Journal of Family and Reproductive Health最新文献

Objective: Maternal mortality remains a major public health challenge in Madagascar, with notable regional disparities. Antenatal care (ANC) plays a critical role in preventing maternal deaths, yet its coverage and quality vary significantly across regions. This study aims to assess the association between ANC quality and maternal mortality rate (MMR), focusing on regional disparities and exploring potential non-linear relationships.

Materials and methods: We conducted a retrospective ecological study using publicly available data from Madagascar's 22 regions. ANC indicators included blood pressure monitoring, blood and urine tests, iron supplementation, and antiparasitic treatment. Linear regression and Generalised Additive Models (GAM) were used to examine associations and non-linear patterns. Statistical analyses were performed using R version 4.2.2, with a significance threshold of 5%.

Results: Considerable disparities were observed in ANC coverage across regions. Linear models revealed no significant association between ANC indicators and MMR (p > 0.05). However, GAM identified significant non-linear relationships for blood pressure monitoring (p < 0.0045) and blood testing (p < 0.0055), suggesting potential threshold effects.

Conclusion: Addressing maternal mortality in Madagascar requires enhancing both access to and the quality of ANC. Accounting for regional disparities and non-linear trends is essential in developing effective public health interventions.

Objective: This study aimed to evaluate the effectiveness of PAW in inhibiting and eliminating four major pathogenic bacterial species: Pseudomonas, Salmonella, Escherichia coli, and Staphylococcus aureus.

Materials and methods: Plasma-activated water (PAW) was generated using a dielectric barrier discharge (DBD) cold plasma device (10 kV, 20 kHz, 4.5 L/min airflow). Two-pipette electrodes generated plasma columns with reactive species. Water hardness, pH, and ozone were measured in triplicate. Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Salmonella spp. were cultured, suspended to 0.5 McFarland, diluted serially, and cultured using the pour plate method. Plasma-generating electrodes were immersed in bacterial suspensions and treated for 2.5, 5, 10, and 15 minutes. Samples were cultured in triplicate using the pour plate method and colony counts were analyzed using t-tests and ANOVA.

Results: Plasma-activated water (PAW) significantly altered pH and hardness and exhibited high bactericidal activity. Hardness increased dramatically post-plasma, while pH decreased. Ozone levels increased with plasma exposure. Duncan's test (p < 0.05) confirmed significant bacterial reduction. PAW completely eliminated some strains within 2.5-5 minutes. PAW eliminated Pseudomonas aeruginosa at all time points. S. aureus was reduced to 78 ± 9 CFU/mL at 2.5 minutes and eliminated thereafter. E. coli was eliminated at 5-15 minutes, with 53 ± 7 CFU/mL remaining at 2.5 minutes. Salmonella spp. was reduced to 66 ± 8 CFU/mL at 2.5 minutes and eliminated thereafter.

Conclusion: Increased ozone concentration along with ROS and RNS enhances disinfection, inactivating Pseudomonas aeruginosa, Salmonella spp., Escherichia coli, and Staphylococcus aureus within 5 minutes. Reactive species disrupt bacterial cell walls and membranes, providing antimicrobial effects. Plasma-activated water offers a portable, user-friendly, and eco-friendly alternative to chemical disinfectants for microbial decontamination in food, medical, sanitation, and hospital settings, while conserving water.

Objective: Antioxidants have shown positive effects on semen quality by improving sperm parameters such as motility and viability. This study investigate the effects of curcumin on sperm parameters, apoptosis, and DNA fragmentation index (DFI) following freezing in oligoteratoasthenospermia (OAT) patients.

Materials and methods: In this experimental study, a total of 40 semen samples obtained from 10 men aged 25-42 years with OAT according to WHO guidelines were treated with different concentrations of curcumin (0, 10, 20, and 30 μM) in a freezing medium. Following the freeze-thaw process, sperm parameters were evaluated. At the optimal dose, DNA fragmentation index (DFI) was assessed using the TUNEL (Terminal deoxynucleotidyl transferase dUTP nick end labeling) assay, and the expression levels of BAX (BCL2-associated X) and BCL2 (B-cell lymphoma-2) genes were measured by real-time PCR in both the optimal dose group and the control group.

Results: The cryopreservation had a significant detrimental effect on sperm parameters. Curcumin treatment, particularly at the 20 μM dose, showed improvements in sperm motility, although these improvements did not reach statistical significance. Also in optimal dose (20 μM dose), there was a significant decrease (p < 0.001) in the level of DFI, in BAX gene expression and BAX/BCL2 ratio, as well as a significant increase in BCL2 gene expression, which It indicates a decrease in apoptosis.

Conclusion: It seems that the addition of curcumin to the sperm- freezing medium has a positive impact on sperm motility. This improvement can be attributed to the reduction in apoptosis and the protective effects on sperm DNA. By mitigating apoptosis, curcumin helps preserve the viability and functionality of sperm cells.

Objective: This study targeted to investigate the potential role of breast milk iodine concentration (BMIC), insulin-like growth factor-1 (IGF-I), and brain-derived neurotrophic factor (BDNF) during the early stage of lactation in child neurocognitive development.

Materials and methods: In this secondary analysis, we examined 122 breastfeeding mothers and their healthy children, all of whom were breastfed for at least six months. Levels of BDNF, IGF-1, and BMIC were assessed in breast milk samples obtained between the third and fifth days after lactation began (before any iodine supplementation intervention). Three-year-old children were administered the Bayley-III screening test to assess their cognitive, motor, and language development.

Results: The median (interquartile range) concentrations of iodine, BDNF, and IGF-1 in breast milk during the starting few days of lactation were 285.0 (181.0-366.0) μg/l, 0.59 (0.52-0.76) ng/ml, and 12.5 (9.6-18.3) ng/ml, respectively. The mean (standard deviation) cognitive, motor, and language scores were 101.0 (10.8), 93.4 (14.6), 100.1 (13.5) and, respectively. Linear regression models revealed a negative relation between breast milk iodine and children's cognitive development ((β unadjusted = -0.004 (P = 0.010); β adjusted = -0.003 (P = 0.024)). However, no associations were found between breast milk BDNF and IGF-1 and cognitive, language, or motor scores in three-year-olds.

Conclusion: Our findings indicate that early exposure to iodine, BDNF, and IGF-1 in breast milk, measured prior to iodine supplementation, has no substantial association with neurodevelopment in three-year-old children. The weak negative association between BMIC and cognitive scores may reflect prenatal iodine status, warranting further research to explore long-term effects of supplementation.

Objective: Respiratory Distress Syndrome (RDA) is a common complication in premature neonates due to immature lungs, and antenatal corticosteroid administration could reduce its incidence. We aim to investigate the role of antenatal melatonin administration in preventing RDS among women with placenta accrete spectrum who usually mandate early delivery.

Materials and methods: This is a single-blinded randomized controlled trial performed in a tertiary hospital among women with placenta accrete spectrum. The melatonin group received Melatonin 10 mg/daily for two weeks before elective cesarean section in addition to corticosteroids, and the control group just received corticosteroids. The RDS occurrence was compared between two groups.

Results: In total, 60 participants were involved in the study (30 in the melatonin group and 30 in the control group). RDS was diagnosed for five (16.7%) neonates in the melatonin group and nine (30.0%) neonates in the control group (P-value= 0.228). Among neonates with RDS, no neonate in the melatonin group required intubation, and six (66.7%) neonates intubation needed in the control group (P = 0.016).

Conclusion: Antenatal melatonin administration may reduce the need for intubation in preterm neonates with RDS, though the lower incidence of RDS observed in the melatonin group was not statistically significant. The small number of RDS cases limits the ability to draw definitive conclusions regarding intubation rates and hospitalization duration. Larger-scale, multicenter studies with long-term follow-up are needed to validate these findings and better understand melatonin's role in neonatal respiratory care.

Objective: Infertility is a global health challenge, affecting many couples worldwide. Male infertility contributes to 20-50% of cases. Although semen analysis parameters are widely regarded as key indicators of male fertility, their association with in vitro fertilization (IVF) success remains debated. This study evaluated the relationship between specific semen parameters and grade A embryo formation in IVF among infertile men.

Materials and methods: This retrospective cross-sectional study was conducted at a referral infertility center from March 2019 to March 2021, involving 104 men diagnosed with male-factor infertility. Semen parameters, including sperm count, motility, morphology, and volume, were analyzed. The primary outcome was the formation of at least one grade A embryo, defined as a successful IVF outcome. Statistical analyses included chi-square tests and logistic regression.

Results: The median age differed significantly between the successful and unsuccessful IVF groups (36 vs. 38 years, p=0.050). No significant differences were observed in semen volume, sperm count, motility, or morphology between groups. Logistic regression revealed that younger age was associated with a higher likelihood of grade A embryo formation (OR=0.935, p=0.012), whereas semen parameters showed no significant association with embryo quality.

Conclusion: This study found no significant association between semen parameters and grade A embryo formation in IVF, suggesting that traditional semen analysis has limited predictive value for embryo quality. Although younger age was associated with a higher likelihood of success, the effect size was small (OR=0.935, p=0.012), and its clinical impact may be limited. These findings highlight the potential for successful embryo development despite suboptimal semen parameters and underscore the need for a broader approach to assessing male fertility beyond standard semen analysis.

Objective: To evaluate the efficacy of 50 mg/day intramuscular (IM) progesterone in achieving optimal serum P4 levels during endometrial preparation and investigate the association between serum P4 levels on embryo transfer (ET) day and subsequent fertility outcomes in hormone replacement therapy (HRT) frozen embryo transfer (FET) cycles.

Materials and methods: This prospective cohort study included 121 women (aged 22-45 years) undergoing HRT-FET at Imam Khomeini Hospital Complex from December 2022 to January 2024. Endometrial preparation began with oral estradiol valerate (6 mg/day) on cycle day 2. Once an endometrial thickness of ≥8 mm was achieved, daily IM P4 (50 mg) was initiated. Serum P4 levels were measured on ET day, and oral dydrogesterone (20 mg/day) was added for patients with P4 levels <10.0 ng/mL. Primary outcomes included chemical pregnancy, clinical pregnancy, miscarriage, and ongoing pregnancy rates.

Results: The mean serum P4 level on ET day was 22.8 ± 10.1 ng/mL, with 78.5% of participants achieving the target range (10-32.5 ng/mL) following IM P4 administration. Overall chemical pregnancy, clinical pregnancy, and ongoing pregnancy rates were 23.1%, 18.2%, and 14.1%, respectively, with a miscarriage rate of 5.0%. Multivariate analysis revealed that P4 levels >27.8 ng/mL were associated with reduced odds of chemical pregnancy (OR = 0.20; 95% CI: 0.05-0.86; p = 0.03), while no significant differences were observed in other pregnancy outcomes across P4 quartiles.

Conclusion: Daily administration of 50 mg IM P4 effectively achieved optimal serum P4 levels in most patients. While higher P4 levels (>27.8 ng/mL) were associated with reduced chemical pregnancy rates, the absence of significant correlations with other pregnancy outcomes highlights the multifactorial nature of embryo implantation success. These findings emphasize the need for further research to refine P4 thresholds and identify additional predictive factors influencing pregnancy outcomes in FET cycles.

Objective: The study explored the lived experiences of adolescent parents in the Philippines and how they were able to transitioned from adolescence to young adulthood.

Materials and methods: It adopts a descriptive phenomenological approach exploring the parenting phenomenon experienced by purposively selected adolescent parents (n=24).

Results: Using an inductive thematic analysis of the content of the entire data set, the research identified one predominant theme: "Rise where you stumbled," along with four sub-themes of adolescent parenting experiences, namely, "a child turns our world upside down," "beating the odds," "in good company," and "our hope and joy."

Conclusion: This study presents a cautionary narrative for adolescent parents in comparable circumstances. It reveals its multifaceted challenges and opportunities for effectively navigating its dynamics, emphasizing the psychosocial factors that facilitated the desired behavior and the underlying motivations that drove their forced transition from adolescence to young adulthood.

Objective: This study aims to analyze the correlation between salivary alpha-amylase (sAA) and stress in adolescents with premenstrual syndrome (PMS), and to assess the predictive ability of sAA levels and stress for PMS.

Materials and methods: Sixty-two adolescents with and without PMS (31 each) were grouped based on their PMS status, measured using the Shortened Premenstrual Assessment Form (SPAF). Stress was measured using the Kessler Psychological Distress Scale (K10). The levels of sAA were measured using Enzyme-Linked Immunosorbent Assay (ELISA). Data were analyzed using the Pearson correlation test, Receiver Operating Characteristic (ROC) curve analysis, and multiple linear regression analysis.

Results: Stress and PMS expressed a significant positive correlation (p=0.001; r=0.66). sAA levels and PMS showed a significant positive correlation (p<0.05; r=0.42). The level of sAA in adolescents with PMS was 23.28±12.02 ng/mL, almost twice higher than in adolescents without PMS (12.10±7.5 ng/mL). The cut-off value of sAA level on PMS was ≥15.02 ng/mL with a sensitivity and specificity of 67.7%. The level of sAA and stress were significantly able to predict PMS (p<0.001). The correlation value of SAA levels and stress with PMS is positive (r=0.705), suggesting they can predict PMS by 49.7% (R²=0.497).

Conclusion: There is a positive relationship between sAA levels and stress in adolescents with PMS. SAA levels and stress were able to predict PMS in adolescents with an accuracy of 49.7%.

Objective: Eating the placenta after birth, or placentophagia, is common in mammals but questionable in humans. There is little scientific evidence to support the claims made by practitioners that it promotes lactation, prevents depression, and aids in postpartum healing.

Materials and methods: This paper reviews the historical background, cultural relevance, ethical considerations, advantages, and potential risks of human placentophagia. The placenta does contain hormones and nutrients, but their efficacy and bioavailability have not been established. Furthermore, safety concerns (such as bacteria and endocrine disturbance) raise doubts about its practice.

Results: Placentophagia is not recommended by the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention because the production of human placentophagy products is unregulated and presents potential health risks.

Conclusion: This review considers the benefits or harms of placentophagia on human health, summarizes recent studies, addresses ethical and medical viewpoints, and emphasizes the need for further research.