = 3.42; 1.16-10.06), history of tubectomy (AOR, 95% CI = 4.45; 1.99-10) and history of vasectomy (AOR, 95% CI = 4.61; 1.18-17.98). Conclusions: Training and distribution of free contraceptive methods would be much more effective and less expensive than paying for costly illegal induction of abortion and unwarranted complications due to abortion. Implications: Vulnerable women who are referred to health centers to receive health services should be trained in contraceptive methods and be informed of the probability of unintended pregnancy with each contraceptive method and the consequences of self-induced abortion. [ABSTRACT FROM AUTHOR]

Introduction: Risky sexual behaviors. Adequate awareness of reproductive health in young people is important because they are in the early years of fertility, and engaging in risky sexual behaviors is more probable. This study aimed to evaluate the sexual attitude and associated factors of risky sexual behaviors among girls and boys and the difference in sexual norms by gender among university students. Methods: A university‐based study with a cross‐sectional survey was conducted for 9 months in 2019. A total of 800 university students were studied by a random sampling technique using a self‐administered structured questionnaire derived from the World Health Organization illustrative questionnaire to assess sexual attitudes among adolescents and young adults. Results: Most of the respondents were female and single. Girls were more religious, more frequently visited the cinemas and were more likely to discuss sex matters with family members than boys. There was no significant difference in the total score of sexual attitudes in girls and boys, and both genders had negative attitudes toward risky sexual behavior (42/72). Those who go to parties, bars, or movies are more likely to have risky sexual behavior. Being a religious person is an essential predictor of having less risky behavior (RR = 2.02, 95% CI = [0.96, 3.41]). Conclusion: Being religious was a protective factor for engaging in risky sexual behavior. More interventions in schools and universities need to educate students to enhance awareness about the consequences of risky sexual behavior and reduce its rate. [ABSTRACT FROM AUTHOR]

Background: Numerous factors play a role in maternal identity formation and function. Recognizing the aspects related to adaptation to the mother role can effectively provide a solution to help mothers construct maternal roles. Consequently, this study aimed to determine the predictors of adaptation to the maternal role in Iranian women.Methods: This cross-sectional study was performed on 564 women who gave birth within one to four months after delivery with a record in Tabriz-Iran health centers, 2020-21. Participants were selected by cluster sampling. Data were collected using questionnaires of socio-demographic and obstetrics characteristics, Birth Satisfaction Scale-Revised (BSS-R), Lipz Maternal Self-Confidence Scale (LMSCS), and maternal role adaptation questionnaire. The general linear model was used to estimate the effect of each of the independent variables (socio-demographic and obstetrics characteristics, childbirth satisfaction, and self-confidence) on the dependent variable (maternal role adaptation).Results: The mean (± SD) total scores of adaptation to the maternal role, childbirth satisfaction, and maternal self-confidence were 77.4 (± 15.2) (score range: 33-165), 17.0 (± 5.9) (score range: 0-40), and 65.1 (± 13.5) (score range: 24-144), respectively. Based on the Pearson correlation test, there was a significant direct correlation between the overall score of adaptation to the maternal role with childbirth satisfaction (r = 0.462, P < 0.001) and maternal self-confidence (r = 0.652, P < 0.001). Based on the adjusted general linear model, the variables of maternal self-confidence, childbirth satisfaction, adequacy of household income, and spouse support were predictors of adaptation to the mother role. They explained 50.6% of the variance in the adaptation to the mother role score.Conclusions: Concerning the study results, adaptation to the maternal role is related to childbirth satisfaction and some socio-demographic variables. Therefore, considering the impact of maternal role on other aspects of women's life and child care, healthcare providers' and policymakers' critical role is to create positive childbirth experiences and strengthen mothers' self-confidence. [ABSTRACT FROM AUTHOR]

Understanding the relationships and sexual behavior of university students will help educators and service-providers meet the reproductive health needs of students. This study aimed to investigate the prevalence of relationship behaviors and their predictors among students attending an American university. A cross-sectional survey was carried out among 924 students attending Central Michigan University. A self-administered structured questionnaire was derived from the World Health Organization and sent via emails to the participants. Descriptive analysis, bivariate and linear regression were used to analyze the data. This study showed that the average age of the first sexual encounter was 18.20 ± 4.31 years and the prevalence of having a girlfriend/boyfriend among university students was 92.1%. In total, 86.9% of students described their relationship as serious, 95.4% of cases announced that their boy/girlfriend was single when they started the relationship and someone who was working or were a full-time student (93.8%). Our results showed that only age was associated with relationship behavior among sociodemographic characteristics as older students had higher relationship behavior scores (OR: 0.09, CI 95% [0.03, 0.16]). There was no association between students' knowledge of risky sexual behavior and sex education (OR: 0.04, CI 95% [0.71–0.17]). Moreover, the history of sex education during school years was not associated with relationship behavior during university years. This study showed that although university students started their sexual relationship at a reasonable age, their knowledge about risky sexual behavior was not significantly associated with sex education. Future interventional studies pointing to the sexual knowledge and behavior of university students are recommended. [ABSTRACT FROM AUTHOR]

Background: Low birth weight might affect adverse health outcomes during a lifetime. Our study analyzes the association between low birth weight and negative health outcomes during adulthood in twin populations. Methods: Searches were conducted using databases inclusive of MEDLINE, CINAHL, Web of Science, and EBSCO. Observational studies on twins with low birth weight and adverse health outcomes during adulthood were included. Two reviewers independently screened the papers, and a third reviewer resolved the conflicts between the two reviewers. Following abstract and title screening, full-texts were screened to obtain eligibility. Eligible full-text articles were then assessed for quality using a modified Downs and Black checklist. Studies with a score within one standard deviation of the mean were included in the analysis. A fixed-effect model was used for analysis. Results: 3987 studies were screened describing low birth weight as a risk factor for adverse health outcomes during adulthood for all twelve-body systems (circulatory, digestive, endocrine, lymphatic, muscular, nervous, reproductive, respiratory, skeletal, urinary, and integumentary systems). One hundred fourteen articles made it through full-text screening, and 14 of those articles were assessed for quality. Five papers were selected to perform two meta-analyses for two outcomes: asthma and cerebral palsy. For asthma, the meta-analyses of three studies suggested a higher odds of low birth weight twins developing asthma (OR 1.33, 95% CI 1.24-1.44, I2 = 77%). Meta-analysis for cerebral palsy included two studies and suggested a 4.88 times higher odds of low birth weight twins developing cerebral palsy compared to normal birth weight twins (OR 4.88, 95% CI 2.34-10.19, I2 = 79%). We could not find enough studies for other adverse health outcomes to pool data for a Forest plot. Conclusions: The odds of low birth weight were found to be high in both asthma and cerebral palsy. There are not enough studies of similar nature (study types, similar body systems) to ensure a meaningful meta-analysis. We recommend that future research considers following up on twins to obtain data about adverse health outcomes during their adult lives. [ABSTRACT FROM AUTHOR]

Background: Sexual function, a significant contributor to quality of life, is affected by various factors, including overall mental health. COVID-19 is a current pandemic that influences the mental health of various populations, especially pregnant women. Despite the importance of sexual health, the specific nature of its relationship to overall mental health during the COVID-19 pandemic is not clearly defined. Thus, this study investigates the relationship between sexual function and mental health during the COVID-19 pandemic in Iranian pregnant women.Methods: This descriptive-analytical, cross-sectional study was carried out among 437 pregnant women using the sociodemographic and obstetrics characteristics questionnaire, Female Sexual Function Inventory, Stress, Depression, and Anxiety Scales. Random sampling was employed to select pregnant women who had a medical record in Health Centers of Tabriz city, Iran. The questionnaires were sent to the participants' cell phones via WhatsApp or text messages, including links of questionnaires and the participants completed these questionnaires. Spearman correlation test was used to determine the relationship between sexual function and stress, anxiety, and depression. Generalized linear modeling was used to estimate each of the independent variables (sociodemographic characteristics, stress, anxiety, and depression) on the dependent variable (sexual function).Results: The mean (Standard Deviation) sexual functioning (total) score was 20.0 (8.50) from the available range of 2 to 36. The mean (SD) of depression, stress, and anxiety scale was 4.81 (5.22), 5.13 (4.37), and 7.86 (4.50) (possible score ranging from 0 to 21), respectively. Based on Spearman's correlation test, there was a significant reverse correlation between the total sexual function score and stress, anxiety, and depression, indicating that all three variables negatively impacted sexual functioning. Variables such as mild stress, spouse type of job, sufficient household income, living with parents, higher marital satisfaction, and higher gestational age had a significant, positive impact on sexual function and could predict 35.8% of the variance model.Conclusions: Sexual functioning was significantly impacted by stress, anxiety, and depression - all of which are heightened during a pandemic. This topic warrants further study, and the general public should be educated on the protective influence of safe sex/intimacy on overall mental health. [ABSTRACT FROM AUTHOR]

Background: The present study was conducted to investigate the relationship between metabolic syndrome and the risk of respiratory and sleep disorders in professional drivers. Methods: This case-control study was conducted on professional drivers in Shahroud, Iran. The snoring, tiredness during daytime, observed apnea, high blood pressure, body mass index, age, neck circumference, gender (STOP-Bang) questionnaire was first used to assess obstructive sleep apnea (OSA). Then, based on the questionnaire scores, the participants were divided into two groups: those with and those without OSA. The relationship between this disorder and metabolic syndrome was then studied. Data were analyzed using descriptive and analytical tests (P<0.05). Results: Based on the STOP-Bang questionnaire, 214 drivers with a high risk of OSA and 214 drivers with low risk were recruited for the study. According to the Adult Treatment Panel III criteria, 204 drivers (47.7%) had metabolic syndrome. There was a significant relationship between driver's license class and the risk of OSA. Metabolic syndrome components including fasting blood sugar, triglycerides, and hypertension, but not high-density lipoprotein cholesterol, were able to predict OSA in the professional drivers. Conclusion: Given the high prevalence of metabolic syndrome and OSA, especially in drivers of high risk who may spend long hours transporting good and operating passenger vehicles, screening and treating these disorders are crucial in this part of the population. The researchers recommend holding regular training sessions about these disorders for professional drivers. [ABSTRACT FROM AUTHOR]

This section presents a correction to the article "Sexual Behavior Prevalence and Its Predictors Among Students in an American University," published in the June 28, 2021 online issue.

Background: Menstruation is a natural occurrence that women experience during their reproductive years and may encounter many years throughout their lifespan. Many adolescent females lack accurate knowledge about menstruation, so they may face issues from receiving incorrect information from unreliable sources. Our study aimed to investigate the practices and beliefs surrounding menstruation among Iranian adolescent females. Methods: This qualitative study was conducted using conventional content analysis. A purposeful sampling method was used to select 18 adolescent females from secondary and high schools located in the three regions of Neyshabur City-Iran. Data were collected through in-depth, semi-structured interviews. Results: Three main themes were extracted, consisting of lifestyle and related beliefs, lake of support, and awareness and information. Conclusions: misconceptions and wrong behaviors during menstruation indicate that the lake of knowledge an traditional factors influence adolescent girls' health. The study provides the basis for intervention planning in this regard and different levels (individual, intrapersonal, health systems, and community). [ABSTRACT FROM AUTHOR]

Introduction: Age at menarche (AAM) is the point in development when the female starts her first menstrual period and is one of the first milestones in female reproductive life. A combination of genetic and environmental factors plays a role in the timing of female's age at menarche.Material and Methods: This study's purpose was to investigate the association between the biological sex of the co-twin and the age at menarche experienced by the female twin. Females from pairs of female-female twins (n = 12,176) and female-male twins (n = 2286) were collected through the Washington State Twin Registry.Results: Environmental and genetic analyses were conducted. There was no significant difference between females with female twins and females with male twins regarding early, late or normal age at menarche (P = 0.87). However, the adjusted odds of early menarche among females with female twins were 35% lower than females with male co-twins (0.65, 95% CI 0.50-0.83). When using Falconer's formula, an estimated heritability of 0.81 was found with shared (21.8%) and non-shared (40.8%) environmental factors contributing to the age at menarche.Conclusion: Having a male twin during fetal life as a co-twin does not change the age of menarche in future life, although female-female twins have lower age of menarche compared to females from female-male pair. Both genetic and environmental factors determine the age of menarche. [ABSTRACT FROM AUTHOR]

Background: Genetic and environmental influences on anthropometric measures can be investigated by comparing dizygotic (DZ) versus monozygotic (MZ) twins. Investigating cohorts living in different geographical areas across the globe can identify the variation in heritability versus environment. Aims: (1) To investigate the association between birth weight and anthropometric measurements during adulthood; (2) to study the genetic and environmental influences on body measures including birth weight, weight and height among twins; and (3) to assess the variation in heritability versus environment among two cohorts of twins who lived in different geographical areas. Subjects and methods: Twins were collected from two twin registers. Data on birth weight, adult weight and height in 430 MZ and 170 DZ twins living in two geographically distinct parts of the world were collected. A genetic analysis was performed using MX software. Results: Birth weight was associated with weight, height and BMI. Both MZ and DZ twins with low birth weight had shorter height during their adult life (p = 0.001), but only MZ twins with lower birth weight were lighter at adulthood (p = 0.001). Intra-pair differences in birth weight were not associated with differences in adult height (p = 0.366) or weight (p = 0.796). Additive genetic effects accounted for 53% of the variance in weight, 43% in height and 55% in birth weight. The remaining variance was attributed to unique environmental effects (15% for weight, 13% for height and 45% for birth weight and only 16% for BMI). Variability was found to be different in the two cohorts. The best fitting model for birth weight and BMI was additive genetic and non-shared environment and for weight and height was additive genetic, non-shared environment (plus common Environment). Conclusions: Data suggests that the association between weight at birth and anthropometric measures in later life is influenced by both genetic and environmental factors. Living in different environments can potentially relate to variation found in the environment. [ABSTRACT FROM AUTHOR]

Introduction Motor vehicle accidents are a significant cause of morbidity and mortality. Safe driving behavior constitutes proper use of seat belts as a driver and as a passenger. The correct use of seat belts has been shown to reduce death and injury following motor vehicle accidents by more than 50%. This study aims at investigating seat belt use and driving habits among Canadians. Method A population-based database from the Canadian Community Health Survey was analyzed. Result About 12% reported that they use seat belts most of the times, rarely or never and 27% of respondents were using cellphone while driving often or sometimes; 8% of respondents admitted to driving after 2 or more alcoholic drinks. Seat belt use in taxi passengers is much lower than in own cars, with 40% not using a seatbelt all of the time when in a taxi. Discussion and conclusions The major risk factors for not wearing seat belt as a passenger include age, education, ethnicity and income. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine whether twin pregnancies with birth weight discordance were associated with higher rates of maternal morbidities. Study design: A large retrospective population-based cohort study of twins born in British Columbia, Canada, from 2000 to 2010 was performed. Maternal morbidities and growth discordant were evaluated. Results: There were 6,328 twin deliveries during the study period. Pregnancies carrying growth-discordant twins had higher frequencies of hypertension disorders, preterm labor, and cesarean delivery compared with growth-concordant twins. They also stayed longer than 3 days in hospital. Multivariate generalized estimating equation modeling found higher odds of preeclampsia, pregnancy-induced hypertension, preterm delivery, and cesarean delivery in mothers carrying growth-discordant twins compared with those carrying growth-concordant category. The modeling also resulted in higher odds in the length of stay longer than 3 days in mothers carrying growth-discordant twins compared with those carrying growth-concordant twins after adjustment for chorionicity. Conclusion: Maternal complications are associated with growth discordance. Screening for birth weight discordance during pregnancy may alert clinicians to predict subclinical maternal conditions. [ABSTRACT FROM AUTHOR]

Background: According to World Health Organization (WHO), the postnatal care provision aims to provide care and treatment with the highest quality and the least intervention to obtain the best health and well-being for the family. The present study aims to adapt international guidelines for the clinical recommendations for the postpartum period and implement and determine its effectiveness. Methods/design: This study will be done in two phases. In the first phase, international clinical guidelines for mother and newborn postnatal care will be adapted. The second phase is a randomized controlled trial in which the adapted guideline recommendations will be implemented, and maternal and neonatal outcomes will be measured. The ADAPTE method for adaptation of clinical guidelines, is usedg in the first phase. A systematic review was conducted in the databases and clinical guidelines related to postpartum care were extracted according to the inclusion criteria. The quality of clinical guidelines was evaluated using the AGREE-II tool. The WHO clinical guideline obtained the highest evaluation score and was chosen as the main guideline, and the NICE clinical guideline, with a second higher evaluation score, was also used to fill some gaps in the WHO guideline. Based on the pre-determined questions, recommendations will be sent to the relevant experts and stakeholders for their evaluation. After the external evaluation and the finalization of the recommendations, the postpartum clinical guideline will be compiled and used in the second phase of the study. In the second phase, 272 women in the immediate postnatal stage of the maternity and postpartum ward of Taleghani and AL-Zahra Hospitals in Tabriz will be assigned into the intervention (receiving care based on adapted guidline recommendations) and control (receiving routine hospital care) groups uing individual stratified block randomization. At 6 weeks after birth, we will complete the Edinburgh postnatal depression scale, postpartum specific anxiety scale and Barkin index of maternal functioning (to assess the primary outcomes), as well as a maternal health problems checklist, infant care behavior, and violence assessment questionnaires (to asses the seconadary outcomes). Further, the maternal health problems checklist and the Edinburgh postnatal depression scale will be completed in the second week after birth. The data will be analyzed using an independent t-test and ANCOVA. Discussion: It is expected that the implementation of evidence-based clinical guidelines improves maternal and neonatal outcomes and experience of the postpartum period. The positive experience can also help to achieve Iran's population policies and the need to increase childbearing in the country. Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N76; Date of registration: 27/1/2023. URL: https://en.irct.ir/user/trial/66874/view; Date of first registration: 27/3/2023. Plain language summary: The postpartum period, starting immediately after childbirth up to the first six weeks (42 days), is a significant and critical period in the lives of mothers and newborns, spouses, caregivers, and families. Maternal and newborn deaths and complications are high during the postpartum period. Postpartum care with high quality could reduce maternal and newborn deaths and complications, and makes the mother have a positive childbirth experience and a favourable attitude toward her next birth. World Health Organization (WHO) recommend providing medical care and treatment with the highest quality and the least intervention to obtain the best health and well-being conditions for the family. The present study aims to localize and use the international recommendations for the postpartum period in Iran. This study will be done in two phases. In the first phase, the international recommendations for mother and newborn care and postnatal well-being will be adapted according to our country's resources and conditions. In the second phase, the recommendations of adapted guideline will be implemented on 272 mothers and newborn in two groups in the maternity and postpartum ward of Taleghani and AL-zahra Hospitals in Tabriz, and we compare the result of using these recommendations and routine care on mothers' and newborns' well-being. In clinical guideline recommendations group, we will educate mothers, fathers and families and will share with them adapted recommendations, up to 6 weeks after birth and we will support them via the network. During the postpartum period we will assess mental and physical health problems of the mothers; counsel about breastfeeding, baby care, family planning, nutrition, activity, pain killer, bonding and emotional attachment, and prevention of postpartum depression; and any questions will be answered. [ABSTRACT FROM AUTHOR]

Objective: Our purpose was to examine the association between discordant growth and perinatal mortality and morbidity among twins with careful adjustment for maternal confounding factors. Study design: Two cohorts with and without chorionicity data were compared using generalized estimating modeling. Results: Our population-based dataset consisted of 12,656 individual twins from whom 4% (452/12,656) had ≥ 30% growth discordance. A subgroup of this population with chorionicity information had an incidence of 7.3% ≥ 30% growth discordance. In growth-discordant twins, perinatal mortality and morbidity were higher than concordant pairs (P < 0.01). Low Apgar score and perinatal mortality were more frequent in growth-discordant twins compared with growth-concordant ones (all P < 0.01). Conclusion: Birth weight discordance (BWD) places twins at increased risk of perinatal mortality. Growth discordance was also an independent risk factor for lower Apgar score of 5 min less than 5. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is a chronic disease of the central nervous system with an unidentified etiology. We systematically reviewed the literature on the possible risk factors associated with MS disease onset, relapses and progression from 1960 to 2012 by accessing six databases and including relevant systematic reviews, meta-analyses, case-control or cohort studies. The focus was on identifying modifiable risk factors. Fifteen systematic reviews and 169 original articles were quality assessed and integrated into a descriptive review. Best evidence, which included one or more prospective studies, suggested that lower exposure to sunlight and/or lower serum vitamin D levels were associated with an increased risk of developing MS onset and subsequent relapses, but a similar quality of evidence was lacking for disease progression. Prospective studies indicated that cigarette smoking may increase the risk of MS as well as accelerate disease progression, but whether smoking altered the risk of a relapse was largely unknown. Infections were implicated in both risk of developing MS and relapses, but data for progression were lacking. Specifically, exposure to the Epstein-Barr virus, particularly if this manifested as infectious mononucleosis during adolescence, was associated with increased MS risk. Upper respiratory tract infections were most commonly associated with an increase in relapses. Relapse rates typically dropped during pregnancy, but there was no strong evidence to suggest that pregnancy itself altered the risk of MS or affected long-term progression. Emerging research with the greatest potential to impact public health was the suggestion that obesity during adolescence may increase the risk of MS; if confirmed, this would be of major significance. [ABSTRACT FROM AUTHOR]

Introduction: Literature suggests that male hormones influence fetal growth in singleton pregnancies. We hypothesized that the same phenomenon is seen in twin gestations.Objectives: (1) to identify the impact of gender associated with fetal birth weight, head circumference, and birth length for twins; (2) to examine the effect of gender on standardized fetal growth at birth, according to gestational age and birth order; (3) to examine the effect of gender on placenta weight and dimensions.Methodology: This was a population-based retrospective cohort study of twins (4,368 twins, 2,184 pairs) born in British Columbia, Canada from 2000-2010. We excluded twins with stillbirth, congenital anomalies, and those delivered with cesarean section. We also controlled for confounding factors, including birth order, gestational age, maternal anthropometric measures, maternal smoking habits, and obstetric history. A subsample of this population was analyzed from Children and Women Hospital to obtain chorionicity information.Results: Male-male twins were heavier than male-females and female-female twin pairs (p=.01). Within sex-discordant twin pairs, males were also heavier than females (p=.01). Regression analysis suggested that gender affects birth weight independent of birth order and gestational age. Other newborn anthropometric measures were not found to be dependent on gender. In analyzing a subsample with chorionicity data, birth weight was the only anthropometric measure that was both statistically and clinically affected by sex, even after adjustment for gestational age, chorionicity, birth order, and maternal age.Conclusion: Birth weight was affected by gender while head circumference and birth length were not. [ABSTRACT FROM AUTHOR]

The article discusses the potential of birth weight discordance (BWD) in detecting risk factors for perinatal results out of twin pregnancies. Topics covered include twin pregnancy conditions linked to BWD like Twin to Twin Transfusion Syndrome, Twin Anemia Polycythemia Syndrome, and Unequal Placental Sharing, the study applying information from databases such as MEDLINE, Web of Science and Paper First, and study results showing that BWD does not affect perinatal results of twin pregnancies.

Postpartum maternal functioning is a multidimensional concept defined as how a woman manages her daily activities and emotional health after giving birth. This study aimed to determine the predictors of postpartum maternal functioning. This cross-sectional study was conducted on 564 women within one to four months after giving birth (with registered medical records in health centers of Tabriz, Iran) from 2020–2021. The participants were selected based on the cluster sampling method, and data were collected using a standard questionnaire inclusive of sociodemographic and obstetric characteristics, obstetric history, and Barkin Index of Maternal Functioning (BIMF). The adjusted general linear model was employed to estimate the effect of each independent variable (sociodemographic and obstetric characteristics) on the dependent variable (maternal functioning). The mean total score of maternal functioning was 93.1 (±SD = 14.8) out of 120. Based on the adjusted generalized linear model (GLM), "spouse support" and "family support" were strong predictors of maternal functioning. The total score of maternal functioning in women with moderate (B: −4.44; 95% CI: −7.71 to −1.17; p < 0.001) and low (B: −4.77; 95% CI: −8.90 to −1.47; p < 0.001) spousal support was significantly lower compared to women who received a high level of spousal support. Additionally, this score in women with moderate (B: −5.22; 95% CI: −8.56 to −1.87; p < 0.001) and low (B: −3.90; 95% CI: −7.31 to −0.48; p < 0.001) family support was significantly lower compared to women who received a high level of family support. Study results suggest that receiving support from both a spouse and family members can improve maternal functioning. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the fertility knowledge and its related factors in married men and women in Zanjan, Iran. In this cross-sectional study, 1200 individuals (including 600 women aged 18–49 years and 600 men aged 18–59 years) referred to urban and rural health centres in Zanjan, were recruited through cluster sampling from June to September 2020. The Cardiff Fertility Knowledge Scale was used to assess fertility knowledge. Data were analysed by descriptive statistical methods such as mean and standard deviation and analytical statistics, including independent sample t-test, ANOVA test, Pearson Correlation and Linear Regression were used. The average correct scores of fertility knowledge were 49.7%, 53.3%, and 51.55% for men, women, and in total, respectively. The multiple linear regression model showed that fertility knowledge was significantly related to being female, being from a higher economic status, having desire to have children in the future, and having desire to increase fertility knowledge (all p < 0.05). Fertility knowledge among the Iranian reproductive-age men and women was modest. The findings suggested that interventions to increase fertility knowledge are essential, especially interventions targeting men and lower socioeconomic groups. [ABSTRACT FROM AUTHOR]

We aimed to determine (1) the prevalence of premenstrual syndrome in a sample of twins and (2) the relative contribution of genes and environment in premenstrual syndrome. A group of 193 subjects inclusive of same gender twins (n = 176) and females from opposite sex twin sets (n = 17) entered the study. Heritability analysis used same gender twin data only. The probandwise concordance rate for the presence or absence of premenstrual syndrome was calculated and the heritability of premenstrual syndrome was assessed by a quantitative genetic model fitting approach using MX software. The prevalence of premenstrual syndrome was 43.0% and 46.8% in monozygotic and dizygotic twins, respectively. The probandwise concordance for premenstrual syndrome was higher in monozygotic (0.81) than in dizygotic twins (0.67), indicating a strong genetic effect. Quantitative genetic modeling found that a model comprising of additive genetic (A) and unique environment (E) factors provided the best fit (A: 95%, E: 5%). No association was found between premenstrual symptom and the following variables: belonging to the opposite gender twin set, birth weight, being breast fed and vaccination. These results established a clear genetic influence in premenstrual syndrome. [ABSTRACT FROM AUTHOR]

The prevalence of domestic violence (DV) during pregnancy could be high and is associated with significant psychological and physical impairment for mother and the fetus. The major objective of this study was to determine the prevalence of DV in expectant mothers who have attended the Iran University of Medical Sciences’ Hospitals (IUMS). In this cross-sectional study, 1,800 subjects were interviewed using a modified questionnaire to determine the prevalence of DV. Consecutive sampling was performed in six major hospitals of IUMS according to the number of referred patients. The prevalence of DV was found to be 60.6% including three types of physical, psychological, and sexual violence with the prevalence of 14.6, 60.5 and 23.5%, respectively. Severe physical DV was 5.3%. Severe psychological and sexual DV were also found in about 24.6 and 3.4% of cases, respectively. DV had a high prevalence in this study. It is recommended that all accessible pregnant women be screened for DV. Study of the prevalence of DV within the community with a larger sample size, and using cluster-sampling methodology would be of immense value. [ABSTRACT FROM AUTHOR]

This feature highlights recently published Cochrane Reviews of interest to the readers of Obstetrics & Gynecology. The brief summaries are published below, and the complete references, along with a hyperlink, are listed in Box 1. [ABSTRACT FROM AUTHOR]

This feature highlights recently published Cochrane Reviews of interest to the readers of Obstetrics & Gynecology. This month, we focus on two obstetric reviews on umbilical cord clamping and induction of labor and one gynecology review on epithelial ovarian cancer. The brief summaries are published below and the complete references, along with a hyperlink, are listed in Box 1 BOX 1. ABSTRACTS DISCUSSED IN THIS SUMMARY. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome is one of the commonest and complex endocrine disorders in females of reproductive age. Attention to self-care behaviors such as health-promoting behaviors can improve physiological and psychological conditions in women with PCOS. This study aimed to determine the efficacy of Social Network-Based Motivational Interviewing on health-promoting behaviors and quality of life of infertile women with polycystic ovary syndrome. In this randomized controlled trial, 60 infertile women with polycystic ovary syndrome were randomly selected and assigned to the interventio (n = 30) or a control group (n = 30). Participants in the control group received routine care. Those in the intervention group received five motivational group sessions in WhatsApp, which were conducted in five groups of six participants each. The data related to health-promoting behaviors and quality of life were collected through an online questionnaire. Both groups were followed up immediately and 2 months after the intervention. Data collected in the two stages were analyzed using the paired-samples t-test, Chi-square, and repeated measures analysis. No significant difference was observed between the two groups before the intervention means health-promoting behaviors and quality of life scores (p>0.05). Immediately and two months after the intervention, the mean scores of health-promoting behaviors and their domains increased in the intervention group. This increase is statistically compared to the first test, and the scores obtained by the control group in the second (p< 0.001, ES = 1.5) and the third test (p< 0.001, ES= 1.3) were significant. The score of the quality of life variable increase was not statistically significant compared to the first test and also to the scores obtained by the control group. However According to the Generalized estimating equations (GEE) test, the changes in quality of life score between the two groups in the three stages of measurement are statistically significant. WhatsApp support increases the health-promoting self-care behaviors rate and has favorable effects on follow-up. Trial registration: Iranian Registry for Clinical Trial (the link to trial: ). Registered August 11 2020. [ABSTRACT FROM AUTHOR]

Aim: To determine the effectiveness of the progressive muscle relaxation (PMR) technique on anxiety caused by Covid‐19 in pregnant women under the auspices of comprehensive health service centers in the nineteenth district of Tehran University of Medical Sciences. Method: This study is a randomized clinical trial. A total of 126 pregnant women were randomly allocated to the intervention group (N = 63) and control group (N = 63). All participants completed demographic questionnaires and the Corona Disease Anxiety Scale electronically. The intervention was held in six sessions through Sky Room (three times a week). It consisted of training and practicing the PMR. The intervention group was re‐evaluated with the related questionnaires immediately after the intervention and 2 weeks later, and the control group 2 and 4 weeks after the baseline. Results: There was a significant difference between the control and intervention groups at the baseline (P =.05). Nevertheless, analysis of variance test results showed that the difference between the intervention and control groups was found to be significantly different statistically; (22.92 ± 6.07) for intervention versus (28.13 ± 6.93) for control, with the second follow up (P =.01). Conclusions: Progressive muscle relaxation is used as a useful intervention to reduce anxiety in pregnant women during coronavirus pandemics educated and recommended with more emphasis and sensitivity in pregnancy care by healthcare providers. [ABSTRACT FROM AUTHOR]

Background: In 2018, the World Health Organization published a set of recommendations for further emphasis on the quality of intrapartum care to improve the childbirth experience. This study aimed to determine the effects of the WHO intrapartum care model on the childbirth experience, fear of childbirth, the quality of intrapartum care (primary outcomes), as well as post-traumatic stress disorder symptoms, postpartum depression, the duration of childbirth stages, the frequency of vaginal childbirth, Apgar score less than 7, desire for subsequent childbearing, and exclusive breastfeeding in the 4 to 6 weeks postpartum period (secondary outcomes). Methods: This study was a randomized controlled trial involving 108 pregnant women admitted to the maternity units of Al-Zahra and Taleghani hospitals in Tabriz-Iran. Participants were allocated to either the intervention group, which received care according to the ' 'intrapartum care model, or the control group, which received the' 'hospital's routine care, using the blocked randomization method. A Partograph chart was drawn for each participant during pregnancy. A delivery fear scale was completed by all participants both before the beginning of the active phase (pre-intervention) and during 7 to 8 cm dilation (post-intervention). Participants in both groups were followed up for 4 to 6 weeks after childbirth and were asked to complete questionnaires on childbirth experience, postpartum depression, and post-traumatic stress disorder symptoms, as well as the pregnancy and childbirth questionnaire and checklists on the desire to have children again and exclusive breastfeeding. The data were analyzed using independent T and Mann-Whitney U tests and analysis of covariance ANCOVA with adjustments for the parity variable and the baseline scores or childbirth fear. Results: The average score for the childbirth experience total was notably higher in the intervention group (Adjusted Mean Difference (AMD) (95% Confidence Interval (CI)): 7.0 (0.6 to 0.8), p < 0.001). Similarly, the intrapartum care quality score exhibited a significant increase in the intervention group (AMD (95% CI): 7.0 (4.0 to 10), p < 0.001). Furthermore, the post-intervention fear of childbirth score demonstrated a substantial decrease in the intervention group (AMD (95% CI): -16.0 (-22.0 to -10.0), p < 0.001). No statistically significant differences were observed between the two groups in terms of mean scores for depression, PTSD symptoms, duration of childbirth stages, frequency of vaginal childbirth, Apgar score less than 7, and exclusive breastfeeding in the 4 to 6 weeks postpartum (p > 0.05). Conclusion: The intrapartum care model endorsed by the World Health Organization (WHO) has demonstrated effectiveness in enhancing childbirth experiences and increasing maternal satisfaction with the quality of obstetric care. Additionally, it contributes to the reduction of fear associated with labor and childbirth. Future research endeavors should explore strategies to prioritize and integrate respectful, high-quality care during labor and childbirth alongside clinical measures. [ABSTRACT FROM AUTHOR]

Background: Perceived care quality and patient satisfaction have been important care quality indicators in recent decades, and healthcare professionals have been influential on women's childbirth experience. This study investigated the measurement properties of the Persian version of the Pregnancy and Childbirth Questionnaire (PCQ), designed to measure mothers' satisfaction with the quality of healthcare services provided during pregnancy and childbirth. Methods: This is a cross-sectional methodological study. Instrument translation, face validity, content validity, structural validity, and reliability evaluation were performed to determine the measurement properties of the PCQ's Persian version. A backward-forward approach was employed for the translation process. Impact scores were selected based on the items' importance to measure face validity. Content validity index (CVI) and content validity ratio (CVR) were calculated to measure content validity, and exploratory and confirmatory factor analyses were used to measure structural validity. The cluster random sampling method was used, resulting in a sample of 250 eligible women referred to the health centers of Tabriz, Iran, who were 4 to 6 weeks after giving birth. Cronbach's alpha coefficient and Intraclass Correlation Coefficient (ICC) using a test-retest approach were used to determine the questionnaire's reliability. Results: The impact scores of all items were above 1.5, which indicates a suitable face validity. The content validity was also favorable (CVR = 0.95, CVI = 0.90). Exploratory factor analysis on 25 items led to the removal of item 2 due to a factor loading of less than 0.3 and the extraction of three factors explaining 65.07% of the variances. The results of the sample adequacy size were significant (< 0.001, and Kaiser-Meyer-Olkin = 0.886). The model's validity was confirmed based on the confirmatory factor analysis fit indicators (i.e., RMSEA = 0.08, SRMR = 0.09, TLI = 0.91, CFI = 0.93, x2/df = 4.65). The tool's reliability was also confirmed (Cronbach's alpha = 0.88, and ICC (95% CI) = 0.93 (0.88 to 0.95)). Conclusion: The validity and reliability of the PCQ's Persian version were suitable to measure the extent to which Iranian women are satisfied with the quality of prenatal and intrapartum care. [ABSTRACT FROM AUTHOR]

Background: Quarantine during COVID-19 disease may be associated with psychological distress and other behavioral problems. This study aimed to investigate depression, anxiety, and stress in self-quarantined pregnant women at home for 14 days during the coronavirus disease outbreak in Iran. Materials and Methods: A cross-sectional web survey was carried out on 874 pregnant women in all governmental health centers of two cities in Iran using the census method in 2020-21. Survey data were collected with the Depression, Anxiety, and Stress Scale-21. Data were analyzed using descriptive statistics and analytical tests (Chi-square, Pearson's correlation coefficient, and logistic regression) at significance level less than 0.05. Results: Approximately 40.04% (N = 350) of the participants were classified as a self-quarantine group. The mean (SD) of the stress score was higher for the quarantine group compared to nonquarantine (8.12 (4.95) vs. 5.96 (4.51)) (F2,874 = 25.180, p < 0.001). But there was no significant difference in the depression and anxiety scores between the quarantine group compared to nonquarantine, respectively. Additionally, the adjusted odds ratio for stress score was associated with an unwanted pregnancy (1.993, 95% CI: 1.108--3.587; p = 0.021), younger age (1.707, 95% CI: 1.082--2.692; p = 0.022) and uninsured coverage (2.240, 95% CI: 1.320--3.801; p = 0.003), and complete quarantine (2.027, 95% CI: 1.548--2.654; p < 0.001). Conclusions: Self-quarantine during the COVID-19 pandemic has been related to high-stress levels, specifically, among women of younger age, uninsured, and unwanted pregnancies. Thus, quarantined pregnant women will need more mental health support and medical supplies. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present study was to evaluate obstetric, maternal, and neonatal outcomes in COVID-19 compared to healthy pregnant women in Iran. Results: A case-control study was conducted on 55 COVID-19 as the case and 55 matched control pregnant women in Hormozgan, Iran. Patients were considered to be cases if they had a positive COVID-19 test plus a positive chest X-ray result. Our measures were COVID-19 symptoms, including laboratory evaluations, clinical symptoms, and maternal and neonatal outcomes. The most prevalent symptoms related to COVID-19 were fever (69.09%) and cough (58.18%). Less common symptoms included fatigue, diarrhea, shortness of breath, sore throat, and myalgia. Hydroxychloroquine/chloroquine (58.18%) and antibiotic therapy (45.45%) were the most prevalent management in COVID-19 patients. Based on our findings, maternal and obstetric outcomes—neonatal in case groups—such as mode of delivery, premature rupture of membrane, postpartum hemorrhage, perineal resection rate, neonates’ birth weight, Apgar score, and neonatal asphyxia rate were similar to pregnant women without COVID-19. We observed a higher incidence rate of premature delivery in COVID-19 cases (25 vs. 10%) (p < 0.05). In the present study, we found that women with COVID-19 had a more than twofold increased odds of preterm labor. History of preterm delivery was also associated with high twofold odds of preterm labor. Conclusion: We observed a higher incidence rate of premature delivery in COVID-19 cases. Women with COVID-19 had a more than twofold increased odds of preterm labor. Considering prematurity has high morbidity and is regarded as the primary cause of mortality in children under 5 years old, more case-control studies are needed to ascertain the results. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to determine the diagnostic accuracy of vaginal urea and creatinine levels in the detection of premature rupture of membrane (PROM). The Cochrane (central), EMBASE, PubMed, Scopus, and Web of Science were searched for studies published from the inception of the databases up to January 2020. We included published observational full-text articles. The mean differences (MD) and 95% confidence intervals (95% CI) were calculated. The significance level was set as 0.05. Eleven studies (n = 1324) were considered for meta-analysis. Using the bivariate model, the summary estimate of sensitivity and specificity for urea was 0.96 (95% CI: 0.86, 0.98) and 0.93 (95% CI: 0.83, 0.97), respectively. The summary estimate of sensitivity and specificity for creatinine was 0.98 (95% CI: 0.92, 0.99) and 0.97 (95% CI: 0.89, 0.99), respectively. The overall mean of urea and creatinine in the case group was significantly higher than that in the control group (MD = 12.63, 95%, CI [12.01, 13.25]) and (MD = 0.31, 95%, CI [0.29, 0.32]), respectively. The results of this systematic review showed that the mean of urea and creatinine in the case group was significantly higher than that in the control group and the sensitivity and specificity of creatinine is higher than urea in the diagnosis of PROM. [ABSTRACT FROM AUTHOR]

Background: Placenta plays a central role in mediating growth and development of fetuses. Sex-specific placentas may complicate this role.Methods: The study aimed at investigating the association between fetal sex and placental pathological findings in twin gestations using generalized estimating equation modeling. We used a large population-based clinical data born in British Columbia (BC) and linked the fetal-maternal data to hand-searched pathology reports of 1493 twin placentas from twins born in BC Women hospital. We analyzed the data using generalized estimating equations taking the cluster nature of twins into consideration.Results: About 26.5% of twins were monochorionic and 73.5% were dizygotic. Most twins were male (51.3%). About 2/3 of twins were sex concordant (66.6%). Of the sex concordant twins, similar percentages were male-male (34.7%) and female-female (31.2%). Of the sex discordant twins, the male-female (33.3%) group constituted about 1/3 of the whole population. Adjusted for chorionicity, birth weight discordance ≥30% and gestational age, the odds of chorionitis (1.38, 95% CI = 1.04-1.84), anastomosis (1.63, 95% CI = 1.22-2.19), unequal sharing of placenta (1.72, 95% CI = 1.11-2.64), placental inflammation (1.30, 95% CI = 1.05-1.62) and lesions (1.83, 95% CI = 1.02-3.31) were higher in male twins compared with females. Twins of either sex from sex-discordant pairs were less likely to have placental anastomosis compared to the reference category. Males from male-male pairs had higher odds of unequal placental sharing (74% higher) and composite inflammation (52% higher) compared with the reference twins.Conclusion: Our findings suggest a relationship between sex and placental pathological results. [ABSTRACT FROM AUTHOR]

Intimate partner violence occurs in all settings. In this paper the authors describe socio-cultural factors affecting intimate partner violence against pregnant women in suburban Hamadan. The PEN-3 model was utilized by semi-structured interviews with 18 pregnant women. According to women, cultural perceptions (patience in case of facing violence, faith in fate and normalization of violence), enablers (communication skills, economic status, and availability of legal support), and nurturers (family support and social expectation of obedience to men) were found to be important factors that influence violence. A better understanding of the cultural perceptions can help decision-makers in identifying the cultural appropriateness of interventions. [ABSTRACT FROM AUTHOR]

This umbrella review aimed to summarize evidence on pregnant persons and/or their birth partners' experiences and expectations of SDM during pregnancy and childbirth. We searched eight databases from 2011 to 2023. Quantitative, qualitative and mixed methods systematic reviews were included in this review. We have identified 26 reviews that report on 622 primary studies involving over 213,000 pregnant persons and 22,000 birth partners, examining a broad range of decision-making scenarios in maternity care. The three-talk model was used to categorise the themes which include communication, weighing options, and making a decision. Multiple reviews have reported that pregnant persons and birth partners have mixed experiences in several decision-making scenarios, with insufficient information and inadequate consideration or answers to their questions being common issues. Pregnant persons and birth partners prefer clear explanations, simple communication, and involvement in decision-making. Exclusion from the decision-making during pregnancy and childbirth may lead to negative experiences, whilst involvement improves satisfaction, reduces distress and fosters empowerment. The review highlights the importance of promoting SDM in maternity care, as it is fundamental to promoting maternal, newborn, and family well-being. Health systems should redesign antenatal classes and train healthcare providers to enhance communication skills and encourage informed decision-making by pregnant persons and birth partners. Keywords • Improved health outcomes and less decisional conflicts with shared decision-making in pregnancy. • Engaging birth partners is crucial. • Healthcare Providers training and antenatal class redesign can promote SDM for better outcomes. [ABSTRACT FROM AUTHOR]

To determine the association between serum vitamin D levels and age at menopause and reproductive lifespan in a group of US postmenopausal women. Data from 6,326 postmenopausal US women in the National Health and Nutrition Examination Survey (NHANES) database 2001–2018 were obtained. Weighted multinomial logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI). Statistical analyzes were performed using SAS (version 9.4; SAS Institute), and complex survey designs were considered. Vitamin D deficiency was associated with a higher likelihood of early menopause (OR = 1.34, 95% CI: 1.15, 1.58; p = 0.008) and lower odds of late menopause (OR = 0.79, 95% CI: 0.52, 0.95) in the unadjusted model but not in the adjusted model. Lower vitamin D levels were associated with a higher risk of a shorter reproductive lifespan. The strongest association was seen in the first tertile of vitamin D deficiency (OR = 1.54; 95% CI: 1:29–1:83). After adjustment, the associations were somewhat weakened but remained statistically significant. The results of this study suggest that vitamin D deficiency and inadequacy might be associated with earlier age at menopause. It may also reduce the reproductive lifespan in women. Given the cross-sectional nature of the NHANES dataset, these results should be interpreted with caution due to temporality bias. Menopausal age is a multifactorial phenomenon, and the identification of factors and their interactions should be evaluated in future studies. [ABSTRACT FROM AUTHOR]

The National Malaysian Twin Registry was established in Royal College of Medicine, Perak, University Kuala Lumpur (UniKL) in June 2008 through a grant provided by UniKL. The general objective is to facilitate scientific research involving participation of twins and their family members in order to answer questions of health and wellbeing relevant to Malaysians. Recruitment is done via mass media, poster, and pamphlets. We now have 266 adult and 204 children twins registered. Several research projects including reproductive health study of twins and the role of co-bedding on growth and development of children are carried out. Registry holds annual activities for twins and seeks to provide health-related information for twins. We seek international collaboration. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the present study was to assess the relationship of sex hormone binding globulin (SHBG) and gestational diabetes mellitus (GDM).Methods: The Cochrane Library, Medline, ScienceDirect, and Web of Science were searched for studies published from the inception of the databases up to February 2019. Our inclusion criteria were published observational full-text articles. All data were analyzed using Review Manager 5.3. Of 208 papers reviewed, 26 studies (n = 6668) were considered for meta-analysis.Results: The SHBG level was significantly lower in women with GDM compared to healthy women (MD = -11.86; 95% CI: [-13.02, -10.71]). Also, SHBG in women with PCOS and GDM and obesity was significantly lower than women with PCOS without GDM (MD = -38.14; 95% CI: [-56.79, -19.48]) and normal weight women (MD: -58.96; 95% CI: [-79.32, -38.59]). SHBG in the second trimester was lower than that in the first trimester and pre-conception.Conclusions: This systematic review showed that the level of SHBG is significantly lower in GDM pregnant women than that in healthy women. The results of this systematic review about the relationship of GDM and SHBG and suggestion to assess this marker in early pregnancy should be considered with caution. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the effect of omega-3 supplements on relief of vasomotor symptoms among menopausal women.Study Design: The Cochrane Library, MEDLINE, SCOPUS, EMBASE, ProQuest, Google Scholar, Web of Science, CINAHL, IranMedex and SID databases were searched until September 2017. Inclusion criteria were (1) women were experiencing vasomotor symptoms in the menopause period, (2) intervention was omega-3 supplements (3) randomized controlled trial (RCT) or quasi-RCT, and (4) outcome measures included changes in the frequency and severity of hot flush or night sweats, sleep problems and side effects.Results: Three randomized controlled trials involving 483 women in the age range of 51 to 54.7 years were included in the review. Overall, the risk of bias in the included studies was moderate. All the participants were found to be blinded. Meta-analysis of the data showed no difference in the frequency and severity of hot flushes, insomnia severity, sleep quality, quality of life and adverse effects between the two groups. Compared to placebo group, women who received omega-3 supplements experienced lower frequency (mean difference: -1.82, 95% CI: -2.81, -0.83) and severity (mean difference: -.89, 95% CI: -1.25, -0.53) of night sweats.Conclusions: RCTs which investigate the impact of omega-3 supplements on vasomotor symptoms in menopausal women are scarce. A comprehensive search in a wide range of databases found only three relevant papers. Our analysis suggests that omega-3 supplements may alleviate night sweats but have no benefit in reducing hot flushes, or improving sleep quality and quality of life during the menopausal period. We recommend high quality RCTs along with a longer follow-up period to investigate this important subject, as there was insufficient evidence to conclude that omega-3 supplements are of benefit in alleviating vasomotor symptoms in menopausal women. [ABSTRACT FROM AUTHOR]

Background. Sexual dysfunction is a common complication in women with multiple sclerosis due to limitation in physical and mental functioning. Expressive writing as a psychological intervention can significantly improve sexual dysfunction in women with other diseases. Aim. The aim of the current study was to determine the effect of expressive writing on sexual dysfunction in Iranian women with multiple sclerosis. Methods. A randomized controlled trial with a Solomon four-group design was conducted on 116 Iranian women with MS in February 2021. Participants were randomly assigned into two control subgroups of A1 (without pretest) and A2 (with pretest) and two intervention subgroups of B1 (without pretest) and B2 (with pretest). Expressive writing was conducted for six weeks at home including morning pages (writing three pages about everything that comes to mind everyday), date with inner child (once a week), and performing weekly creative assignments. Sexual dysfunction was assessed using MSISQ-19 before the intervention in two groups of A2 and B2 and follows in immediately, four weeks and eight weeks after the intervention in all subgroups. The control group was provided with routine care of treatment. Data were analyzed using the intention to treat method. P < 0.05 was considered significant. Results. Twenty-nine women were analyzed in each subgroup. Although expressive writing had a positive and significant effect on primary, tertiary, and overall sexual dysfunction in B2 intervention subgroup compared with A2 control subgroup (P ≤ 0.001), it could not improve secondary sexual dysfunction. Since tertiary sexual dysfunction was related to psychological aspects and the present intervention was also a subset of psychotherapy, most of the changes were observed at this level, which included a decrease of 7-8 points. Comparison between the two groups of with and without pretest in each of the control and intervention groups revealed that completing the pretest questionnaire did not have a significant impact on sexual dysfunction score. Conclusion. As a cost-effective and noninvasive intervention, expressive writing can be used along with the main treatment for women suffering from multiple sclerosis to improve sexual dysfunction. [ABSTRACT FROM AUTHOR]

Background: The birth plan is an approach for pregnant women to offering their expectations of labor and birth. The purpose of this study was to investigate the effect of birth plan on maternal and neonatal outcomes.Methods: This study was a randomized controlled clinical trial performed on 106 pregnant women, 32-36 weeks of pregnancy, referring to Taleghani educational hospital in Tabriz city-Iran. Participants were randomly assigned to the two groups of birth plan and control using a randomized block method. Participants in the birth plan group received the interventions based on the mother's requested birth plan. The birth plan included items of the mother's preferences in labor, mobility, eating and drinking, monitoring, pain relief, drug options, labor augmentation, pushing, amniotomy, episiotomy, infant care, and caesarean section. The control group received routine hospital care. The primary outcomes were childbirth experience and duration of the active phase of labor and the secondary outcomes were support and control in labor, fear of labor, post-traumatic stress disorder (PTSD), postpartum depression, duration of the second and third phases of labor, frequency of vaginal delivery, frequency of admission of newborn in NICU (Neonatal Intensive Care Unit), the mean first and fifth minute Apgar scores. The socio-demographic and obstetrics characteristics questionnaire, Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-versions A), and Edinburgh Postnatal Depression Scale (EPDS) were completed at the beginning of the study (at the gestational age of 32-36 weeks). The questionnaire of delivery information, neonatal information, and Delivery Fear Scale (DFS) was completed during and after the delivery. Also, a partogram was completed for all participants by the researcher. The participants in both groups followed up until 4-6 weeks post-delivery, whereby the instruments of Childbirth Experience Questionnaire 2.0 (CEQ2.0), Support and Control In Birth (SCIB) scale, EPDS, and PTSD Symptom Scale 1 (PSS-I) were completed by the researcher through an interview. The independent t-test, the chi-square test, and ANCOVA was used to analyze.Results: The mean (SD) of CEQ score was singificnalty higher in in the birth plan group (3.2 ± 0.2) compared to the control (2.1 ± 0.2) (MD = 1.0; 95% CI: 1.1 to 0.9; P˂0.001). Also, the mean (SD) SCIB score in the birth plan group was significantly higher than that of those in the control group (P˂0.001). The mean scores of DFS (P = 0.015), EPDS (P˂0.001), and PTSD (P˂0.001) as well as the frequency of emergency caesarean section (P = 0.007) in the birth plan group were significantly lower than those in the control group.Conclusion: This was the first study to assess the implementation of a birth plan in Iran. Based on the findings, a birth plan improves childbirth experiences; increases perceived support and control in labor; reduces fear of delivery; suppresses psychological symptoms of depression and PTSD, and increases the frequency of vaginal delivery.Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N58. Date of registration: 07/07/2020; URL: https://en.irct.ir/trial/47007 ; Date of first registration: 19/07/2020. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MetS) is one of the most important health issues around the world and a major risk factor for both type 2 diabetes mellitus (T2DM) and cardiovascular diseases. The etiology of MetS is determined by the interaction between genetic and environmental factors. Effective prevention and treatment of MetS notably decreases the risk of its complications such as diabetes, obesity, hypertension, and dyslipidemia. According to recent genome-wide association studies, multiple genes are involved in the incidence and development of MetS. The presence of particular genes which are responsible for obesity and lipid metabolism, affecting insulin sensitivity and blood pressure, as well as genes associated with inflammation, can increase the risk of MetS. These molecular markers, together with clinical data and findings from proteomic, metabolomic, pharmacokinetic, and other methods, would clarify the etiology and pathophysiology of MetS and facilitate the development of personalized approaches to the management of MetS. The application of personalized medicinebased on susceptibility identified genomes would help physicians recommend healthier lifestyles and prescribe medications to improve various aspects of health in patients with MetS. In recent years, personalized medicine by genetic testing has helped physicians determine genetic predisposition to MetS, prevent the disease by behavioral, lifestyle-related, or therapeutic interventions, and detect, diagnose, treat, and manage the disease. Clinically, personalized medicine is providing effective strategies for the prevention and treatment of MetS by reducing the time, cost, and failure rate of pharmaceutical clinical trials. It is also eliminating trial-and-error inefficiencies that inflate health care costs and undermine patient care. [ABSTRACT FROM AUTHOR]

In this month's issue, the journal continues to bring new insights from Cochrane systematic reviews to the readers of Obstetrics & Gynecology. This month, we highlight the use of intrauterine progestins for the treatment of endometrial hyperplasia and an overview review of interventions to prevent gestational diabetes. The summaries are published below. The complete references with hyperlinks are listed in Box 1. [ABSTRACT FROM AUTHOR]

Background: Fear of childbirth is an anxiety associated with childbirth, which manifests itself in physical and concentration problems. It is often associated with requesting a cesarean section, and it is prevalent in nulliparous women. This is a study aimed to summarize the published research on the factors for fear of childbirth in nulliparous women in Iran.Methods: This study was conducted based on the PRISMA statement. A literature search was performed on nine electronic databases (Web of Sciences, Since Direct, Scopus, PubMed, Cochrane Library, ProQuest, and Persian databases including Scientific Information Database, Irandoc, and Magiran) using keywords related to fear of childbirth, factors, nulliparous, and Iran from 2000 to 2020. This study included cross-sectional studies with full-text in English or Persian in Iran. The quality of the selected studies was evaluated independently by two authors and via the STROBE checklist.Results: In this study, 93 articles were identified,13 duplicate articles were excluded, 80 articles were screened by title and abstract, 62 were excluded, and the full-text of 18 articles was assessed for analysis. Of these, 12 were excluded, and six articles were reviewed. Six studies were conducted in different provinces of Iran. Based on the study results, factors of the fear of childbirth in nulliparous women were: biological (the process of labor and childbirth and labor pain, concern for the baby (harm to the baby and baby infirmity), psychological (painful injections during labor and suturing in childbirth), and individual (loss of control during labor).Conclusions: This study identified four main factors that affect fear of childbirth status in nulliparous women, and concern for the baby was a more common factor in this study. In conclusion, these factors can be reduced by increasing their assurance about child health, training during pregnancy, talking about positive experiences, and holding workshops. [ABSTRACT FROM AUTHOR]

Background: Sexual dysfunction has many factors in multiple sclerosis, but there is no reliable treatment for this challenge. Objective: Determining effective sexual function or dysfunction interventions in individuals with multiple sclerosis. Materials and Methods: To find the relevant published interventional studies that at least had an English abstract or in Persian, we searched International Statistical Institute, PubMed, Scopus, Cochrane, Medline, PsycINFO, EMBASE, CINAHL, and Google Scholar from January 1990 to June 2021. The results were analyzed using RevMan 5.3 software. The p < 0.05 was considered significant. Results: Out of 568 articles, 41 were included after deleting the duplicate and irrelevant articles. Studies were divided into 2 groups of sexual function (n = 27) and dysfunction (n = 14). Interventions in each category have 4 subgroups: psychoeducational, exercise and rehabilitation, and medical and multi-type interventions. For improving sexual function, more than half of psychoeducational interventions showed a significant improvement after interventions (p = 0.0003). In sexual dysfunction studies, most of the interventions (n = 13/14) had improved at least one subscale of sexual dysfunction. Medical interventions were effective on men's sexual dysfunction, and psychoeducational interventions had been more effective in women's sexual dysfunction. Conclusion: Psychoeducational and medical interventions are the commonest effective interventions. The psychoeducational studies conducted specifically on women had a positive impact, and only 4 articles with medical interventions were specifically targeted at men, which had a positive effect. [ABSTRACT FROM AUTHOR]

Background: Fathers' depression is an understudied subject, and the increasing participation of fathers on the care of their children, this is an issue of great importance. This study aimed to determine the relationship of paternal postpartum depression with prenatal and postpartum depression of mothers and their marital satisfaction.Methods: This longitudinal study was conducted among 352 expecting couples in 28-40 weeks of pregnancy and 6-8 weeks after delivery from April to September 2019. Eligible participants were selected from primary health care centers in northern Iran using a two-stage sampling method. Socio-demographic information, Edinburgh Postpartum Depression Scale, and ENRICH Couple Scale were used for data collection. The primary basis of data analysis was cross-lagged structural equation modeling to explore the underlying mechanism for paternal postpartum depression.Results: The results showed that a) maternal prenatal depression indirectly (βstand = 0.32, p = 0.004); b) maternal postpartum depression directly (βstand = 0.56, p <0.001); c) paternal prenatal depression indirectly (βstand = 0.11, p = 0.028) were associated with paternal postpartum depression. Also, marital satisfaction directly (βstand = -0.19, p = 0.002) and indirectly (βstand = -0.11, p = 0.007) had a relationship to paternal postpartum depression.Limitations: Culturally-sensitive measures of marital satisfaction, especially in conservative context of developing countries, along with self-reported data of psychological problems may lead to under-reported findings.Conclusion: The major contribution of marital satisfaction and maternal depression during prenatal period on the paternal postpartum depression, emphasizes on the prenatal period as the ideal time for fathers' mental health improvement. [ABSTRACT FROM AUTHOR]

With this issue, the journal launches a new feature titled "Cochrane Review Summaries." This feature highlights recently published Cochrane Reviews of interest to the readers of Obstetrics & Gynecology. The brief summaries are published below, and the complete references, with hyperlinks to the full Cochrane Review, are listed in . [ABSTRACT FROM AUTHOR]