Antidepressants during and after Menopausal Transition: A Systematic Review and Meta-Analysis

To assess the therapeutic benefits of antidepressants in depressive women during and after menopausal transition, PubMed, Cochrane Library, EMBASE and Science Direct were systematically searched from inception to February 1, 2020 for randomized controlled trials examining antidepressants compared to placebo. Primary outcome was change in depressive symptom severity, while secondary outcomes were rates of response/remission rates and dropout/discontinuation due to adverse events. Seven trials involving 1,676 participants (mean age = 52.6 years) showed significant improvement in depressive symptoms (k = 7, Hedges’ g = 0.44, 95% confidence interval (CI) = 0.32 to 0.57, p < 0.001) relative to that in controls. Furthermore, response (k = 3, odds ratio (OR) = 2.53, 95% CI = 1.24 to 5.15, p = 0.01) and remission (k = 3, OR = 1.84, 95% CI = 1.32 to 2.57, p < 0.001) rates were significantly higher in antidepressant-treated groups compared to those with controls. Although dropout rates did not differ between antidepressant and control groups (k = 6, OR = 0.93, 95% CI = 0.70 to 1.26, p = 0.68), the rate of discontinuation due to adverse events was significantly higher in antidepressant-treated groups (k = 6, OR = 0.55, 95% CI = 0.35 to 0.86, p = 0.01). Subgroup analysis indicated that antidepressants were also efficacious for depressive symptoms in those without diagnosis of MDD. The results demonstrated that antidepressants were efficacious for women with depressive syndromes during and after menopausal transition but associated with a higher risk of discontinuation due to adverse events

Exercise and Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy affecting both the metabolism and reproductive system of women of reproductive age. Prevalence ranges from 6.1-19.9% depending on the criteria used to give a diagnosis. PCOS accounts for approximately 80% of women with anovulatory infer-tility, and causes disruption at various stages of the reproductive axis. Evidence suggests lifestyle modification should be the first line of therapy for women with PCOS. Several studies have examined the impact of exercise interventions on reproductive function, with results indicating improvements in menstrual and/or ovulation frequency following exercise. Enhanced insulin sensitivity underpins the mechanisms of how exercise restores reproductive function. Women with PCOS typically have a cluster of metabolic abnormalities that are risk factors for CVD. There is irrefutable evidence that exercise mitigates CVD risk factors in women with PCOS. The mechanism by which exercise improves many CVD risk factors is again associated with improved insulin sensitivity and decreased hyperinsulinemia. In addition to cardiometabolic and reproductive complications, PCOS has been associated with an increased prevalence of mental health disorders. Exercise improves psychological well-being in women with PCOS, dependent on certain physiological factors. An optimal dose-response relationship to exercise in PCOS may not be feasible because of the highly individualised characteristics of the disorder. Guidelines for PCOS suggest at least 150 min of physical activity per week. Evidence confirms that this should form the basis of any clinician or healthcare professional prescription

The effect of maternal body mass index on spontaneous versus induced preterm birth: a prospective study

&quot;n Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Preterm birth which is defined as delivery before 37 completed weeks was implicated in approximately two thirds of neonatal death. Also preterm labors are the most common cause of mortality and morbidity of infants in recent years and it costs high prices for health system. We evaluate the relationship between prepregnancy maternal body mass Index (BMI) and spontaneous and indicated preterm birth.&quot;n&quot;n Methods: This study included 250 healthy pregnant women, without any risk factors of preterm birth, were classified into categories that were based on their body mass index. Association between BMI, weight gain and rout of delivery were examined. Rates of indicated and spontaneous preterm birth were compared.&quot;n&quot;n Results: Obese women delivered at a more advanced gestational age. (38/34&amp;plusmn;1/66 weeks vs 37/61&amp;plusmn;2/44, p=0/006). Obese patients had significantly lower incidence of spontaneous preterm birth at &amp;lt; 37 weeks of gestation (16/8% vs 31/2% p=0/008). Obese women had larger infants (3354/95&amp;plusmn;596/75 vs 311.24&amp;plusmn;558/357 p=0/001), and had more frequent cesarean delivery (69/6% vs 52/8%, p=0/006). Weight gain during pregnancy is poorly correlated with prepregnancy BMI (14/41&amp;plusmn;7/93 kg vs 13/78&amp;plusmn;4/94kg, p=0/4) and preterm birth.&quot;n&quot;n Conclusion: In this survey, there was adverse correlation between body mass index (BMI) before pregnancy and preterm labor less than 37 completed weeks and we suggest more study for evaluation between spontaneous and induced preterm labor mechanism and in obese and non obese women. However according to this survey obesity before pregnancy is associated with a lower rate of spontaneous preterm birth

Serum zinc levels in gestational diabetes

&quot;nBackground: Maternal zinc deficiency during pregnancy has been related to adverse pregnancy outcomes. Most studies in which pregnant women have been supplemented with zinc to examine its effects on the outcome of the pregnancy have been carried out in industrialized countries and the results have been inconclusive. It has been shown that women with gestational diabetes (GDM) have lower serum zinc levels than healthy pregnant women, and higher rates of macrosomia. Zinc is required for normal glucose metabolism, and strengthens the insulin-induced transportation of glucose into cells by its effect on the insulin signaling pathway. The purpose of this study was to assess the serum zinc levels of GDM patients and evaluate the effect of zinc supplementation. &quot;nMethods: In the first stage of this prospective controlled study, we enrolled 70 women who were 24-28 weeks pregnant at the Prenatal Care Center of Mirza Kochak Khan Hospital, Tehran, Iran. The serum zinc level of each subject was determined. In the second stage, among these 70 subjects, the diabetics receiving insulin were divided into two groups, only one of which received a zinc supplement and the other group was the control group. Birth weight of neonates and insulin dosages were recorded. &quot;nResults: The mean serum zinc level in the GDM group was lower than that of the control group (94.83 vs. 103.49mg/dl, respectively) and the mean birth weight of neonates from the GDM women who received the zinc supplement was lower than that of the control group (3849g vs. 4136g). The rate of macrosomia was lower in the zinc supplemented group (20% vs. 53%). The mean of increase of insulin after receiving the zinc supplement was lower (8.4u vs. 13.53). &quot;nConclusion: Maternal insulin resistance is associated with the accumulation of maternal fat tissue during early stages of pregnancy and greater fetoplacental nutrient availability in later stages, when 70% of fetal growth occurs, resulting in macrosomia. In our study, zinc supplementation is associated with a reduction in the rate of fetal macrosomia among pregnant women with GDM

ANDROGEN LEVELS IN PREECLAMPSIA

Preeclampsia is a major cause of morbidity and mortality during pregnancy. Several independent investigators have demonstrated the association of androgens with hypertension. The main purpose of this study was to determine whether maternal levels of sex hormones, especially testosterone, are higher in patients with preeclampsia than in matched normotensive control subjects. Serum levels of testosterone, free testosterone, dehydroepiandrosterone sulfate (DHEA-S) and estradiol were measured in 60 subjects in the 3rd trimester of pregnancy with documented preeclampsia (including 30 cases of mild and 30 cases of severe preeclampsia) and 60 healthy normotensive women with similar maternal and gestational ages and body mass index (BMI) and neonatal sex. All subjects were primigravid with singleton pregnancies. Cases of polycystic ovary (PCO), diabetes, chronic hypertension and chronic systemic diseases such as lupus and patients using steroid hormones and anti-hypertensive drugs were excluded. Levels of testosterone, DHEA-S and estradiol were not higher in primigravid women with preeclampsia than in normotensive women with similar gestational and maternal ages, BMI and neonatal sex. There were no significant differences in sex hormones measured between groups of mild and severe preeclampsia and normotensive women. There were also no significant differences in sex hormone levels according to neonatal sex. These findings are against the hypothesis of mediating or amplifying role of high androgen levels in pathophysiology of preeclampsia

Homocysteine in Gestational Diabetes and Normal Pregnancy plus Effects of Folic Acid

&quot;nBackground: The aim of study was to assess serum homocysteine and its relation with serum folate, vit B12 and lipid pro&amp;shy;files in gestational diabetes mellitus and comparison with normal pregnant women as well as effect of different doses of fo&amp;shy;lic acid on Homocysteine (Hcy) and pregnancy outcome.&quot;nMethods: &amp;nbsp;In a biphasic study first prospective controlled study 80 pregnant women were chosen at 24-28 weeks of gesta&amp;shy;tion. In case group pregnant women with gestational diabetes mellitus and control group who had normal Oral Glucose Toler&amp;shy;ance test (GTT) results. Levels of fasting glucose, homocysteine, vit B12, and folic acid, uric acid, total cholesterol, triglyc&amp;shy;eride, LDL, HDL, were measured. In phase II study a randomized clinical trial was done with diabetic women 15 with 1mg folic acid and 15 with 5 mg folic acid for six weeks and then above variables and pregnancy outcome was evalu&amp;shy;ated.&quot;nResults: The mean levels of homocysteine in Gestational Diabetes Mellitus (GDM) group were significantly higher but fo&amp;shy;lic acid and vit B12 were significantly lower. Hcy levels were decreased in both groups after six weeks folic acid but de&amp;shy;crease in Hcy for group 5mg was significantly more than 1mg group.&amp;nbsp;&quot;nConclusion: Homocysteine levels were higher in GDM than normal pregnancy. High dose folic acid can reduce Hcy levels more than low dose and it may be a safe, simple, inexpensive intervention that prevents major pregnancy complications. &quot;n&amp;nbsp

Risk factors for recurrent preterm delivery in three university hospitals

Background: Preterm labor is defined as delivery before 37 weeks of gestation. Recurrence of preterm labor in future pregnancies is 6-8%. History of preterm labor is a strong risk factor for future preterm labor. Preterm labor is the leading cause of neonatal mortality in developed countries, but permanent morbidity in these premature neonates has many side effects for the newborn as well as their family members and society. For this reason we conducted a survey to identify risk factors for recurrent preterm delivery among primiparous women with previous preterm delivery. Methods: This prospective case–control study included patients from three university hospitals, namely Imam Khomeini, Shariati and Mirza Koochakkhan Hospitals, all in Tehran, Iran. Subjects, including 539 primiparous women who delivered preterm (22–36 weeks), were divided into two groups: 47 had a second preterm delivery (study group) and 492 had first preterm delivery (control group). Exclusion criteria were induced preterm delivery due to medical indications in mother and primigravid. Data collection and analysis was performed using SPSS 10 and t-test and &amp;#967;2 test were used to analyze the significance of the results. Results: From a total of 6,537 deliveries, we found 539 cases of preterm delivery, among which 47 cases were identified as recurrent preterm delivery. The control group was composed of 492 deliveries. The recurrence of preterm delivery was 8.7%. Uterine anomaly, cardiovascular, renal and thyroid disease in mother and blood group A had a significant correlation with recurrent preterm delivery. Conclusion: Expectant mothers with uterine anomalies, cardiovascular, renal or thyroid diseases or group A blood type should receive extra care, observation and instructions in order to limit the risk of preterm delivery and its subsequent effects

Serum homocysteine level in gestational diabetes: a prospective study

&quot;n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Increased total plasma homocysteine (Hcy) is an accepted risk factor of cardiovascular disease (CVD), stroke, preclampsia, recurrent abortion and diabetes type I and II. The aim of the current study was to assess serum homocysteine and its relation with serum folat, vitamine B12 and lipid profile in gestational diabetes mellitus and to compare these with those of pregnant women.&quot;n&quot;n Methods: In a prospective controlled survey 80 pregnant women (24-28 weeks) with uncomplicated pregnancies were evaluated. They were assigned to one of two groups according to the results of 100g-OGTT. In the case group there were pregnant women with gestational diabetes mellitus according to the OGTT and in the control group women who had normal OGTT results were put. Levels of fasting glucose, homocysteine, vit B12, and folic acid, uric acid, total cholesterol, triglyceride, Low Density Lipoprotein cholesterol (LDL) and High Density Lipoprotein cholesterol (HDL) were measured in both groups.&quot;n&quot;nResults: The mean level of homocysteine in GDM group was significantly higher than control group (p=0.000). The mean level of folic acid and vit B12 was significantly lower than the level in control group (p=0.001, p=0.004 respectively). Body mass index (BMI) in GDM group was higher (p=0.000) and HDL level was lower (p=0.006) than control group. There were no significant differences among the groups with respect to levels of total cholesterol and triglyceride.&quot;n&quot;n Conclusion: We found that patients with gestational diabetes have higher homocysteine level than normal pregnant women. This increased level seems to be related to an abnormal OGTT. Further investigations are needed to follow up these patients in the postpartum period and later on

The relationship between fetal biophysical profile and cord blood PH

&quot;nBackground: The Biophysical Profile (BPP) is a noninvasive test that predicts the presence or absence of fetal asphyxia and, ultimately, the risk of fetal death in the antenatal period. Intervention on the basis of an abnormal biophysical profile result has been reported to yield a significant reduction in prenatal mortality, and an association exists between biophysical profile scoring and a decreased cerebral palsy rate in a given population. The BPP evaluates five characteristics: fetal movement, tone, breathing, heart reactivity, and amniotic fluid (AF) volume estimation. The purpose of study was to determine whether there are different degree of acidosis at which the biophysical activity (acute marker) are affected. &quot;nMethods: In a prospective study of 140 patients undergoing cesarean section before onset of labor, the fetal biophysical profile was performed 24h before the time of cesarean and was matched with cord arterial PH that was obtained from a cord segment (10-20cm) that was double clamped after delivery of newborn. (using cord arterial PH less than 7.20 for the diagnosis of acidosis). &quot;nResults: The fetal biophysical profile was found to have a significant relationship with umbilical blood PH. The sensitivity, specificity, positive predictive value, negative predictive value of fetal biophysical profile score were: 88.9%, 88.6%, 50%, 98.1%. &quot;nConclusion: The first manifestations of fetal acidosis are nonreactive nonstress testing and fetal breathing loss; in advanced acidemia fetal movements and fetal tone are compromised. A protocol of antepartum fetal evaluation is suggested based upon the individual biophysical components rather than the score alone

Meconium-Stained Amniotic Fluid as an Independent Risk Factor for Fever and Postpartum Infection in Term Pregnancy

Background: The aim of this study was to statistically evaluate the hypothesis that the presence of meconium-stained amniotic fluid is associated with postpartum maternal infection.Methods: This prospective cohort study included 573 term pregnant women in labor, with no other medical problems, that underwent cesarean section for pregnancy termination. Women with prolonged active-phase labor, prolonged rupture of membranes, complicated cesarean section and pre-operative infections were excluded from this study.The subjects were divided into two groups: 280 women with meconium-stained amniotic fluid (M group), and 293 women with clear amniotic fluid (C group). A comparison was done regarding postpartum fever, endometritis and wound infection between the two groups. Students t-test and chi square test were used for data analysis, along with linear regression, with p<0.05 indicating significance.Results: Among the 573 women, a total of 82 women (14%) had fever after cesarean; 42 women from the M group, and 40 women from the C group (p= 0.3). Among the 82 women who had fever, 33 women had continuous fever, 6.5% in group M and 2.7% in group C (p<0.05, RR: 1.98, 95% CI 1.3-3.1). Among the 573 women, 4% developed endometritis 5% in group M and 2% in group C (p<0.05, RR: 2.3, 95%, CI 1.3-3.4). Similarly, among the 573 women, a total of 5 women (1%) developed wound infection, 1.7% in group M and 0.68% in group C (p=0.7).Conclusion: Meconium-stained amniotic fluid is associated with increased postpartum infection independent of other risk factors for infection