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Showing 41 results for Preeclampsia

Bibi Seema, Saima Ghaffar, Shazia Memon, Shaneela Memon,
Volume 10, Issue 2 (7-2012)

Background: Postpartum period is the critically important part of obstetric care but most neglected period for majority of Pakistani women. Only life threatening complications compel them to seek for tertiary hospital care. We describe the nature of these obstetric morbidities in order to help policymakers in improving prevailing situation.
Objective: To find out the frequency and causes of severe post-partum maternal morbidity requiring tertiary hospital care and to identify the demographic and obstetrical risk factors and adverse fetal outcome in women suffering from obstetric morbidities.
Materials and Methods: This prospective cross-sectional study was carried out in the Department of Gynecology and Obstetrics, Liaquat University Hospital Hyderabad, between April 2008-July 2009. The subjects comprised of all those women who required admission and treatment for various obstetrical reasons during their postpartum period. Women admitted for non-obstetrical reasons were excluded. A structured proforma was used to collect data including demographics, clinical diagnosis, obstetrical history and feto-maternal outcome of index pregnancy, which was then entered and analyzed with SPSS version 11.
Results: The frequency of severe postpartum maternal morbidity requiring tertiary hospital care was 4% (125/3292 obstetrical admissions). The majority of them were young, illiterate, multiparous and half of them were referred from rural areas. Nearly two third of the study population had antenatal visits from health care providers and delivered vaginally at hospital facility by skilled birth attendants. The most common conditions responsible for life threatening complications were postpartum hemorrhage (PPH) (50%), preeclampsia and eclampsia (30%) and puerperal pyrexia 14%. Anemia was associated problem in 100% of cases. Perinatal death rate was 27.2% (34) and maternal mortality rate was 4.8%.
Conclusion: PPH, Preeclampsia, sepsis and anemia were important causes of maternal ill health in our population. Perinatal mortality was high.
Seyede Hajar Sharami, Azita Tangestani, Roya Faraji, Ziba Zahiri, Amiri Azam,
Volume 10, Issue 2 (7-2012)

Background: Obesity is an independent risk factor of preeclampsia with unknown mechanism and hyperlipidemia might be a probable case of it. Objective: The objective of this study was to determine the role of hyper-triglyceridemi in association with high prepregnancy body mass index and the risk of preeclampsia.
Materials and Methods: The authors conducted this case-control study of 42 preeclamptic and 41 normotensive overweight pregnant women. The two groups were comparable with respect to age, gestational age, and body mass index. Blood samples were collected at the time of diagnosis of preeclampsia, after 14 hour fasting to determine plasma lipid concentrations. Enzymatic photometric tests were used to determine lipid profile. Data was analyzed with independent “t-test”, Chi-square and one-way ANOVA and post HOC Tukey HSD test. The statistical significance was set at 0.05 levels. Results: In the subjects with preeclampsia, serum triglyceride and total cholesterol levels were significantly increased and plasma HDL-cholesterol concentrations were decreased compared with the controls, (p<0.05), but plasma LDL cholesterol levels didn’t differ between the two groups. Women who developed severe preeclampsia had higher concentrations of TG and cholesterol and lower levels of HDL compared to noromotensive group. Mean TG: 375.16 vs. 202.85, p<0.001, Mean cholesterol: 245.64 vs. 214.32, p=0.04, Mean HDL: 40.80 vs. 48.95, p=0.03).
Conclusion: We noted that dyslipidemia, particularly hypertriglyceridemia was highly correlated with prepregnancy high BMI in preeclamptic women. These findings continue to support a role for dyslipidemia in BMI related preeclampsia.
Ashraf Jamal, Forozan Milani, Ashraf Al-Yasin,
Volume 10, Issue 3 (7-2012)

Background: Women with polycystic ovary syndrome (PCOS) often are infertile and even if they become pregnant, there are complications with some adverse outcomes. It has been reported that aspirin and metformin improve uteroplacental circulation and reduce pregnancy complications.
Objective: To determine and compare uteroplacental circulation and obstetrics complications in pregnant women with PCOS treated with metformin, aspirin and control group.
Materials and Methods: 105 pregnant women with PCOS were enrolled in this study after assessing uterine artery pulsatility index (PI) with Doppler ultrasonography at 12 weeks of gestation. The patients were divided into three groups and received metformin 2000 mg or aspirin 80 mg daily, or no intervention until the end of pregnancy. PI was assessed for the patients at 20 week of gestation and groups were followed up till delivery. PI and obstetrics complications such as gestational diabetes, preterm labor, preeclampsia and IUGR were compared among groups.
Results: All groups had significant reduction in the mean uterine artery PI at 20 weeks measurement (p<0.05), but this reduction was more in metformin and aspirin groups than control group (p=0.002). There was a significant difference in mean uterine artery PI 20 week of gestation in three groups (p=0.005). Adverse outcomes have seen 4 out of 35 in metformin group, 7 out of 35 in aspirin group and 11 out of 35 in control group. There weren’t significant differences among groups (p=0.12).
Conclusion: Metformin and low dose aspirin reduced uterine artery impedance but there was not associated with reduced obstetrics complication in women with PCOS.

Fakhrolmolouk Yassaee, Roghieh Eskandari, Zohreh Amiri,
Volume 10, Issue 5 (10-2012)

Background: Idiopathic thrombocytopenic purpura (ITP) is a disease that commonly affects women of reproductive age and is associated with maternal and fetal complications.
Objective: The aim of the present study was to report the perinatal outcome in pregnant women with ITP. Materials and Methods: Twenty one pregnant women with ITP admitted in a teaching hospital in Tehran, from October 2008 to February 2010, were enrolled in this prospective historical cohort study; course and perinatal outcome of pregnancies were studied.
Results: Seven (33.3%) cases had been diagnosed before pregnancy, while the other fourteen (66.7%) were diagnosed during pregnancy. During hospitalization, thirteen (62%) patients required treatment, eight (61.5%) of them with steroids, two (15.3%) received intravenous immunoglobulin (IVIG), and three (23%) were treated with steroids and IVIG. Three babies were delivered vaginally (14.3%), seventeen (81%) through cesarean section and one patient aborted her fetus. Nine mothers (42.9%) had platelet counts &lt;50000/ml at the time of delivery; but postpartum hemorrhage occurred in 4 (19%) women and one women received platelet transfusion during cesarean section. Six (28.6%) women developed gestational diabetes. Pregnancy was complicated by preeclampsia in one woman and by abruptio placenta in another. One pregnancy terminated in intrauterine fetal death. Seventeen infants (89.5%) had normal platelet counts, and two (10.5%) had moderate thrombocytopenia. No infant showed signs of hemorrhage, but 2 neonates (10.5%) were diagnosed with intrauterine growth restriction.
Conclusion: Rate of gestational diabetes in pregnant women with ITP is higher than the general population. Rate of gestinational diabetes is 3-5% and postpartum hemorrhage is 5-7% in general. Postpartum hemorrhage is common in these women. Severe thrombocytopenia and bleeding in the newborns are uncommon.
Roya Faraji Darkhaneh, Atefeh Ghanbari, Maryam Asgharnia, Mitra Kian,
Volume 11, Issue 1 (4-2013)

Background: Asphyxia is a common cause of perinatal mortality in 5-10% of all births worldwide. The present parameters for determining perinatal asphyxia, e.g. preeclampsia, cannot be considered as markers per se, and require auxiliary markers, e.g. increased number of nucleated red blood (NRBC) cells, for early diagnosis of perinatal asphyxia.
Objective: In this study, we evaluated the mean NRBC count in preeclampsia and to determine the usefulness of the NRBC as independent prognostic factors of perinatal complications.
Materials and Methods: This was a cross-sectional study in order to compare the NRBC in the umbilical cord of term neonates born to 50 mothers with preeclampsia and 150 normal mothers. The exclusion criteria were mother’s affliction with complications of pregnancy and inexact last menstrual period. The variables under study were maternal and neonatal data. The count of NRBC was determined with standard laboratory procedures in the blood samples from umbilical cord of the neonates. The acquired data were fed into SPSS 16 software and analyzed using statistical tests.
Results: The mean value of NRBC count was significantly higher in preeclamptic women (p<0.0001). The average 1st and 5th minute Apgar scores were significantly higher in normal mothers (p<0.001).
Conclusion: Increase of NRBC in neonates born to mothers with preeclampsia may be due to chronic hypoxia; this group of neonates has increased risk and requires more precise and extensive care during delivery and after birth in order to have reduced mortality and complications during the neonatal period.
Maryam Asgharnia, Roya Faraji, Nooshaz Mirhaghjoo, Zahra Atrkar Roshan, Babak Ashrafkhani, Mina Moslehi,
Volume 11, Issue 8 (11-2013)

Background: Measuring the 24-hour urine protein ≥300 mg is the standard threshold value for diagnosis of preeclampsia.
Objective: This study was intended to determine if a patient’s 4-hour urine protein correlate with the 24-hour value for diagnosis of preeclampsia.
Materials and Methods: This was a cross sectional study performed on 84 women with suspected preeclampsia due to positive urinary test strip with minimum protein content of 1+ and BP ≥140/90 at Al-zahra Educational Hospital in Rasht (Iran) from May 2007 to January 2008. Urine samples were collected within 24 hours in successive periods: The first 4-hour and the next 20-hours urine, in separate containers. The protein contents of 4-hour and 24-hour urine samples were calculated. Data were analyzed by intra-class correlation coefficient, and Receiver Operating Characteristic (ROC) curve.
Results: The ROC curve showed the cut-off point of 55.5 for 4-hour urine protein. The correlation between 4- and 24-hour urine protein excretions identified that most women (about 85.1%) with protein excretion rate of 300 mg/24h or more (with preeclampsia) had the same amount of protein of 55.5 or more in their 4-hour urine excretion (p<0.001). Also, most of them (about 83.7%) with a total urinary protein excretion of less than 300 mg/24h (no preeclampsia) had a protein excretion rate of less than 55.5 mg/4h.
Conclusion: This study showed 4-hour protein collection can be used as acceptable substitute for assessing the protein content of 24-hour urine samples as a more convenient, faster, and cheaper method for diagnosis of preeclampsia and the cut-off point for 4-hour urine protein is 55.5 mg.
Maryam Asgharnia, Roya Faraji, Fatemeh Salamat, Babak Ashrafkhani, Seyedeh Fatemeh Dalil Heirati, Samira Naimian,
Volume 11, Issue 9 (12-2013)

Background: Amniotic fluid is an indicator of placental function on the fetal development. The amniotic fluid index is the most commonly used method of measuring amniotic fluid.
Objective: The purpose of this study was to compare the pregnancy outcomes of a borderline versus normal AFI.
Materials and Methods: This cross-sectional study was carried out on a total of 235 pregnant women referred to Alzahra Medical Center between 2009-2011. Women with a singleton pregnancy in third trimester were enrolled into this study; of these subjects, 141 cases were in normal AFI group and 94 cases in borderline AFI group. Adequate information was obtained from the patients' medical record and the groups were compared on maternal and fetal complications. Data analysis was performed by using SPSS.
Results: The mean maternal age in borderline AFI group was 25.96±5.92 years and in normal AFI group was 27.88±6.5 years (p=0.023). Maternal outcomes such as preterm delivery and labor induction in women with borderline AFI were considerably higher than those in normal group (p=0.01 and p=0.001). There were no significant differences between the two groups in terms of high blood pressure, preeclampsia, diabetes and neonatal respiratory distress. The borderline AFI group had higher rate of neonatal complications such as Apgar score of less than 7 (p=0.004), IUGR (0.0001), LBW (0.001), and crucial need to NICU (0.003).
Conclusion: Findings indicated that there are statistical differences between adverse outcomes in borderline AFI group and normal group.
Rahele Alijahan, Sadegh Hazrati, Mehrdad Mirzarahimi, Farhad Pourfarzi, Peymaneh Ahmadi Hadi,
Volume 12, Issue 1 (2-2014)

Background: Preterm birth is a leading cause of perinatal mortality and long-term morbidity as well as the long-term health consequences and cognitive outcomes.
Objective: Present study was conducted to determine prevalence and risk factors associated with preterm birth in Ardabil, Iran.
Materials and Methods: A case control study was conducted between Nov 2010 and July 2011 in all three maternal hospitals in Ardabil. All the live newborns during the study period were investigated. Of 6705 live births during the study period 346 births occurred in <37 weeks were taken as a case and 589 term neonates were taken as a control group. Data were obtained through review of prenatal and hospital delivery records. Univariate and multivariate logistic regression analysis were applied to obtain magnitude of association between independent variables and preterm birth.
Results: The prevalence rate of preterm birth was 5.1%. History of previous preterm birth (OR=12.7,CI: 3.9-40.4, p<0.001), hypertension (OR=7.3, CI:2.1-25.4, p=0.002), Oligohydramnios (OR=3.9, CI:1.6-9.5, p=0.002), spouse abuse (OR=3.7, CI:1.1-11.8, p=0.024), preeclampsia (OR=3.6, CI:1.3-10.3, p=0.014), premature rupture of membrane (OR=3.1, CI:1.9-4.9, p=0.000), bleeding or spotting during pregnancy (OR=2.0, CI:1.0-3.8, p=0.037), Hyperemesis Gravid arum (OR=2.0, CI: 1.1-3.8, p=0.015), urinary tract infection in 26-30 weeks , (OR=1. 8 CI:1.0-3.2, p=0.04), diastolic blood pressure ≤60 mmg (OR=1.5, CI: 0.99-2.2, p=0.049) were determined as significant risk factors for preterm birth.
Conclusion: Early detection and treatment of diseases or disorders among pregnant women especially hypertension, Oligohydramnios, preeclampsia, bleeding or spotting, Hyperemesis Gravid arum, urinary tract infection, and low diastolic blood pressure as well as the improving health care quality delivered to pregnant women may reduce preterm prevalence rate. 
Nafiseh Saghafi, Atieh Mohammadzadeh Vatanchi, Fatemeh Tara, Leila Pourali, Salmeh Dadgar,
Volume 12, Issue 12 (12-2014)

Background: Preeclampsia is one of the common complications during pregnancy with considerable maternal and fetal mortality and morbidity. Hypercoagulability due to thrombophilic factors is discussed as the etiology involved in this disease.
Objective: The aim of this study was to evaluate selected thrombotic factors among pregnant women with preeclampsia and normal pregnant women.
Materials and Methods: This case-control study was performed on 200 pregnant women at third trimester of pregnancy between 2012 and 2013. 100 pregnant women admitted to Qaem and Imam Reza hospitals of Mashhad, due to preeclampsia, were selected as case group and 100 pregnant women without preeclampsia referred to OB/GYN clinic of these hospitals as control group. Blood samples were taken from two groups for evaluation of the coagulation factors including factor V Leiden, protein C, protein S, antithrombin III, anti-cardiolipin antibodies, and lupus anticoagulant antibodies.
Results: Two groups were not significantly different in terms of maternal age and parity (p>0.05). Levels of factor V Leiden, protein C, protein S, antithrombin III, anti-cardiolipin antibodies and lupus anticoagulant antibodies were compared between two groups. The number of patients with abnormal factor V Leiden and protein C was significantly higher in case group than in the control group (p<0.01 respectively), but other factors were not significant different between two groups. Thrombophilia disorders were significantly more in case group compared to control (p<0.001).
Conclusion: The risk of thrombophilia disorders is higher in preeclamptic patients than normal pregnant women.

Homeira Vafaei, Maryam Dalili, Seyed Amin Hashemi,
Volume 13, Issue 1 (1-2015)

Background: Preeclampsia is a disorder of pregnancy without any specific reasons that characterized by high blood pressure and large amounts of protein in the urine. This disorder is caused by multiple factors and finding any factor related to this disorder can help on time prevention of this disease.
Objective: In this study, serum levels of calcium (Ca), magnesium (Mg) and zinc (Zn) were evaluated in preeclampsia women and compared to normotensive ones.
Materials and Methods: This was a case-control study on 40 normotensive pregnancies as controls, 20 mild and 20 severe preeclamptic pregnancies as case groups. The women were studied in their 28-40 weeks of pregnancy. Simple random sampling was done based on inclusion and exclusion criteria and data were collected by blood sampling.
Results: The serum Ca levels of 4.96±0.62, 4.89±0.34, 5.05±0.35 mg/dL, Mg levels of 0.83±0.08, 0.85±0.11, 0.84±0.11 mg/dL and Zn levels of 107.55±22.74, 108.00±22.40, 107.50±22.30 mg/dL was detected in normotensive, mild and severe preeclampsia, respectively. Statistical analysis revealed that there were no significant differences between three groups in serum levels of Ca (p=0.6), Mg (p=0.827) and Zn (p=0.997).
Conclusion: The findings of this study showed that the assessment of serum Ca, Mg and Zn levels does not have any clinical values for predicting and/or managing of preeclampsia. However, based on the positive relationship between serum Ca and Mg concentration and the severity of preeclampsia in this study, we recommend assessment of serum levels of these two mineral elements as indices of the severity of preeclampsia.
Zhang Jie, Ding Yiling, Yu Ling,
Volume 13, Issue 3 (3-2015)

Background: More and more infertile patients have accepted the assisted reproductive technique (ART) therapy. Concerns have been raised over an increased risk of adverse maternal outcomes in ART populations as compared with natural conception (NC).
Objective: The aim was to improve the ART in clinicial work and to reduce the incidence of pregnancy complications in ART group according to analyzing the reasons of high incidence of pregnancy complications in ART group, comparing the incidence of pregnancy complications in different controlled ovarian hyperstimulation (COH) programs and evaluating the effects of ART which attribute to adverse pregnancy outcomes.
Materials and Methods: In this prospective population-based cohort study,3216 pregnant women with gestational age ≤12 weeks, regular antenatal examination,and ultrasound identification of intrauterine pregnancy were enrolled from January 2010 to June 2013. According to having ART history, the participantswere divided into two groups: ART group (contains fresh embryo transfer group or frozen-thawed embryo transfer group) and NC group. We compared the incidence of pregnancy complications between different groups and evaluated the factors which could affect the occurrence of these complications.
Results: When compared to NC group, significantly increased rates of gestational diabetes mellitus (GDM) (p<0.01), preeclampsia (PE) (p<0.01) and intrahepatic cholestasis of pregnancy (ICP) (p˂0.01) were observed in ART group. There was no significant difference in the incidence of birth defect between the two groups (p=0.07). Multiple pregnancies and Gonadotropin (Gn) were risk factors in GDM, PE, and ICP. The exogenous progesterone treatment had no effect on GDM, PE or ICP.
Conclusion: ART increases the risk of adverse maternal complications such as GDM, PE and ICP. The dosages of Gn should be reduced to an extent and the number of embryo implantation should be controlled. Exogenous progesterone treatment is safe.
Pooneh Nikuei, Kianoosh Malekzadeh, Minoo Rajaei, Azim Nejatizadeh, Nasrin Ghasemi,
Volume 13, Issue 5 (7-2015)

Preeclampsia is an important pregnancy disorder with serious maternal and fetal complications which its etiology has not been completely understood yet. Early diagnosis and management of disease could reduce its potential side effects. The vascular endothelial growth factor (VEGF) family including VEGF-A is the most potent endothelial growth factor which induces angiogenesis and endothelial cell proliferation and has basic role in vasculogenesis. VEGF and its tyrosine kinase receptors (Flt1 and KDR) are major factors for fetal and placental angiogenic development. Finding mechanisms involved in expression of angiogenic factors may lead to new prognostic and therapeutic points in management of preeclampsia. Recent researches, has shown capability of some anti-angiogenic factors as potential candidate to be used as early predictors for preeclampsia. Soluble fms-like tyrosin kinase-1 (sFlt1) is a truncated splice variant of the membrane-bound VEGF receptor Flt1, that is produced by the placenta and it can bind to angiogenic growth factors and neutraliz, their effects. It is also observed that the ratio of sFlt1 to placental growth factor is valuable as prognostic marker. In this review, VEGF family member’s role in angiogenesis is evaluated as biomarkers to be used for prediction of preeclampsia.
Sima Nazarpour, Fahimeh Ramezani Tehrani, Masoumeh Simbar, Fereidoun Azizi,
Volume 13, Issue 7 (9-2015)

Background: Pregnancy has a huge impact on the thyroid function in both healthy women and those that have thyroid dysfunction. The prevalence of thyroid dysfunction in pregnant women is relatively high.
Objective: The objective of this review was to increase awareness and to provide a review on adverse effect of thyroid dysfunction including hyperthyroidism, hypothyroidism and thyroid autoimmune positivity on pregnancy outcomes.
Materials and Methods: In this review, Medline, Embase and the Cochrane Library were searched with appropriate keywords for relevant English manuscript. We used a variety of studies, including randomized clinical trials, cohort (prospective and retrospective), case-control and case reports. Those studies on thyroid disorders among non-pregnant women and articles without adequate quality were excluded.
Results: Overt hyperthyroidism and hypothyroidism has several adverse effects on pregnancy outcomes. Overt hyperthyroidism was associated with miscarriage, stillbirth, preterm delivery, intrauterine growth retardation, low birth weight, preeclampsia and fetal thyroid dysfunction. Overt hypothyroidism was associated with abortion, anemia, pregnancy-induced hypertension, preeclampsia, placental abruption, postpartum hemorrhage, premature birth, low birth weight, intrauterine fetal death, increased neonatal respiratory distress and infant neuro developmental dysfunction. However the adverse effect of subclinical hypothyroidism, and thyroid antibody positivity on pregnancy outcomes was not clear. While some studies demonstrated higher chance of placental abruption, preterm birth, miscarriage, gestational hypertension, fetal distress, severe preeclampsia and neonatal distress and diabetes in pregnant women with subclinical hypothyroidism or thyroid autoimmunity; the other ones have not reported these adverse effects.
Conclusion: While the impacts of overt thyroid dysfunction on feto-maternal morbidities have been clearly identified and its long term impact on childhood development is well known, data on the early and late complications of subclinical thyroid dysfunction during pregnancy or thyroid autoimmunity are controversial. Further studies on maternal and neonatal outcomes of subclinical thyroid dysfunction maternal are needed.
Maryam Khoshnood Shariati, Zohreh Karimi, Mahroo Rezaienejad, Azita Basiri, Farahnaze Torkestani, Soraya Saleh Gargari,
Volume 13, Issue 11 (12-2015)

Background: Morbidity and mortality of preterm babies are important issues in perinatal medicine. In developed countries, preterm delivery is the cause of about 70% of mortality and 75% of morbidity in the neonatal period, respectively. Objective: The aim of this study was to determine the risk factors for preterm labor and the outcomes, in terms of perinatal mortality and morbidity at the time of discharge home, among preterm infants at less than 34 weeks gestation. Materials and Methods: A retrospective study was conducted and all infants with a gestational age of 24 to 33 weeks and 6 days who were born from November 1st, 2011 to March 31, 2012 were enrolled in this study. Results: From 1185 preterm infants were born during this period, 475 (40.08%) infants with less than 34 weeks gestational age were included in the study. Our study showed the major obstetrical risk factors for preterm labor were as follows: preeclampsia (21%), premature rupture of membranes (20.3%), abruption of placenta (10%), and idiopathic cases (48.7%). The neonatal mortality rate in less than 34 weeks was 9.05%. Significant perinatal morbidity causesd in less than 34 weeks were as follows: sepsis (46.94%), respiratory distress syndrome (41.47%), patent ductus arteriosus (21.47%), retinopathy of prematurity (3.57%), necrotizing entrocolitis (1.68%), intra-ventricular hemorrhage (9%), and broncho-pulmonary dysplasia (0.84%). Conclusion: Preterm birth is associated with adverse perinatal outcome. This situation needs to be improved by directing appropriately increased resources for improving prenatal health services and providing advanced neonatal care.
Mahdieh Mojibian, Sedigheh Soheilykhah, Mohammad Ali Fallah Zadeh, Maryam Jannati Moghadam,
Volume 13, Issue 11 (12-2015)

Background: Vitamin D supplementation during pregnancy has been supposed to defend against adverse gestational outcomes. Objective: This randomized clinical trial study was conducted to assess the effects of 50,000 IU of vitamin D every two weeks supplementation on the incidence of gestational diabetes (GDM), gestational hypertension, preeclampsia and preterm labor, vitamin D status at term and neonatal outcomes contrasted with pregnant women that received 400 IU vitamin D daily. Materials and Methods: 500 women with gestational age 12-16 weeks and serum 25 hydroxy vitamin D (25 (OH) D ) less than 30 ng/ml randomly categorized in two groups. Group A received 400 IU vitamin D daily and group B 50,000 IU vitamin D every 2 weeks orally until delivery. Maternal and Neonatal outcomes were assessed in two groups. Results: The incidence of GDM in group B was significantly lower than group A (6.7% versus 13.4%) and odds ratio (95% Confidence interval) was 0.46 (0.24-0.87) (P=0.01). The mean ± SD level of 25 (OH) D at the time of delivery in mothers in group B was significantly higher than A (37.9 ± 19.8 versus 27.2 ± 18.8 ng/ml, respectively) (P=0.001). There were no differences in the incidence of preeclampsia, gestational hypertension, preterm labor, and low birth weight between two groups. The mean level of 25 (OH) D in cord blood of group B was significantly higher than group A (37.9 ± 18 versus 29.7 ± 19ng/ml, respectively). Anthropometric measures between neonates were not significantly different. Conclusion: Our study showed 50,000 IU vitamin D every 2 weeks decreased the incidence of GDM.
Leila Pourali, Sedigheh Ayati, Shahrzad Jelodar, Ahmadreza Zarifian, Mohammad Sobhan Sheikh Andalibi,
Volume 14, Issue 5 (5-2016)

Introduction: Regarding to the recent advances in assisted reproductive techniques (ART), twin and multiple pregnancies have increased during past years.
Objective: This study was performed to compare obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART with spontaneous pregnancy.
Materials and Methods: In this cross-sectional study which was performed in Ghaem Hospital, Mashhad University of Medical Sciences, 107 dichorionic twin pregnancy were enrolled in two groups: spontaneous group (n=96) and ART group (n=31). Basic criteria and obstetrics and neonatal outcomes information including demographic data, gestational age, mode of delivery, pregnancy complications (preeclampsia, gestational diabetes, preterm labor, and intrauterine growth retardation (IUGR), postpartum hemorrhage), neonatal outcomes (weight, first and fifth minute Apgar score, Neonatal Intensive Care Unit (NICU) admission, mortality, respiratory distress, and icterus) were recorded using a questionnaire.
Results: Preterm labor, gestational diabetes, and preeclampsia were significantly higher in ART group compared to spontaneous pregnancy group. However, other factors such as anemia, IUGR, postpartum hemorrhage, and intrauterine fetal death (IUFD) were not significantly different between groups. There were no significant differences between groups in terms of neonatal outcomes (weight, 1st and 5th min Apgar score <7, NICU hospitalization, mortality, respiratory distress, and icterus).
Conclusion: With regard of significantly higher poor outcomes such as preeclampsia, gestational diabetes and preterm labor in ART group, the couples should be aware of these potential risks before choosing ART.
Aynadis Alemu, Betelihem Terefe, Molla Abebe, Belete Biadgo,
Volume 14, Issue 11 (11-2016)

Thyroid dysfunctions such as hypothyroidism, thyrotoxicosis and thyroid nodules may develop during pregnancy leading to abortion, placental abruptions, preeclampsia, preterm delivery and reduced intellectual function in the offspring. Epidemiological data have shown the significant role of maternal thyroid hormone in fetal neurologic development and maternal health. It has been suggested that the deleterious effects of thyroid dysfunction can also extend beyond pregnancy and delivery to affect neuro-intellectual development in the early life of the child. Pregnancy poses an important challenge to the maternal thyroid gland as hormone requirements are increased during gestation as a result of an increase in thyroid- binding globulin, the stimulatory effect of HCG on TSH receptors, and increased peripheral thyroid hormone requirements. Maternal thyroid dysfunction is associated with increased risk for early abortion, preterm delivery, neonatal morbidity and other obstetrical complications. Early diagnosis for thyroid dysfunction of pregnant women and treatment of thyroid dysfunction during pregnancy is important and cost effective to avoid both fetal and maternal complications secondary to thyroid dysfunction. Therefore the aim of this review was to assess the thyroid function changes occurring during pregnancy, the different disorders with their maternal and fetal implications, the laboratory diagnosis and the best ways of management of these conditions.
Pooneh Nikuei, Minoo Rajaei, Kianoosh Malekzadeh, Abdolazim Nejatizadeh, Fatemeh Mohseni, Fatemeh Pourdarvishi, Nasrin Ghashghaeezadeh, ,
Volume 15, Issue 3 (5-2017)

Background: Preeclampsia (PE) is a serious complication of pregnancy withhallmarks of incomplete placentation, placental ischemia and endothelialdysfunction. Imbalance between vascular endothelial growth factor (VEGF),placenta growth factor (PlGF) and their receptors play important role inpathophysiology of PE.
Objective: This study was aimed to asses PlGF mRNA expression in placenta ofwomen affected with PE.
Material and Methods: In this cross-sectional study, expression of PlGF mRNAwas evaluated in 26 mild PE cases, 15 severe preeclamptic women and 20normotensive controls. Patients were sub-classified as early onset PE (9) and lateonset (32). After RNA extraction, PlGF expression was quantified with qRT-PCR.
Results: The results of PlGF mRNA expression between mild-severe, and early-lateonset PE patients showed no statistically significant difference compared with thecontrol group (p=0.661, p=0.205 respectively).
Conclusion: Despite we found no distinct differential expression of PlGF mRNA inplacental tissue of PE patients compared with control women, but according todecreased level of this angiogenic factor in PE even before clinical onset of thedisease, determining molecular mechanisms related to reduced secretion of PlGFinto the maternal circulation may be useful for future therapeutics.
Milad Azami, Tayebe Azadi, Sepidezahra Farhang, Shoobo Rahmati, Khadijeh Pourtaghi,
Volume 15, Issue 5 (6-2017)

Background: Several studies have reported the uncertain role of multi-minerals andvitamins in the prevention of preeclampsia.
Objective: The present study aims to investigate the effect of multimineral-vitaminD supplements (calcium, magnesium, zinc and Vitamin D) and vitamins (C+ E) inthe prevention of preeclampsia.
Materials and Methods: In this randomized clinical trial, 90 pregnant women weredivided into three groups: group A received Ferrous sulfate (1 tablet/day) + onetablet of Claci-care multimineral-vitamin D containing 800mg calcium, 200mgmagnesium, 8mg zinc and 400 IU Vitamin D3 per day; group B received Ferroussulfate (1 tablet/day) + 250 mg vitamin C + 55 mg vitamin E; and the controlsreceived only one Ferrous sulfate tablet daily.
Results: The incidence of preeclampsia in group A was significantly lower than thecontrol group (p=0.03), while there was no significant difference between group Band controls (p=0.50), as well as groups A and B (p=0.063). The incidence ofneonatal complications in the group A was significantly lower than the control group(p=0.01), while there was no significant difference between group B and control(p=0.48).
Conclusion: According to the results, calcium, magnesium, and zinc supplementshave a significant effect on the prevention of preeclampsia. In addition, prescriptionof multimineral-vitamin D during pregnancy can be a low-cost and affordable wayto reduce the incidence of preeclampsia in women who are at high risk ofpreeclampsia
Ahmed Elmaraezy, Abdelrahman Ibrahim Abushouk, Amany Emara, Omar Elshahat, Hussien Ahmed, Magdy I. Mostafa,
Volume 15, Issue 8 (9-2017)

Background: Metformin reduces maternal and neonatal weight gain in gestational diabetes mellitus; however, this effect is poorly investigated in non-diabetic women.
Objective: We performed this meta-analysis to investigate the effect of metformin intake during pregnancy on maternal and neonatal outcomes in obese non-diabetic women.
Materials and Methods: We searched Medline, EMBASE, and Cochrane CENTRAL for eligible randomized controlled trials addressing the efficacy of metformin in pregnant obese non-diabetic women. Data were extracted and analyzed using RevMan software (Version 5.3). Neonatal birth weight was the key outcome. Secondary outcomes included maternal weight gain, the incidence of preeclampsia, and neonatal adverse effects (miscarriage, stillbirth and congenital anomalies).
Results: Pooled data from two RCTs (n=843) showed that metformin caused a significant reduction in maternal gestational weight gain (MD-1.35, 95% CI: [2.08, -0.630]), compared to placebo. The summary effect-estimate did not favor either of the two groups in terms of reduction of neonatal birth weight Z score (MD-0.09, 95% CI: [0.23, 0.06]). Metformin was associated with 41% reduction in the risk of preeclampsia; however, this reduction was not statistically significant [RR 0.59, 95% CI: [0.03, 11.46]). None of the neonatal adverse events including stillbirth [RR 1.14, 95% CI: 0.42, 3.10]) and congenital anomalies (RR= 1.36, 95% CI: [0.58, 3.21]) differed significantly between the two groups.
Conclusion: For obese pregnant women, metformin could decrease gestational weight gain with no significant reduction in neonatal birth weight. In light of the current evidence, metformin should not be used to prevent poor pregnancy outcomes in obese non-diabetic women.

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