Golnaz Mahmoudvand; Hamze Ali Torang; Arian Karimi Rouzbahani
Abstract
Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that involves multiple organs. Pregnant women previously diagnosed with SLE are at risk of experiencing gestational complications. However, cases of initial SLE manifestation during pregnancy are rare.Case Presentation: ...
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Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that involves multiple organs. Pregnant women previously diagnosed with SLE are at risk of experiencing gestational complications. However, cases of initial SLE manifestation during pregnancy are rare.Case Presentation: A 45-year-old pregnant woman (G7P2Ab4) was admitted to Shahid Rahimi Hospital in Khorramabad, Iran, in the 29th week of gestation due to thrombocytopenia. The patient had received a diagnosis of SLE during a routine prenatal visit but had not responded to the prescribed medications. After a comprehensive clinical and paraclinical evaluation, the patient was treated with pulse intravenous methylprednisolone, followed by prednisolone, dramatically improving her clinical condition.Conclusion: Diagnosing and managing SLE during pregnancy can be controversial. An accurate evaluation of the patient’s clinical condition is essential for determining the most effective treatment strategy. A multidisciplinary approach is necessary to ensure the best possible outcomes for the mother and the fetus.
Najmeh Maharlouei; Mohammadamin Sadeghdoust; Niloufar Salemi; Kamran Bagheri Lankarani
Abstract
Background: Anxiety disorders during pregnancy can lead to adverse neonatal outcomes in different ways. This research aimed to investigate the association between anxiety levels in pregnant women and neonatal health outcomes during COVID-19 pandemic.Methods: This was a prospective cohort study in which ...
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Background: Anxiety disorders during pregnancy can lead to adverse neonatal outcomes in different ways. This research aimed to investigate the association between anxiety levels in pregnant women and neonatal health outcomes during COVID-19 pandemic.Methods: This was a prospective cohort study in which pregnant women were recruited via a prenatal teaching clinic between March and July 2020, at Hafez Hospital in Shiraz, Iran. Neonate health outcomes were recorded, including the living status, gestational age, route of delivery, the APGAR at the 1st and the 5th minutes of life, anomalies, head circumference, weight, and height. To compare the effect of stress and anxiety of mothers during the first trimester of pregnancy on neonate health outcomes, we used the short form of the Depression Anxiety Stress Scales (DASS-21) score available from the previous phase of the study.Results: In the present work, 146 pregnant women were recruited. There was no significant difference in terms of living status, APGAR scores, and congenital anomalies of neonates born to mothers without anxiety (n=121) compared to those with an abnormal level of COVID-19-related anxiety (n=25) during their pregnancy (P>0.05 for all). Furthermore, our results revealed no association between COVID-19-related anxiety during pregnancy and poor neonatal outcomes, such as low birth weight, NICU admission, macrocephaly, or microcephaly (P=0.85).Conclusions: The obtained findings revealed that COVID-19-induced anxiety did not affect neonatal clinical outcomes. However, the concern still exists regarding the potential effect of COVID-19-induced anxiety on pregnancy and neonatal outcomes. Further investigation could be thus recommended using laboratory assessments.
Aymen Elsous; Dina El-oka; Fadwa Abo-Namos; Amna Jnead; Eslam Abo-Ajwa
Abstract
Background: Causes of maternal deaths could be prevented if women are aware of maternity danger signs. We aimed to examine women’s awareness about obstetric danger signs and associated factors among females attending primary health facilities in Gaza strip, Palestine.Methods: A cross-sectional ...
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Background: Causes of maternal deaths could be prevented if women are aware of maternity danger signs. We aimed to examine women’s awareness about obstetric danger signs and associated factors among females attending primary health facilities in Gaza strip, Palestine.Methods: A cross-sectional clinic-based study was employed. An interview-based questionnaire, prepared after a review of literature, comprises two parts: socio-demographic and Obst/Gyn information and second awareness about obstetric danger signs during pregnancy, delivery, and after delivery was administered to 185 women between September and mid of November, 2020. Descriptive analysis (mean, percentage, mean, and standard deviation) was employed. Moreover, bivariate and multivariate logistic regression were applied to determine independent factors related to women knowledge.Results: One hundred thirty-eight (138) women participated. The mean age was 26.3±6.1 years and 76.1% were married for less than 10 years. Women had adequate knowledge about obstetric danger signs during pregnancy, childbirth, and post-partum (82.6%, 71%, and 68.1% respectively). Common danger signs reported were blurred vision, severe headache, convulsion, and severe vaginal bleeding. One third of women relied on more than two sources of information regarding danger signs and 90.6% thought that danger signs lead to death. Independent factors related to the knowledge about obstetric danger signs are being literate (OR: 2.46; CI95%: 1.77–6.23), previous maternal health problem (OR: 2.4; CI95%: 1.67–5.93), utilization of ante-natal care services (OR 2.21; CI95%: 1.72–4.02), and parity (OR: 3.6; CI95%: 1.48–5.64).Conclusion: Women have an adequate level of awareness about obstetric danger signs; however, it is quite less in post-partum. Efforts should be made to target knowledge deficit about danger signs in post-partum and to reduce the stress resulted from these danger signs.
Antonio Mastroianni; Sonia Greco; Luciana Chidichimo; Maria Vittoria Mauro; Francesca Greco; Filippo Urso; Valeria Vangeli
Abstract
Introduction: The Covid-19 pandemic has so far been characterized by significant morbidity and a high mortality rate worldwide. People who are frail due to age and / or the presence of comorbidities, including pregnant women, are exposed to a greater risk of developing a very serious disease. However, ...
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Introduction: The Covid-19 pandemic has so far been characterized by significant morbidity and a high mortality rate worldwide. People who are frail due to age and / or the presence of comorbidities, including pregnant women, are exposed to a greater risk of developing a very serious disease. However, only recently, certain experimental studies have focused on the role of anti- Covid-19 drugs during pregnancy. Convalescent plasma (CP), derived from the people who recover from Covid-19, can represent an interesting therapeutic option for improving the antiviral immune response, owing to its specific neutralizing content and different immune mediators against SarsCov-2. It can also improve the survival of the patients who are diagnosed with the disease early and treated in the primary stages of the disease.Case Presentation: We reported the case of a pregnant patient safely treated with CP at our hospital and conducted a comprehensive literature search using extensive database for similar case reports published from February 12, 2020 to May 31, 2021.Conclusions: An extensive literature search documented the publication of a limited number of case reports concerning Covid-19 hyperimmune plasma treatment (CPT) during pregnancy. The available results are not homogeneous; however, a very early use of CPT may possibly be effective in pregnancy. The evolution of Covid-19-related pneumonia, due to a reduction in both viremia and the concentration of proinflammatory cytokines, can be positively influenced by CPT, together with the standards of care treatment.
Hora Ameri Ahmad; Masoumeh Rostami; Sahar Dalvand; Azam Rahmani; Reza Ghanei Gheshlagh
Abstract
Contex: Sexual function during pregnancy affects martial satisfaction of couples and increases empathy in the completion of pregnancy and women’s self-confidence with reduction in fears. Studies on the sexual function of Iranian pregnant women have shown controversial results. The present study ...
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Contex: Sexual function during pregnancy affects martial satisfaction of couples and increases empathy in the completion of pregnancy and women’s self-confidence with reduction in fears. Studies on the sexual function of Iranian pregnant women have shown controversial results. The present study aimed to review the sexual function of Iranian pregnant women. Methods: The international and national databases of Web of Science/ISI, PubMed, Scopus, MagIran, and SID databases using “sex”, “sexuality”, “sexual intercourse”, “sexual function”, “sexual dysfunction”, and “pregnancy” without a time limit. We included all the papers published in Persian and English reporting the mean score of sexual function of pregnant women. Based on the pre-designed form, the required data included the name of the first authors, year of publication, sample size, research setting, questionnaire type, and methodological quality, which were extracted and recorded. Data analysis was performed in STATA version 14 using a meta-analysis method and random-effects models. The heterogeneity of the studies was evaluated utilizing the I2 test. Results: In total, 11 articles with the total sample size of 2,657 were reviewed. The highest and lowest standard scores of sexual function were reported in the first pregnancy trimester (58.92%; 95% CI: 54.08-63.75) and the third trimester (47.70%; 95% CI: 23.18-39.56), respectively. In addition, publication bias was significant in the first (P=0.001), second (P=0.009), and third trimesters (P=0.014). Conclusion: The sexual function of women was found to reduce through pregnancy progress. Therefore, sexual function assessment and counseling on pregnancy care seem crucial for pregnant women.
Adebukunola Olajumoke Afolabi; Adenike Ayobola Olaogun; Kolade Afolayan Afolabi
Abstract
Background: The gap between women’s reproductive intention and contraceptive behavior could be attributed to the increasing rate of unintended pregnancies globally. The present study was conducted to explore nursing mothers’ perception of contraception,identify the pattern of contraceptive ...
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Background: The gap between women’s reproductive intention and contraceptive behavior could be attributed to the increasing rate of unintended pregnancies globally. The present study was conducted to explore nursing mothers’ perception of contraception,identify the pattern of contraceptive uptake, examine the variations in pregnancy intention, and ultimately, to identify factors influencing contraceptive uptake and pregnancy intention in Nigeria.Methods: The current study adopted sequential explanatory mixed method. We collected the quantitative data from 400 nursing mothers in Irewole and Ife Central Local Government Areas of Osun State, Southwest Nigeria employing semi-structuredquestionnaire. Our nursing mothers were selected through multi-stage sampling technique. This excluded mothers whose index child were older than 2 years old. Focus Group Discussion was conducted with use of focus group discussion guide was conducted for the qualitative survey. Eight discussants selected by convenient sampling participated in each session. We analyzedthe quantitative data using SPSS software at univariate, bivariate and multivariate levels. Binary and multinomial regression analysis examined the association between dependent and independent variables while the level of significance was consideredat p < 0.05. The qualitative findings were reported thematically.Results: The participants in this work perceived that inappropriate contraceptive use influenced pregnancy intention, 8.5% of the nursing mothers used barrier method of contraception, 9.5% used intrauterine device, 4% hormonal pills, 8% hormonal injections,6.5% implants, 1% calendar methods, and 0.5% traditional methods whereas 62% did not use any form of contraception. About 37% of the nursing mothers had previous pregnancies unintended, 52% were ambivalent while 11% had their pregnanciesplanned. Age (P=0.02, relative risk ratio (RRR)=0.42, CI=0.20-0.87), parity (P=0.001, RRR=10.38, CI=3.27-32.92), ethnicity (P=0.002, RRR=0.13,CI=0.03-0.48), and religion (P=0.048, RRR=0.26, CI=0.07-0.99) were the main predictors of pregnancyintention while Islamic religion (P=0.02, OR=2.23, CI=1.16 - 4.26) and grand multiparty (P=0.01, OR=3.61, CI=1.37-9.51) significantly influenced contraceptive choices.Conclusion: Nursing mothers’ parity, age, religion and ethnicity were the main predictors of pregnancy intention, among which religion and parity significantly influenced contraceptive choices. These variables should be incorporated into future interventionprograms which aim to develop effective strategies towards improving uptake and utilization of reproductive health services
Sulekha T; Niresh Chandran; Avita Rose Johnson
Abstract
Background: Birth-preparedness and complication readiness (BPCR) is an evidence-based strategy for reducing maternal and neonatal mortality. This study aimed to assess the knowledge and practice regarding BPCR and the associated factors among rural women in south Karnataka. Methods: In this cross-sectional ...
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Background: Birth-preparedness and complication readiness (BPCR) is an evidence-based strategy for reducing maternal and neonatal mortality. This study aimed to assess the knowledge and practice regarding BPCR and the associated factors among rural women in south Karnataka. Methods: In this cross-sectional study, 100 mothers who had delivered in the previous year were randomly selected from 17 villages near Bangalore, south India and interviewed using the JHPIEGO BPCR Tools and Indicators for Maternal and Newborn Health from 2016 to 2017. The association between various exposure variables and knowledge and practice of BPCR was investigated with Chi-square test and Fischer’s exact test; a P value of Results: The proportion of women with adequate knowledge and practice of BPCR was 8% and 38%, respectively. All women identified a health facility for delivery, 73% arranged advance emergency transport, 50% saved money; however, only 4% identified a potential blood donor in spite of 88% being aware of their blood group. Though severe bleeding was a commonly stated danger sign, prior arrangement for blood was not practiced. This issue is of public health importance as haemorrhage continues to be one of the leading causes of maternal mortality. Conclusion: The knowledge and practice of BPCR among rural women who had delivered in the previous year were low. Knowledge and practice of BPCR were associated with higher maternal education and higher socio-economic status. It is recommended that pregnant women and their families receive information regarding BPCR during routine antenatal visits and during home visits from village level workers.
Chidozie Emmanuel Mbada; Hamdalah A Adesunkanmi; Okechukwu Ernest Orji; David Olakorede; Adebanjo Babalola Adeyemi; Esther Kikelomo Afolabi; Chidiebele Petronilla Ojukwu; Abolaji Blessed Adeyemi; Olabisi Aderonke Akinwande; Moses Oluwatosin Makinde; Dolapo Adeola Ojo
Volume 6, Issue 3 , July 2019, , Pages 22-30
Abstract
Background: Physical activity (PA) and health-related quality of life (HRQoL) are significantly affected in pregnancy.
Objectives: The aim of this study was to assess these constructs among Nigerian pregnant women and also examine the relationship between them.
Methods: A total of 140 pregnant women ...
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Background: Physical activity (PA) and health-related quality of life (HRQoL) are significantly affected in pregnancy.
Objectives: The aim of this study was to assess these constructs among Nigerian pregnant women and also examine the relationship between them.
Methods: A total of 140 pregnant women were recruited from four selected antenatal clinics in Ile-Ife, Osun State, Nigeria, who participated in this cross-sectional study. The pregnancy physical activity questionnaire (PPAQ); consisting of 33 questions aimed at evaluating different day to day activities and SF-12 health survey; an eight scale grouped questionnaire were used to assess PA and HRQoL, respectively. Descriptive statistics (mean, standard deviation, frequency, and percentage) and inferential statistics (Pearson product moment correlation and one-way ANOVA) were used for data analysis. Alpha level was set at P < 0.05.
Results: The mean age of the participants was 30.4±4.33 years. Household (347.0±452.1) and vigorous intensity (14.3±30.8) PA constituted the highest and least forms of PA. On the other hand, role limitation-physical (82.0±18.3) and health perception (82.0±18.0), and role limitation-mental (54.2±50), respectively were the highest and least rated scales on SF-12. The HRQoL scores were not significantly different (P > 0.05) across the three trimesters of pregnancy except for physical functioning (P = 0.023). However, there were significant differences in PA across the three trimester of pregnancy (P < 0.05), except for vigorous intensity (P = 0.072), sport (P = 0.057), and occupational activity (P = 0.057). There were significant correlations among HRQoL sub-scales and each household, occupational, and moderate intensity PA only (P < 0.05).
Conclusions: Light to moderate intensity and household PA are predominant among Nigerian pregnant women than vigorous intensity, occupational, and sports-related PA. Higher health perception and physical role limitation in HRQoL were mostly demonstrated by the pregnant women. There was a significant inverse relationship between HRQoL and each of moderate intensity, occupational, and household PA.
Nawfal R Hussein; Hashim A Sharaf; Shaveen Mahdi
Abstract
Background: Hepatitis C virus (HCV) is a public health issue, worldwide. HCV infection during pregnancy is associated with vertical transmission. Objectives The current study aimed at investigating the prevalence of HCV in pregnant women.
Methods: The current cross sectional study was conducted in Duhok, ...
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Background: Hepatitis C virus (HCV) is a public health issue, worldwide. HCV infection during pregnancy is associated with vertical transmission. Objectives The current study aimed at investigating the prevalence of HCV in pregnant women.
Methods: The current cross sectional study was conducted in Duhok, Kurdistan region of Iraq from January 2016 to December 2018. In the study, pregnant women were tested for HCV antibodies (HCV-Ab) positivity. The infection then was confirmed by HCV-real time polymerase chain reaction (RT-PCR).
Results: During the study, 37,200 pregnant women were recruited; 15 (0.04%) subjects were positive for HCV-Ab. To confirm the infection, HCV-RT PCR was performed for subjects with positive results and only three cases were confirmed using this method; giving a prevalence of 3/37,200 (0.001%).
Conclusions: HCV prevalence in pregnant women was low in Duhok city. Continuous screening is required to control infection and prevent vertical transmission.
Chidozie Emmanuel Mbada; Okechukwu Ernest Orji; Ademola Matthew Iyiola; Adebanjo Babalola Adeyemi; Esther Kikelomo Afolabi; Ojukwu Chidiebele Petronilla; Abolaji Blessed Adeyemi; Olabisi Aderonke Akinwande; Moses Oluwatosin Makinde
Abstract
Background: Physical inactivity and fatigue are two common phenomena in pregnancy with attendant negative consequences. However, reports on the nexus between physical activity (PA) and fatigue seems to be sparse in literature.
Objectives: This study evaluated levels and correlation between PA and pregnancy-related ...
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Background: Physical inactivity and fatigue are two common phenomena in pregnancy with attendant negative consequences. However, reports on the nexus between physical activity (PA) and fatigue seems to be sparse in literature.
Objectives: This study evaluated levels and correlation between PA and pregnancy-related fatigue among Nigerian pregnant women.
Methods: This cross-sectional study involved 189 consenting pregnant women from five selected health facilities in Osun State, south west, Nigeria, yielding a response rate of 94.5%. PA and fatigue were assessed using the pregnancy physical activity questionnaire and fatigue symptoms checklist over a three-month period (July to September, 2016). Data was analyzed using descriptive and inferential statistics. Significant level was set at P < 0.05.
Results: The mean age of respondents in this study was 29.8 ± 5.11 years. The highest and least form of PA was household (1263 ± 633.4) and vigorous intensity (6.4 ± 6.8) PA. Fatigue was most severe in the third trimester of the pregnancy (48.7 ± 11.7) and least in the second trimester (43.7 ± 8.1). There was a significant difference in the fatigue scores across trimesters of pregnancy (P = 0.042), while there was no significant difference in the PA scores across trimesters of pregnancy (P > 0.05). There was a significant relationship between total PA and fatigue (r = 0.195; P = 0.009).
Conclusions: Nigerian pregnant women seem averred to vigorous intensity, occupational, and sports related PA; however, they are mostly involved in light intensity and household physical activity. Pregnancy-related fatigue is dominant in the third trimester and least severe in the second trimester. There is significant relationship between pregnancy-related fatigue and physical activity except sedentary, moderate intensity, and occupational physical activity.
Seyedeh Azam Pour Hosseini; Sara Mirzaeian; Reza Jafarzadeh Esfehani; Nayereh Ghomian
Abstract
Small intestine gangrene during pregnancy is a rare and difficult diagnosis. This condition is mainly caused by a complicated obstruction of the small bowel resulting from adhesions due to previous surgical operations such as hernia, or small intestine volvulus. Vascular causes including thrombosis, ...
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Small intestine gangrene during pregnancy is a rare and difficult diagnosis. This condition is mainly caused by a complicated obstruction of the small bowel resulting from adhesions due to previous surgical operations such as hernia, or small intestine volvulus. Vascular causes including thrombosis, emboli, and vasculitis are common. The current report discussed a case of entire small bowel gangrene following small intestinal volvulus in a 24 - year - old multigravida in the 36th week of pregnancy, presenting with severe abdominal and back pain. During the operation, the small intestine was not recoverable, leading to a successful near - total enterectomy. The current case demonstrated the importance of a full diagnostic work - up of pregnant females present with gastrointestinal symptoms, especially when there is more than one etiology possible for patient’s clinical condition.
Viroj Wiwanitkit
Seyedeh Houra Vahedolain; Seyedeh Azam Pourhosaini; Nayere Khadem; Seyed Mostafa Pashang; Ali Akbary; Seyed Taghi Heydari
Abstract
Background: Infertility is becoming a world-wide concern in developed and developing countries. Multiple causes are responsible for the situations and various therapies have been developed to overcome this problem in infertile couples, as in the case of intrauterine insemination (IUI), with considerable ...
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Background: Infertility is becoming a world-wide concern in developed and developing countries. Multiple causes are responsible for the situations and various therapies have been developed to overcome this problem in infertile couples, as in the case of intrauterine insemination (IUI), with considerable variations between pregnancy rates in relation to the method employed.
Objectives: To compare pregnancy rate, by human chorionic gonadotropin (HCG) administration and urinary luteinizing hormone (LH) surge method, for insemination in patients undergoing IUI.
Patients and Methods: The present study included 309 infertile women, candidate for IUI, randomly divided into LH surge and HCG groups (each participant was assigned a number from 1 to 309, of which odd numbers were for LH and even numbers for HCG groups, respectively). All patients were subjected to baseline ultrasound and received clomiphene citrate before undergoing serial transvaginal sonography. The LH was measured using LH kit, when 2 - 5 follicles (18 - 20 mm) appeared in LH surge group, and, if positive, IUI was performed after 24 hours. In HCG group, the patients received HCG 1000 units and underwent IUI after 36 hours. The pregnancy rate was then compared in LH and HCG groups.
Results: We found no significant differences in pregnancy rates between the two groups. Also, we compared pregnancy rates between the two groups based on age, infertility cause, number of follicles, number of previous IUI and previous abortions. We found no significant differences between the subgroups, in terms of pregnancy rate.
Conclusions: The urinary LH surge and HCG administration methods for IUI timing are similar and none had any considerable advantages over the other. However, the use of the urinary LH surge has no side effects or injection pain, in relation to HCG administration methods
Monireh Toosi; Marzieh Akbarzadeh
Abstract
Background: Exercise can play a major role in health during pregnancy. Therefore, it is essential to consider the physiological conditions of females regarding the exercise.
Objectives: The present study aimed to determine the effect of a cycle of exercises on pregnancy outcomes.
Methods: In this clinical ...
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Background: Exercise can play a major role in health during pregnancy. Therefore, it is essential to consider the physiological conditions of females regarding the exercise.
Objectives: The present study aimed to determine the effect of a cycle of exercises on pregnancy outcomes.
Methods: In this clinical trial, 120 pregnant females referring to Shiraz hospitals in 2015 were randomly divided into the intervention and control groups. The intervention group subjects were required to do aerobic exercises for eight weeks since the 20th week of gestation in addition to receiving the routine care. However, mothers in the control group only received the routine pregnancy care. Then, pregnancy outcomes such as length of pregnancy, delivery phases, type of delivery and infants’ physiological indexes such as Apgar score, weight, height and head circumference were measured. Finally, the data were transferred into the SPSS statistical software and analyzed using T-test and Chi-square test.
Results: The two study groups were similar based on their age, level of education, income, employment status and satisfaction with their husbands. Also, no significant difference was observed between the two groups regarding the length of pregnancy, weight, height and Apgar score at birth. However, a significant difference was observed between the two groups concerning type of delivery, duration of active phase of delivery and pain intensity in the active phase of delivery. In addition, back pain intensity significantly decreased in the intervention group, but increased with progress in pregnancy in the control group.
Conclusions: Special attention is paid to supportive methods such as exercising during pregnancy in the recent years. Exercising has positive effects on mothers and infants health. Thus, these exercises are recommended to be incorporated in pregnancy care.
Maryam Yazdani; Elnaz Amirshahi; Aria Shakeri; Reza Amirshahi; Leila Malekmakan
Abstract
Background: The increased maternal age is associated with many prenatal and perinatal complications including stillbirth, preterm birth and cesarean delivery.
Objectives: This study was carried out to investigate the prenatal and maternal outcomes among mothers older and younger than 35 in Fars province, ...
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Background: The increased maternal age is associated with many prenatal and perinatal complications including stillbirth, preterm birth and cesarean delivery.
Objectives: This study was carried out to investigate the prenatal and maternal outcomes among mothers older and younger than 35 in Fars province, Iran.
Patients and Methods: This study included 1962 singleton deliveries. The prenatal and neonatal outcomes were recorded retrospectively and compared between mothers aged older and younger than 35 years. A designed questionnaire was used for data collection of parity, gravida (gravidity and parity are two terms that refer to the number of times a female has been pregnant and carried the pregnancies to a viable gestational age), outcomes of the pregnancy, labor, and neonatal outcome. Data were analyzed using SPSS, version 15, and the P < 0.05 was considered significant.
Results: The mean age of 978 mothers < 35 years-old and 984 of those aged ≥ 35 years was 31.6 ± 6.8 years. Mothers aged ≥ 35 years experienced higher risk of preeclampsia (P < 0.001), gestational diabetes mellitus (P < 0.001), placental abruption (P = 0.003), cesarean delivery (P < 0.001), low Apgar at 1 minute (P = 0.001) and low Apgar at 5 minutes (P = 0.001) compared to those aged less than 35 years.
Conclusions: Women should be alerted by the higher risks for prenatal and maternal morbidity associated with delayed pregnancy. Health care providers should be aware of the impact of delayed childbearing on the health care resources.
