Influence of Environment and Genetics on Reproductive Health of Twins

Reproductive health is a dynamic part of our lives with a broad spectrum of events. Study of twins can assist to investigate the relationship between environmental and hereditary causes of reproductive diseases, which would otherwise be difficult if not impossible to study. High concordance between twin pairs suggests a strong influence for genetic factors, whereas low concordance indicates a weak influence. Preventive measures can be taken into consideration for those who are at risk of environmental influences if and only when the role of genetic is minor even though gene therapy may minimize the occurrence of genetic disease. This cross-sectional descriptive study of reproductive health of twins investigated the heritability of qualitative and quantitative measured variables related to reproductive events or behavior of adult twins. Subjects included 156 identical and 110 non-identical twins, 15 years and above who were living in urban areas of Iran and Malaysia. Basic and modern genetic analysis was adopted. Maximum likelihood analysis and model fitting analysis suggested that birth weight, weight, height, age of menarche, premenstrual symptoms, acne, hirsutism, baldness and infertility are mostly determined by genetic factors while characteristics of menstruation were more likely under the influence of environmental factors. Classical genetic analysis using Falconer’s formula suggested higher similarity between monozygotic twins than dyzyotics in relation to reproductive behaviors such as age of first pregnancy and number of pregnancies. Probandwise concordance rate analysis showed higher similarity between identical twins in adopting correct reproductive behavior such as undergoing pap smear and using family planning techniques. Model fitting analysis for the ACE model supported these findings. Same-sex twins had a higher risk of congenital abnormality, gynecological problem, and irregular menstruation than opposite sex twins. Other reproductive events were not found to be significantly different between the two groups indicating that hormonal transition from male to female may not be a valid explanation for reproductive ill health. Birth weight was not found to affect reproductive morbidity during adult life as frequency of reproductive event was found to be higher among low birth weight twins compared with normal weight twins. This finding is not consistent with fetal origin hypothesis or thrifty gene hypothesis. Reproductive ill-health influenced by environmental factors may be minimized using careful primary care evaluation, early detection and prevention while genetic predisposition can be monitored for those variables under genetic influence. Early reproductive health consultation for adolescents is recommended to avoid complications of reproductive ill-health

Letter to Editor: A neglected critical time to prevent maternal and offspring’s adverse outcomes: The preconception period

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The heritability of premenstrual syndrome

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

The most effective sexual function and dysfunction interventions in individuals with multiple sclerosis: A systematic review and meta-analysis

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. Key words: Clinical trial, Multiple sclerosis, Sexual dysfunction, Systematic review

Pharmacotherapy and Associated Factors in Women with Gestational Diabetes

Introduction Pharmacotherapy is an indicator of severity of hyperglycemia in pregnancy that may reflect β-cell dysfunction in women with gestational diabetes mellitus. Methods and Results  Life after gestational diabetes Ahvaz Study (LAGAs) is a population-based prospective cohort study to investigate potential short and long-term metabolic outcomes of gestational diabetes in mothers and their offsprings. Pregnant women attending 25 urban public and private centers seeking prenatal care were recruited from March 2015. 19.3% (34/176) of women with gestational diabetes required pharmacotherapy in pregnancy (12.5% insulin and 6.8% metformin). The mean age of women who needed pharmacotherapy was 31.0 (SD, 4.6) years vs 29.3 (SD, 5.3) years in diet-treated women. Cesarean delivery, higher FPG at first visit of pregnancy and premature delivery were significantly associatiated  with need to pharmacotherapy in pregnancy (p<0.05).  Conclusions Although the use of oral anti-diabetic drugs in pregnancy is not recommended by the American diabetes Association (ADA), consumption of them in women exposed to gestational diabetes is considerable. Use of insulin or metformin for management of hyperglycemia in pregnancy strongly prognoses metabolic disturbance later in life.  Therefore postpartum prevention and screening program for cardiovascular risk factors is important for women with GDM who required pharmacotherapy for management of hyperglycemia in pregnancy

Umbilical vein injection for management of retained placenta.

BackgroundRetained placenta is a common complication of pregnancy affecting 1% to 6% of all births. If a retained placenta is left untreated, spontaneous delivery of the placenta may occur, but there is a high risk of bleeding and infection. Manual removal of the placenta (MROP) in an operating theatre under anaesthetic is the usual treatment, but is invasive and may have complications. An effective non-surgical alternative for retained placenta would potentially reduce the physical and psychological trauma of the procedure, and costs. It could also be lifesaving by providing a therapy for settings without easy access to modern operating theatres or anaesthetics. Injection of uterotonics into the uterus via the umbilical vein and placenta is an attractive low-cost option for this. This is an update of a review last published in 2011.ObjectivesTo assess the use of umbilical vein injection (UVI) of saline solution with or without uterotonics compared to either expectant management or with an alternative solution or other uterotonic agent for retained placenta.Search methodsFor this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (14 June 2020), and reference lists of retrieved studies.Selection criteriaRandomised controlled trials (RCTs) comparing UVI of saline or other fluids (with or without uterotonics), either with expectant management or with an alternative solution or other uterotonic agent, in the management of retained placenta. We considered quasi-randomised, cluster-randomised, and trials reported only in abstract form.Data collection and analysisTwo review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach. We calculated pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs), and presented results using 'Summary of findings' tables.Main resultsWe included 24 trials (n = 2348). All included trials were RCTs, one was quasi-randomised, and none were cluster-randomised. Risk of bias was variable across the included studies. We assessed certainty of evidence for four comparisons: saline versus expectant management, oxytocin versus expectant management, oxytocin versus saline, and oxytocin versus plasma expander. Evidence was moderate to very-low certainty and downgraded for risk of bias of included studies, imprecision, and inconsistency of effect estimates. Saline solution versus expectant management There is probably little or no difference in the incidence of MROP between saline and expectant management (RR 0.93, 95% CI 0.80 to 1.10; 5 studies, n = 445; moderate-certainty evidence). Evidence for the following remaining primary outcomes was very-low certainty: severe postpartum haemorrhage 1000 mL or greater, blood transfusion, and infection. There were no events reported for maternal mortality or postpartum anaemia (24 to 48 hours postnatal). No studies reported addition of therapeutic uterotonics. Oxytocin solution versus expectant management UVI of oxytocin solution might slightly reduce in the need for manual removal compared with expectant management (mean RR 0.73, 95% CI 0.56 to 0.95; 7 studies, n = 546; low-certainty evidence). There may be little to no difference between the incidence of blood transfusion between groups (RR 0.81, 95% CI 0.47 to 1.38; 4 studies, n = 339; low-certainty evidence). There were no maternal deaths reported (2 studies, n = 93). Evidence for severe postpartum haemorrhage of 1000 mL or greater, additional uterotonics, and infection was very-low certainty. There were no events for postpartum anaemia (24 to 48 hours postnatal). Oxytocin solution versus saline solution UVI of oxytocin solution may reduce the use of MROP compared with saline solution, but there was high heterogeneity (RR 0.82, 95% CI 0.69 to 0.97; 14 studies, n = 1370; I² = 54%; low-certainty evidence). There were no differences between subgroups according to risk of bias or oxytocin dose for the outcome MROP. There may be little to no difference between groups in severe postpartum haemorrhage of 1000 mL or greater, blood transfusion, use of additional therapeutic uterotonics, and antibiotic use. There were no events for postpartum anaemia (24 to 48 hours postnatal) (very low-certainty evidence) and there was only one event for maternal mortality (low-certainty evidence). Oxytocin solution versus plasma expander One small study reported UVI of oxytocin compared with plasma expander (n = 109). The evidence was very unclear about any effect on MROP or blood transfusion between the two groups (very low-certainty evidence). No other primary outcomes were reported. For other comparisons there were little to no differences for most outcomes examined. However, there was some evidence to suggest that there may be a reduction in MROP with prostaglandins in comparison to oxytocin (4 studies, n = 173) and ergometrine (1 study, n = 52), although further large-scale studies are needed to confirm these findings.Authors' conclusionsUVI of oxytocin solution is an inexpensive and simple intervention that can be performed when placental delivery is delayed. This review identified low-certainty evidence that oxytocin solution may slightly reduce the need for manual removal. However, there are little or no differences for other outcomes. Small studies examining injection of prostaglandin (such as dissolved misoprostol) into the umbilical vein show promise and deserve to be studied further

Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section in China: A mixed-methods systematic review

Background: China has witnessed a rapid increase of caesarean section (CS) rates in recent years. Several non-clinical factors have been cited as contributing to this trend including maternal request and perceived convenience. We aimed to assess preferences for mode of delivery and factors for preferences for CS in China to inform the development of future interventions to mitigate unnecessary CSs. Methods and Findings: We conducted a mixed-methods systematic review and included longitudinal, cross-sectional studies and qualitative studies in mainland China, Hong Kong and Taiwan that investigated preferences for mode of delivery among women and family members and health professionals, and the reasons underlying such preferences. We searched MEDLINE/PUBMED, EMBASE, CINAHL, Popline, PsycINFO, Global Health Library and one Chinese database (CNKI) using a combination of the following key terms “caesarean section”, “preference”, “choice”, “knowledge”, “attitude”, “culture”, “non-clinical factors”, “health professionals-patient relations” between 1990 and 2018 without language restriction. Meta-analysis of quantitative studies and meta-synthesis of qualitative studies were applied. We included 66 studies in this analysis: 47 quantitative and 19 qualitative. For the index pregnancy, the pooled proportions of preference for CS reported by women in longitudinal studies were 14% in early or middle pregnancy (95%CI 12-17%) and 21% in late pregnancy (95%CI 15-26%). In cross-sectional studies, the proportions were 17% in early or middle pregnancy (95%CI 14-20%), 22% in late pregnancy (95%CI 18-25%) and 30% at postpartum (95%CI 19-40%). Women’s preferences for CS were found to rise as pregnancy progressed (a mean difference to test preference change across longitudinal studies; mean difference 7%, 95%CI 1%-13%). One longitudinal study reported that the preference for CS among women’s partners increased from 8% in late pregnancy to 17% in the immediate postpartum. In addition, 18 quantitative studies revealed some pregnant women did not have straightforward preference for a mode of delivery, even in late pregnancy ranging from 4% to 34%. The qualitative meta-synthesis found that women’s perceptions of CS as preferable were based on prioritizing the baby’s and woman’s health and appeared to intensify through interactions with the system. Women valued the convenience of bypassing labour because of fear of pain, antagonistic relations with providers, and beliefs of deteriorating quality of care during labour and vaginal birth fostering the feeling that CS is the safest option. Health professionals’ preference for CS was influenced by financial drivers and malpractice fears. This review has some limitations, including high heterogeneity (despite sub-group and sensitivity analysis) in the quantitative analysis, and the potential for over-reporting of women’s preferences for CS in the qualitative synthesis (due to some included studies only including women who requested CS). Conclusion: Despite a minority of women expressing a preference for CS, individual, health system and socio-cultural factors converge contributing to high CS rate in mainland China, Hong Kong and Taiwan. In order to reduce the use of unnecessary CS, interventions need to address all these non-clinical factors and concerns

Healthcare Workers Coronavirus (COVID-19) Infection during an Early Phase of the Pandemic: A Systematic Review and Meta-Analysis

Background: Infection and death of health care workers (HCWs) with COVID-19 is an important health problem and will lead to inadequate care of patients, causes more damage and more spread of this pandemic. This study aimed to combine data on COVID-19 infection among HCWs through a systematic review and meta-analysis study. Methods: We searched PubMed via MEDLINE, the SCOPUS, and Web of Science (ISI) to identify the studies on the prevalence of HCWs infection among COVID-19 patients. We used an eight-item checklist critically appraised to assess the quality of publications on the COVID-19 infection among HCWs. Random-effect models and meta-regression were used for the meta-analysis of the results. Results: Overall, 98 articles were retrieved from the databases, of which, seven met the eligibility criteria published between December 2019 to March 2020. The total sample size of the included studies contained 72677 COVID-19 confirmed cases, of which 3131 were HCWs. The pooled COVID-19 infection prevalence among HCWs was 4% (95% CI: 3% to 5%). Conclusions: According to the results, COVID-19 infection in HCWs was 4% of all cases in the early phase of the pandemic. So HCWs need special care including regular screening and appropriate, adequate, and standard personal protective equipment (PPE). Keywords: Novel Coronavirus, COVID-19, Health Care Workers, Medical Staff