Explore the vast range of titles available.

Background Preeclampsia (PE) is a severe hypertensive disorder affecting approximately 6.7% of pregnancies worldwide. Identifying reliable biomarkers for early prediction could significantly reduce the incidence of PE and facilitate closer monitoring and timely management. This study aims to investigate the association between albuminuria in early pregnancy and the subsequent development of PE, and to explore its predictive abilities. Methods A systematic search was conducted across PubMed, Embase, and Web of Science on July 15, 2024, for studies published between January 1, 1990, and June 30, 2024. Quality assessments were performed using the Joanna Briggs Institute Critical Appraisal and Risk of Bias in Non-randomized Studies - of Exposures Checklists. Random-effects models in STATA were used to conduct meta-analyses comparing urine albumin and albumin-to-creatinine ratio levels in patients who later developed PE versus those who did not. The incidence of PE was also compared between patients with and without albuminuria in early pregnancy. The predictive ability of albuminuria for PE was assessed using META-DISC software. Results A total of 26 studies comprising 7,640 pregnant women were systematically reviewed. Of these, 17 studies met the quality criteria for inclusion in the meta-analyses. Our findings indicate that urine albumin (Hedges’s g = 0.48 [95% confidence interval (CI): 0.16–0.80]; p-value  < 0.001) and albumin-to-creatinine ratio (Hedges’s g = 0.48 [95% CI: 0.16–0.80]; p-value  = 0.003) were significantly higher in the early stages of pregnancy in patients who later developed PE compared to those who did not. The incidence of PE was higher in patients with early-diagnosed albuminuria (log odds ratio = 2.56 [95% CI: 1.75–3.38]; p-value  < 0.001). The pooled sensitivity and specificity for albuminuria in predicting PE were 56% [95% CI: 48-64%] and 87% [95% CI: 85-89%], respectively. Conclusions Elevated maternal urine albumin and albumin-to-creatinine ratio in early pregnancy are associated with a higher risk of developing PE. While these biomarkers show promise for early identification of at-risk patients, the relatively low sensitivity suggests that albuminuria alone may not be a robust predictor of PE, which underscores the need for future research in this regard. Trial registration Review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the code CRD42024575772.

The topic of induced abortion has been a subject of extensive debate among various moral and religious frameworks and continues to pose significant challenges within the domains of medical ethics and policy formulation. In the context of Iran, an Islamic republic, the approach to induced abortion has been notably influenced by historical, social, and political dynamics. Following the implementation of the 'Rejuvenation of the Population and Protection of the Family Law (RPPF)' in 2021, access to induced abortion and contraceptive measures has been markedly restricted as a response to concerns surrounding population decline. This study aims to assess the attitudes of Iranian medical and health science students toward induced abortion as future executives of health programs. This cross-sectional study administered a structured questionnaire for self-completion to medical and health science students of Tehran University of Medical Sciences, including medical students, obstetrics and gynecology residents, and nursing and midwifery students. The scoring of responses was between ‒12 and + 12, with the score ranging from 0 to positive, 12 showing an attitude negative to induced abortion, and the score below zero to ‒12 reflecting a positive attitude toward induced abortion. A total of 237 participants were involved in the study, with 52% being female, and 60% originally from cities other than Tehran. The median (min, max) of the total score of the attitude toward induced abortion was ‒5.0 (12,10). The mean score varied by the age of the respondents, with ‒4.0 (‒12, 10) for those aged above 30 years compared to ‒5.0 (‒12,10) for those aged below 30 years (P-value = 0.043). The score was 0.0 (‒12,10) for married compared to ‒6.0 (‒12,10) among single participants (P-value < 0.001). The score for participants who agreed with RPPF was 0.0 (‒12,10), compared to a more positive attitude of ‒8.0 (‒12,9) for participants who disagreed (P-value < 0.001). Iranian medical and health science students support induced abortion before 16 weeks of gestation. The attitudes of medical students who are future providers of health care and implementers of RPPF and other health laws are, therefore, at variance with current laws and policies.

Background Given the high prevalence of gestational diabetes mellitus and its significant impact on maternal and neonatal health, identifying reliable biomarkers for prediction and diagnosis is essential. The increased incidence of gestational diabetes mellitus among patients with intrahepatic cholestasis of pregnancy suggests a possible association between serum total bile acid levels and gestational diabetes mellitus. This study evaluated the relationship between total bile acid levels and gestational diabetes mellitus incidence. Methods A systematic search was performed on February 19, 2024, for studies examining the association between total bile acid levels and gestational diabetes mellitus incidence in both the general pregnant population and patients diagnosed with intrahepatic cholestasis of pregnancy. Meta-analyses were conducted to compare pooled total bile acid levels between patients with and without gestational diabetes mellitus, as well as to assess gestational diabetes mellitus prevalence in patients with mild (10 ≤ total bile acid < 40 µmol/L) vs. moderate-to-severe intrahepatic cholestasis of pregnancy (total bile acid ≥ 40 µmol/L). Results 15 observational studies involving 7,238 pregnant women were systematically reviewed. Our meta-analysis found significantly higher serum total bile acid levels in women diagnosed with gestational diabetes mellitus compared to controls in the general population (Hedge’s g = 0.29 [0.03,0.54]). However, subgroup analysis indicated that total bile acid levels were only significantly higher in patients measured earlier in pregnancy, before the gestational diabetes mellitus diagnosis, compared to healthy controls (Hedge’s g = 0.48 [0.33,0.64]), while no significant difference in total bile acid levels was observed when measurements were taken after the gestational diabetes mellitus diagnosis (Hedge’s g = 0.00 [-0.26,0.27]). Additionally, we found that the prevalence of gestational diabetes mellitus was significantly lower in patients with mild intrahepatic cholestasis of pregnancy compared to those with moderate-to-severe intrahepatic cholestasis of pregnancy (Log odds ratio=-0.56 [-0.95,-0.17]). Conclusions This study highlights a complex relationship between serum total bile acid levels and gestational diabetes mellitus incidence, influenced by the timing of measurement. Elevated total bile acid levels early in pregnancy may predict gestational diabetes mellitus, but its diagnostic value may decline later in pregnancy. Trial registration The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 3/3/2024 under CRD42024516164.

Caffeine's potential benefits on multiple sclerosis (MS), as well as on the ambulatory performance of non-MS populations, prompted us to evaluate its potential effects on balance, mobility, and health-related quality of life (HR-QoL) of persons with MS (PwMS). This single-arm pilot clinical trial consisted of a 2-week placebo run-in and a 12-week caffeine treatment (200 mg/day) stage. The changes in outcome measures during the study period (weeks 0, 2, 4, 8, and 12) were evaluated using the Generalized Estimation Equation (GEE). The outcome measures were the 12-item Multiple Sclerosis Walking Scale (MSWS-12) for self-reported ambulatory disability, Berg Balance Scale (BBS) for static and dynamic balance, Timed Up and Go (TUG) for dynamic balance and functional mobility, Multiple Sclerosis Impact Scale (MSIS-29) for patient's perspective on MS-related QoL (MS-QoL), and Patients' Global Impression of Change (PGIC) for subjective assessment of treatment efficacy. GEE was also used to evaluate age and sex effect on the outcome measures over time. (Iranian Registry of Clinical Trials, IRCT2017012332142N1). Thirty PwMS were included (age: 38.89 ± 9.85, female: 76.7%). Daily caffeine consumption significantly improved the objective measures of balance and functional mobility (BBS; P-value<0.001, and TUG; P-value = 0.002) at each study time point, and the subjective measure of MS-related QoL (MSIS-29; P-value = 0.005) two weeks after the intervention. Subjective measures of ambulatory disability (MSWS-12) and treatment efficacy (PGIC) did not significantly change. The effect of age and sex on the outcome measures were also assessed; significant sex-time interaction effects were found for MSWS-12 (P-value = 0.001) and PGIC (P-value<0.001). The impact of age on BBS scores increased as time progressed (P-value = 0.006). Caffeine may enhance balance, functional mobility, and QoL in PwMS. Being male was associated with a sharper increase in self-reported ambulatory disability over time. The effects of aging on balance get more pronounced over time. This study was registered with the Iranian Registry of Clinical Trials (Registration number: IRCT2017012332142N1), a Primary Registry in the WHO Registry Network.

Background Breastfeeding is a critical health equalizer and predictor of significant maternal and infant health outcomes, profoundly influenced by the socioeconomic and cultural status of mothers. Previous research has suggested that migration negatively impacts the breastfeeding practices of immigrant mothers. Given that Iran hosts approximately 3 million Afghan refugees, this study aimed to compare the breastfeeding practices of immigrant Afghan mothers in Iran with those of Iranian mothers. Methods This prospective cohort study included postpartum Iranian mothers ( n  = 209) and Afghan immigrant mothers ( n  = 327) referred to Nekuei Hedayati Forqani Hospital in Qom and Imam Khomeini Hospital complex in Tehran from January 1, 2023, to May 1, 2023. Breastfeeding quality was assessed using the Bristol Breastfeeding Assessment Tool (BBAT) at baseline (after birth) and at 2-, 4-, and 6-month follow-ups. Breastfeeding continuity was qualitatively assessed based on mothers’ reports of daily frequency and duration of breastfeeding episodes over six months. Results The mean BBAT score of the Iranian cohort was significantly higher than that of Afghan mothers at baseline (7.0 ± 1.5 vs. 6.7 ± 1.7; P-value = 0.032) and at the 6-month follow-up (7.7 ± 0.5 vs. 7.1 ± 1.3; P-value < 0.001), with no significant differences at 2- and 4-month follow-ups (P-values > 0.05). Additionally, the Iranian cohort demonstrated a higher frequency of daily breastfeeding episodes (P-value = 0.001) and longer mean duration per episode compared to the Afghan cohort (P-value < 0.001). Conclusions Our findings suggested that Afghan immigrant mothers tend to have poorer breastfeeding practices than Iranian mothers, which highlights the need for Iran’s healthcare system to offer a multicultural, accessible, educational, and supportive framework to improve these outcomes. Nonetheless, our relatively small sample size, significant sociodemographic disparities between the Iranian and Afghan cohorts, and restriction to urban sampling may limit the generalizability of our results. Future research would benefit from larger, longitudinal studies with nationally representative samples that systematically examine how socioeconomic factors influence breastfeeding practices among Afghan migrant populations in Iran. Trial registration Not applicable.

Background While the link between body growth indices in the first three years of life and neurodevelopment is well established, the relationship between these indicators and intelligence levels in later stages is not well understood. This study aimed to investigate the association between various anthropometric indices and Intelligence Quotient in early school-aged children. Methods This cross-sectional study recruited healthy students aged 7 to 8 years from four primary schools in Tehran, Iran. Measurements included body weight, height, body mass index, arm circumference, waist circumference, and hip circumference. Intelligence Quotient was assessed using the Raven's Standard Progressive Matrices Test, with scores standardized by age according to the Raven's manual. Separate univariate linear regression analyses evaluated the association between each anthropometric index and children’s Intelligence Quotient scores. Multivariate linear regression analyses were then performed to adjust for potential confounding factors, including the child's sex, age, and parental education levels. Results A cohort of 160 children (80 females), with a mean age of 7.5 ± 0.6 years, was included in the study. The participants exhibited the following mean anthropometric values: weight 27.7 ± 6.5 kg, height 1.2 ± 0.1 m, body mass index 17.9 ± 3.4 kg/m 2 , arm circumference 20.7 ± 2.8 cm, waist circumference 56.4 ± 6.4 cm, and hip circumference 68.1 ± 6.6 cm. Their mean Intelligence Quotient score was 106 ± 16.6. In the univariate analysis, children's weight was not significantly associated with Intelligence Quotient score ( P -value = 0.153, β = 0.288 [-0.108, 0.684]), while height was negatively associated ( P -value = 0.048, β = -31.685 [-63.142, -0.228]) and body mass index showed a positive association ( P -value = 0.001, β = 1.265 [0.524, 2.006]). Abdominal circumference was not significantly associated with Intelligence Quotient ( P -value = 0.913, β = 0.051 [-0.870, 0.972]), but both waist circumference ( P -value = 0.007, β = 0.542 [0.147, 0.937]) and hip circumference ( P -value = 0.013, β = 0.484 [0.102, 0.866]) demonstrated significant positive associations with Intelligence Quotient. However, none of the anthropometric indices maintained statistically significant associations with Intelligence Quotient after adjusting for potential confounders ( P -values > 0.05). Conclusions This study indicated no strong relationship between various body measurements and intelligence levels in school-aged children after adjusting the analyses for confounders. This suggests that intelligence in these children may be largely shaped by genetic and sociodemographic factors, with minimal influence from physical growth patterns.

Background Early identification of gestational diabetes mellitus is essential for improving maternal and neonatal outcomes. While risk factors such as advanced maternal age, elevated pre-pregnancy body mass index, multiparity, and a history of gestational diabetes have been recognized, the role of serum biomarkers remains uncertain. This study explores the predictive value of early-pregnancy laboratory findings in conjunction with maternal demographic and clinical characteristics for gestational diabetes mellitus. Methods Early-pregnancy data from the first pregnancy visits at 6–12 weeks of gestation from women in the Mothers and Children’s Health cohort were collected. Comprehensive maternal demographic data (e.g., age and body mass index) and obstetrics history (e.g., gravidity, parity, miscarriage, intrauterine growth retardation, gestational diabetes mellitus, and preeclampsia) were recorded. Maternal blood samples were analyzed for complete blood count and biochemistry parameters. Gestational diabetes mellitus was diagnosed based on 75-g oral glucose tolerance test results between 24 and 28 weeks of gestation, following the International Association of Diabetes and Pregnancy Study Groups criteria. Multivariate logistic regression analysis assessed the predictive capacity of various variables. Receiver operating curve analysis was conducted to identify optimal predictive cut-offs for continuous variables. Results 1,565 pregnant women with a mean age of 32.6 ± 5.7 years, mean body mass index of 25.5 ± 4.9 kg/m², mean gravidity of 1.1 ± 1.1, and mean parity of 0.8 ± 0.8 were included. 297 pregnancies (19.0%) were complicated by gestational diabetes mellitus. In the multivariate analysis, higher maternal age ( p  < 0.001, odds ratio = 1.076 [1.035–1.118]), a history of gestational diabetes mellitus ( p  < 0.001, odds ratio = 3.007 [1.787–5.060]) and preeclampsia ( p  = 0.007, odds ratio = 2.710 [1.310–5.604]), and elevated early-pregnancy fasting blood sugar ( p  < 0.001, odds ratio = 1.062 [1.042–1.083]) emerged as independent predictors of gestational diabetes mellitus. Moreover, the receiver operating curve yielded an optimal cut-off of 89.5 mg/dL for early-pregnancy fasting blood sugar in predicting gestational diabetes mellitus. Conclusions Our findings demonstrated that, in addition to established risk factors, a history of preeclampsia and elevated early-pregnancy fasting blood glucose are independent predictors of gestational diabetes mellitus. Therefore, close monitoring of pregnant women with these risk factors in early pregnancy is warranted to facilitate timely diagnostic and therapeutic interventions, reducing the burden of gestational diabetes. Trial registration Not applicable.

Background An enduring challenge for women diagnosed with Turner syndrome (TS) is infertility. Oocyte donation (OD) offers a chance of pregnancy for these patients. However, current data on pregnancy outcomes are inadequate. Hence, this systematic review aims to explore the clinical outcomes of OD in patients with TS. Methods A systematic search was conducted in PubMed, Web of Sciences, Scopus, and Embase for relevant papers from 1 January 1990 to 30 November 2023. Our primary research objective is to determine the live birth rate among women with TS who have undergone in vitro fertilization (IVF) using OD for fertility purposes. Specifically, we aim to calculate the pooled live birth rates per patient and per embryo transfer (ET) cycle. For secondary outcomes, we have analyzed the rates of clinical pregnancy achievement per ET cycle and the incidence of gestational hypertensive complications per clinical pregnancy. Prevalence meta-analyses were performed using STATA 18.0 by utilizing a random-effects model and calculating the pooled rates of each outcome using a 95% confidence interval (CI). Results A total of 14 studies encompassing 417 patients were systematically reviewed. Except for one prospective clinical trial and one prospective cohort study, all other 12 studies had a retrospective cohort design. Our meta-analysis has yielded a pooled live birth rate per patient of 40% (95% CI: 29-51%; 14 studies included) and a pooled live birth rate per ET cycle of 17% (95% CI: 13-20%; 13 studies included). Also, the pooled clinical pregnancy achievement rate per ET cycle was estimated at 31% (95% CI: 25-36%; 12 studies included). Moreover, the pooled rate of pregnancy-induced hypertensive disorders per clinical pregnancy was estimated at 12% (95% CI: 1-31%; 8 studies included). No publication bias was found across all analyses. Conclusions This study demonstrated promising pregnancy outcomes for OD in patients with TS. Further studies are essential to address not only the preferred techniques, but also the psychological, ethical, and societal implications of these complex procedures for these vulnerable populations. Trial registration This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration code CRD42023494273.

Background Digital Polymerase Chain Reaction (dPCR) presents a promising approach for quantifying DNA and analyzing copy number variants, particularly in non-invasive prenatal testing. This method offers a streamlined and time-efficient procedure in contrast to the widely used next-generation sequencing for non-invasive prenatal testing. Studies have reported encouraging results for dPCR in detecting fetal autosomal aneuploidies. Consequently, this systematic review aimed to evaluate the effectiveness of dPCR in screening for trisomy 21, 18, and 13. Methods A systematic search was conducted in PubMed, Web of Sciences, and Embase for relevant articles published up to December 30, 2023. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was utilized for the quality assessment of the included articles. Furthermore, a bivariate random-effect regression model was used to conduct a meta-analysis on the utility of dPCR for trisomy 21 screening. Results A total of 9 articles were included in this review, with all of them assessing the utility of dPCR in trisomy 21 screening, and 2 and 1 studies conducting additional analysis on the screening abilities of dPCR for trisomy 18 and 13, respectively. A bivariate random-effects model calculated pooled sensitivity and specificity with a 95% confidence interval (CI). Meta-analysis of 6 studies comparing trisomy-21 screening with karyotyping demonstrated dPCR's pooled sensitivity of 98% [95% CI: 94 -100] and specificity of 99% [95% CI: 99 -100]. While conducting a meta-analysis for trisomy 13 and 18 proved impractical, reported values for sensitivity and specificity were favorable. Conclusions These findings suggest that dPCR holds promise as an effective tool for non-invasive prenatal testing, presenting a less time-consuming and intricate alternative to next-generation sequencing. However, further research is necessary to evaluate dPCR's applicability in clinical settings and to delineate its specific advantages over next-generation sequencing. This study contributes valuable insights into the potential of dPCR for enhancing prenatal screening methodologies. Trial registration The protocol of this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 7/3/2024, with a registration code of CRD42024517523.

Current medical and surgical treatments for ectopic pregnancy are associated with significant adverse effects, highlighting the need for safer alternatives. This systematic review and meta-analysis evaluate the efficacy of ultrasonography-guided local absolute ethanol injection into trophoblastic tissue for managing ectopic pregnancy at various sites, including tubal, cervical, interstitial, cesarean scar, and peritoneal locations. A systematic search was conducted in PubMed, Scopus, Embase, Web of Science, and Cochrane Library on January 16, 2024. The primary outcome was treatment success, defined as declining beta-human chorionic gonadotropin levels, while ectopic pregnancy resolution time was the duration from ethanol injection to beta-human chorionic gonadotropin reaching the negative level for pregnancy (< 5 mIU/mL). Study quality was evaluated using the Joanna Briggs Institute (JBI) Clinical Appraisal Tools. Using STATA 18, we conducted a random-effects meta-analysis to determine pooled success rates and compare them with laparoscopic surgery. Six retrospective studies encompassing a total of 432 patients were included, with all meeting quality thresholds on JBI appraisal. The ectopic pregnancy site distribution was as follows: tubal (n = 3), cervical (n = 3), interstitial (n = 3), cesarean scar (n = 3), and peritoneal (n = 1). Mean baseline beta-human chorionic gonadotropin levels ranged from 1641.9 to 35,640.0 mIU/mL, with four studies including cases of fetal cardiac activity. The procedure's success rate varied between 84 and 100%, with a pooled estimate of 93.3% (95% CI 89.1-97.6%; p-value < 0.001; I.sup.2 = 66.7%). Only one study reported self-resolving peritoneal irritation; no other complications were documented. Furthermore, only one study compared ethanol injection versus laparoscopic surgery, demonstrating lower success rates in our meta-analysis (log odds ratio = - 1.803 [95% CI - 3.382, - 0.224]; p-value = 0.025). Local absolute ethanol injection to the trophoblastic tissue appears to be a potentially effective treatment for ectopic pregnancy, demonstrating high success rates and minimal side effects. However, the limited number of studies, small sample sizes, and heterogeneity necessitate further large-scale comparative trials for validation.