Risk factors for C-section delivery and population attributable risk for C-section risk factors in Southwest of Iran: A prospective cohort study

Background: Iran has a high C-section rate (40.6 in 2005). The objective of this study was to assess the associations and population-attributable risks (PAR) of risk factors combinations and Csection in the Southwest Iran. Methods: We performed a population-based cohort study using the reports provided by Shiraz University of Medical Sciences. The cohort included pregnant women within September 2012 and February 2013 (n=4229), with follow-up until delivery. Then, the actual delivery was recorded; i.e., C-section delivery, vaginal delivery, and miscarriage. A multiple logistic regression model was used to estimate the point and the interval probability. The adjusted population attributable risks (aPARs) were calculated through adjusted odds ratio from the final multiple logistic regression models for each variable. Results: Of 4,217 deliveries, 2,624 ones were C-section (62.2). The rate of C-section was significantly higher in healthcare departments of private clinics compared to governmental clinics. The rate increased steadily with the mother's age, marriage age, family income and education. The multiple logistic regression analysis showed that local healthcare, supplementary insurance, maternal age, age of marriage, place of birth, family income, maternal education, education of husband and occupation were the key contributing factors to choose the mode of delivery. The multiple logistic regression analysis for reproductive factors showed that parity, previous abortion and stillbirth, previous infertility, birth weight (g) and number of live births were selected risk factors for C-section. Among the exposures, family income, location of healthcare and place of birth showed the highest population attributable risks: 43.86, 19.2 and 18.53; respectively. Conclusion: In this survey, a relatively large contribution of non-medical factors was identified against the background of C-section. All of these factors influence the knowledge, attitudes and norms of the society. Thus, the attention of policymakers should be drawn to the factors associated with this mode of delivery

Non-medical factors affecting antenatal preferences for delivery route and actual delivery mode of women in southwestern Iran

Objective: Assessment of the contribution of non-medical factors to mode of delivery and birth preference in Iranian pregnant women in southwestern Iran. Study design: This cohort study used data from a structured questionnaire completed in early pregnancy and information about the subsequent delivery obtained through personal contact. Women were recruited by random sampling from antenatal clinics when scheduling visits over the course of 5 weeks from December 2012 to February 2013 and were followed-up 1 month after birth. Of the 2199 women recruited, 99.63 were eligible for the study. Results: Of the 748 women who expressed a desire to deliver their babies by cesarean section (CS) in early pregnancy, 87 had an elective cesarean section. The logistic regression analyses showed that normative beliefs (odds ratio OR 1.792, 95% confidence interval (1) 1.073�2.993), control beliefs (OR: 0.272, 95% CI: 0.162�0.459), and evaluation of outcomes (OR: 0.431, 95% CI: 0.268�0.692) favored the preference for cesarean section. The desire for delivery by elective cesarean section was associated with normative beliefs (OR: 1.138; 95% CI: 1.001�1.294), control beliefs (OR: 0.804; 95% CI: 0.698�0.927), and expectations about maternity care (OR: 0.772; 95% CI: 0.683�0.873), medical influences (OR: 1.150; 95% CI: 1.023�1.291), evaluation of outcome (OR: 0.789; 95% CI: 0.696�0.894), age, preference for cesarean section (OR: 5.445; 95% CI: 3.928�7.546), spouse educational level, and number of live births. Conclusions: A woman�s preference for delivery by cesarean section influenced their subsequent mode of delivery. Asking women in early pregnancy about their preferred mode of delivery provides the opportunity to extend their supports which might reduce the rate of elective cesarean section. This decision is affected by age, spouse educational level, number of live births, and preconceived maternal attitudes about delivery. © 2016 Taylor & Francis

The effects of ginger intake on weight loss and metabolic profiles among overweight and obese subjects: A systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to summarize the effect of ginger intake on weight loss, glycemic control and lipid profiles among overweight and obese subjects. We searched the following databases through November 2017: MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. The relevant data were extracted and assessed for quality of the studies according to the Cochrane risk of bias tool. Data were pooled using the inverse variance method and expressed as Standardized Mean Difference (SMD) with 95 Confidence Intervals (95 CI). Heterogeneity between studies was assessed by the Cochran Q statistic and I-squared tests (I2). Overall, 14 studies were included in the meta-analyses. Fourteen RCTs with 473 subjects were included in our meta-analysis. The results indicated that the supplementation with ginger significantly decreased body weight (BW) (SMD ¡0.66; 95 CI, ¡1.31, ¡0.01; P D 0.04), waist-to-hip ratio (WHR) (SMD ¡0.49; 95 CI, ¡0.82, ¡0.17; P D 0.003), hip ratio (HR) (SMD ¡0.42; 95 CI, ¡0.77, ¡0.08; P D 0.01), fasting glucose (SMD ¡0.68; 95 CI, ¡1.23, ¡0.05; P D 0.03) and insulin resistance index (HOMA-IR) (SMD ¡1.67; 95 CI, ¡2.86, ¡0.48; P D 0.006), and significantly increased HDL-cholesterol levels (SMD 0.40; 95 CI, 0.10, 0.70; P D 0.009). We found no detrimental effect of ginger on body mass index (BMI) (SMD ¡0.65; 95 CI, ¡1.36, 0.06; P D 0.074), insulin (SMD ¡0.54; 95 CI, ¡1.43, 0.35; P D 0.23), triglycerides (SMD ¡0.27; 95 CI, ¡0.71, 0.18; P D 0.24), total-(SMD ¡0.20; 95 CI, ¡0.58, 0.18; P D 0.30) and LDL-cholesterol (SMD ¡0.13; 95 CI, ¡0.51, 0.24; P D 0.48). Overall, the current meta-analysis demonstrated that ginger intake reduced BW, WHR, HR, fasting glucose and HOMA-IR, and increased HDL-cholesterol, but did not affect insulin, BMI, triglycerides, total-and LDL-cholesterol levels. © 2018 Taylor & Francis Group, LLC

The effects of ginger intake on weight loss and metabolic profiles among overweight and obese subjects: A systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to summarize the effect of ginger intake on weight loss, glycemic control and lipid profiles among overweight and obese subjects. We searched the following databases through November 2017: MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. The relevant data were extracted and assessed for quality of the studies according to the Cochrane risk of bias tool. Data were pooled using the inverse variance method and expressed as Standardized Mean Difference (SMD) with 95 Confidence Intervals (95 CI). Heterogeneity between studies was assessed by the Cochran Q statistic and I-squared tests (I2). Overall, 14 studies were included in the meta-analyses. Fourteen RCTs with 473 subjects were included in our meta-analysis. The results indicated that the supplementation with ginger significantly decreased body weight (BW) (SMD -0.66; 95 CI, -1.31, -0.01; P = 0.04), waist-to-hip ratio (WHR) (SMD -0.49; 95 CI, -0.82, -0.17; P = 0.003), hip ratio (HR) (SMD -0.42; 95 CI, -0.77, -0.08; P = 0.01), fasting glucose (SMD -0.68; 95 CI, -1.23, -0.05; P = 0.03) and insulin resistance index (HOMA-IR) (SMD -1.67; 95 CI, -2.86, -0.48; P = 0.006), and significantly increased HDL-cholesterol levels (SMD 0.40; 95 CI, 0.10, 0.70; P = 0.009). We found no detrimental effect of ginger on body mass index (BMI) (SMD -0.65; 95 CI, -1.36, 0.06; P = 0.074), insulin (SMD -0.54; 95 CI, -1.43, 0.35; P = 0.23), triglycerides (SMD -0.27; 95 CI, -0.71, 0.18; P = 0.24), total- (SMD -0.20; 95 CI, -0.58, 0.18; P = 0.30) and LDL-cholesterol (SMD -0.13; 95 CI, -0.51, 0.24; P = 0.48). Overall, the current meta-analysis demonstrated that ginger intake reduced BW, WHR, HR, fasting glucose and HOMA-IR, and increased HDL-cholesterol, but did not affect insulin, BMI, triglycerides, total- and LDL-cholesterol levels

The effects of ginger intake on weight loss and metabolic profiles among overweight and obese subjects: A systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to summarize the effect of ginger intake on weight loss, glycemic control and lipid profiles among overweight and obese subjects. We searched the following databases through November 2017: MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. The relevant data were extracted and assessed for quality of the studies according to the Cochrane risk of bias tool. Data were pooled using the inverse variance method and expressed as Standardized Mean Difference (SMD) with 95 Confidence Intervals (95 CI). Heterogeneity between studies was assessed by the Cochran Q statistic and I-squared tests (I2). Overall, 14 studies were included in the meta-analyses. Fourteen RCTs with 473 subjects were included in our meta-analysis. The results indicated that the supplementation with ginger significantly decreased body weight (BW) (SMD ¡0.66; 95 CI, ¡1.31, ¡0.01; P D 0.04), waist-to-hip ratio (WHR) (SMD ¡0.49; 95 CI, ¡0.82, ¡0.17; P D 0.003), hip ratio (HR) (SMD ¡0.42; 95 CI, ¡0.77, ¡0.08; P D 0.01), fasting glucose (SMD ¡0.68; 95 CI, ¡1.23, ¡0.05; P D 0.03) and insulin resistance index (HOMA-IR) (SMD ¡1.67; 95 CI, ¡2.86, ¡0.48; P D 0.006), and significantly increased HDL-cholesterol levels (SMD 0.40; 95 CI, 0.10, 0.70; P D 0.009). We found no detrimental effect of ginger on body mass index (BMI) (SMD ¡0.65; 95 CI, ¡1.36, 0.06; P D 0.074), insulin (SMD ¡0.54; 95 CI, ¡1.43, 0.35; P D 0.23), triglycerides (SMD ¡0.27; 95 CI, ¡0.71, 0.18; P D 0.24), total-(SMD ¡0.20; 95 CI, ¡0.58, 0.18; P D 0.30) and LDL-cholesterol (SMD ¡0.13; 95 CI, ¡0.51, 0.24; P D 0.48). Overall, the current meta-analysis demonstrated that ginger intake reduced BW, WHR, HR, fasting glucose and HOMA-IR, and increased HDL-cholesterol, but did not affect insulin, BMI, triglycerides, total-and LDL-cholesterol levels. © 2018 Taylor & Francis Group, LLC

Family history of diabetes and the risk of gestational diabetes mellitus in Iran: A systematic review and meta-analysis.

OBJECTIVE Gestational diabetes is the most prevalent metabolic disorder being firstly diagnosed during pregnancy. The relationship between the family history of diabetes and the gestational diabetes mellitus (GDM) has been investigated in several primary studies with a number of contradictions in the results. Hence, the purpose of the present study is to determine the relationship between the GDM and the family history of diabetes using the meta-analysis method. METHOD All published papers in main national and international databases were systematically searched with some specific keywords to find the related studies between 2000 and 2016. We calculated the odds ratio (OR) with 95% confidence interval (CI) in analysis for each study using a random-effect and Mantel-Haenzel method. We also determined heterogeneity among these 33 articles and their publication bias. RESULTS We entered 33 relevant studies of 2516 articles into the meta-analysis process including 2697 women with family history of diabetes mellitus as well as 29134 women without. Of them, 954 and 4372 subjects developed GDM respectively. Combining the results of the primary studies using the meta-analysis method, the overall odds ratio of family history for developing GDM was estimated as of 3.46 (95% CI: 2.80-4.27). CONCLUSION This meta-analysis study revealed that the family history of diabetes is an important risk factor for the gestational diabetes mellitus