Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 15 3 2021 09 07 141 149 EN Angeline Maher Edinburgh Medical School, University of Edinburgh, Edinburgh, UK Agata Sobczyńska-Malefora Faculty of Life Sciences & Medicine, Kings College London, London, UK AND Nutristasis Unit, Viapath, St. Thomas' Hospital, London, UK 2021 01 21 2021 06 13 The incidence of gestational diabetes mellitus (GDM) is rising, which warrants attention due to the associated complications during pregnancy and in the long term for both mother and offspring. Studies have suggested a relationship between maternal folate (vitamin B9) and vitamin B12 status and GDM risk. Seemingly the most problematic scenario occurs when there is B-vitamin imbalance, with high folate and low vitamin B12. This nutritional state can occur in vitamin B12 deficient women who exceed the recommended folic acid supplementation. However, the pathological mechanisms behind this relationship are currently unclear and are explored in this review article. A high folate/low B12 can lead to a functional folate deficiency through the methyl-trap phenomenon, impairing re-methylation of homocysteine and regeneration of folates for DNA synthesis and repair. Consequently elevated homocysteine concentration leads to endothelial dysfunction and oxidative stress. Vitamin B12 deficiency also leads to an impairment of the conversion of methylmalonyl-CoA to succinyl-CoA, which has been associated with insulin resistance. Insulin resistance is thought to contribute to the etiology of GDM. More studies are needed to confirm the impact of these and other mechanisms on disease development. However, it highlights a potential avenue for GDM risk modification through a vitamin B12 supplement and improvement of maternal metabolic health. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1678 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1678/566

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 15 3 2021 09 07 172 178 EN Nargess Moghadasi Department of Occupational Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran Iraj Alimohammadi Department of Occupational Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran Ali Safari Variani Department of Occupational Health Engineering, School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran Azadeh Ashtarinezhad Department of Occupational Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran 2020 12 13 2021 06 13 Objective: Due to the growing use of communication instruments such as cell phones and wireless devices, there is growing public concern about possible harmful effects, especially in sensitive groups such as pregnant women. This study aimed to investigate the oxidative stress induced by exposure to 900 MHz mobile phone radiation and the effect of vitamin C intake on reducing possible changes in pregnant mice. Materials and methods: Twenty-one pregnant mice were divided into three groups (control, mobile radiation-exposed, and mobile radiation plus with vitamin C intake co-exposed (200 mg /kg)). The mice in exposure groups were exposed to 900 MHz, 2 watts, and a power density of 0.045 μw /cm2 mobile radiation for eight hours/day for ten consecutive days. After five days of rest, MDA (Malondialdehyde), 8-OHdG (8-hydroxy-2' -deoxyguanosine), and TAC (Total Antioxidant Capacity) levels were measured in the blood of animals. The results were analyzed by SPSS.22.0 software. Results: The results showed that exposure to mobile radiation increased MDA (P=0.002), and 8-OHdG (P=0.001) significantly and decreased Total Antioxidant Capacity in the exposed groups (P=0.001). Taking vitamin C inhibited the significant increase in MDA and 8-OHdG levels in exposed groups. Conclusion: Although exposure to mobile radiation can cause oxidative stress in the blood of pregnant mice, vitamin C as an antioxidant can prevent it. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1634 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1634/568

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 15 3 2021 09 07 210 214 Sangam Jha Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Bihar, India Akanksha Singh Department of Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Bihar, India 2021 04 29 2021 07 19 Objective: Arteriovenous malformation (AVM) can occur in cesarean scar ectopic pregnancy. The presence of retained product of conception can pose a diagnostic dilemma and clinical presentation could be similar. Case report: A 27 year old female presented with continuous vaginal bleeding for two and half months following dilatation and evacuation (D&E) done for cesarean scar pregnancy (CSP) of 10 weeks 4days period of gestation. Sonography with color Doppler revealed dilated tortuous vessels around the mass in lower uterine segment suggesting CSP with AVM. Digital subtraction angiography confirmed the diagnosis. Bilateral uterine artery embolization achieved complete devascularisation as confirmed on post intervention angiogram. Patient became symptom free since then. Conclusion: Uterine artery embolization is an effective mode of treatment of AVM complicating CSP if future fertility is desired. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1775 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1775/571

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 15 3 2021 09 07 150 159 Farideh Zafari Zangeneh Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran Maryam Sarmast Shoushtari Chemical and Environmental Engineering Department, Engineering Faculty, Malaysia Putra university, Selangor, Malaysia 2021 05 16 2021 09 11 Objective: Female sex hormones have a pro-inflammatory effect, which may help to minimize inflammation. Estrogen's immunoregulatory properties play a significant role in the bi-directional neuroendocrine-immune activity in females. As a result, sex hormones can play a role in men's high mortality rate from coronavirus-2019 (COVID-19). It is aimed to clarify the role of 17-estradiol (E2) in the battle against COVID-19. Materials and methods: Until April 2021, a study on PubMed was performed. COVID-19, 17-estradiol (E2), immunoregulatory properties, pregnancy, menopausal symptoms, hormonal therapy, ER/ expression on immune cells, and mortality were some of the concepts used in the search. Results: Regulation of pro-inflammatory immune processes against COVID-19 appears to be associated with increased immune function (pro-inflammatory), anti-inflammatory regulation, and antiviral defense. Women with a severe coronavirus infection had higher serum IgG antibody levels than men, and their IgG production was faster in the early stages of infection. 17-estradiol (E2) levels of blood will increase by 100-fold during pregnancy. COVID-19 in pregnant women had a 15-fold lower mortality rate than other women. While menopause replacement therapy (MRT) for pre/post-menopausal women and its effectiveness in reducing COVID-19 infection is debatable. Conclusion: MRT may be considered as a viable treatment option for pre/post-menopause women with coronavirus, referring to the fact that sex hormones reduce inflammatory responses and modulate ACE2 expression. The task's difficulty and achieving the desired outcome seem to be challenging.   https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1787 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1787/576

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 15 3 2021 09 07 179 185 EN Alireza Zarinara Reproductive Biotechnology Research Centre, Avicenna Research Institute, Tehran, Iran Koorosh Kamali Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran Mohammad Mahdi Akhondi Reproductive Biotechnology Research Centre, Avicenna Research Institute, Tehran, Iran 2021 04 09 2021 07 19 Objective: To analyze and compare four methods for estimating the chance of treatment success in infertile couples. Materials and methods: In a retrospective cohort study, information on demographic and clinical features, including age, body mass index (BMI), duration of infertility, semen analysis, previous history of treatment and clinical examination of infertile couples were analyzed. Treatment success (childbearing) was calculated with four methods as live birth ratio, conditional probability and survival analysis (life table and Kaplan-Meyer method) and results are compared. Results: The fertility ratio for the first treatment cycle was 29.72% which decreased to 23.13% by total treatment cycles. The success rate was 75.4%. With conditional probability calculation at the end of the five treatment cycles. With the life table method in a five-year period, the probability for live birth was 78% and by Kaplan-Meyer method 73.1% and the median of treatment time was 562 days. Conclusion: Calculation of infertility treatment success rate by only simple live birth ratio of childbearing couples is associated with underestimation. Using the conditional probability method reduces that underestimation, but it is not considered the censored cases in the treatments. It seems life table (as a proxy of survival analysis) presents the closest estimation to clinical facts with considering the repetition of the treatment cycle and the duration of treatment. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1557 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1557/573

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 15 3 2021 09 07 215 219 Mitra Ghazizadeh Ahsaie Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran Reza Tabrizi Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohamadamir Alizadehtabrizi Department of Oral and Maxillofacial Surgery, School of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran Sanaz Gholami Toghchi Department of Oral and Maxillofacial Pathology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2021 06 05 2021 07 19 Objective: Intraosseous Arteriovenous malformation (AVM) is a vascular hamartoma with almost 50% of cases occurring in the head and neck. These lesions are of great importance as they may cause massive bleeding during tooth extraction and surgeries. Case report: A 33 year old female complained of swelling and gingival bleeding on the right side of the maxilla and hard palate. The swelling was noticed during pregnancy and the patient underwent a surgical excision 6 months after labor. The specimen was submitted for histological examination. An intraosseous AVM presenting in maxilla was diagnosed. Conclusion: Although rare, intraosseous AVM may occur. The role of pregnancy and hormonal changes is still controversial. Clinical, radiographic and histological characteristics of AVM should be thoroughly assessed before surgical excision. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1805 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1805/575

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 15 3 2021 09 07 160 171 Abirami Kirubarajan Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada AND Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Andrew Lam Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Amy Yu Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada Cameron Taheri Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Shawn Khan Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Claire Sethuram Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Vikita Mehta Arts and Sciences, McMaster University, Hamilton, Ontario, Canada Nancy Olivieri Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada AND Division of Pediatrics, University of Toronto, Toronto, Ontario, Canada 2021 03 13 2021 06 13 Objective: The objective of our study is to characterize the knowledge, information sources, and institutional trust of patients regarding medication use in pregnancy. Materials and methods: We conducted a review of three databases: MEDLINE, EMBASE, and CINAHL. We included observational studies and knowledge assessments that examined the knowledge, attitudes, beliefs or information sources of pregnant patients related to medication use during pregnancy. Extraction was completed by two independent reviewers, outcomes were summarized descriptively, and appraisal was conducted. Results: Of the 1359 search results, 34 studies met inclusion criteria. Thus, our systematic review encompasses the beliefs of 11,757 pregnant participants. In most studies, participants described apprehension regarding potential risks to the fetus and the inadequacy of safety information. Across the 23 knowledge assessments, the majority of studies reported patient misconceptions about prescription medication in pregnancy. The most preferred information source was a healthcare provider. However, many participants expressed frustration, mistrust, and skepticism regarding physician knowledge. A common source of mistrust was due to perceived physician self-interest as well as a lack of education tailored to pregnancy. Consequently, informal sources of information were also popular. Conclusion: There is a need to improve the health literacy and trust among pregnant patients regarding drug prescribing. There are modifiable risk factors for mistrust that require further attention. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1729 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1729/567

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 15 3 2021 09 07 https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2108 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/2108/623

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 16 4 2022 12 13 272 281 Mamak Shariat Maternal, Fetal and Neonatal Health Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran Nasrin Abedinia Maternal, Fetal and Neonatal Health Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran Hasti Charousaei Maternal, Fetal and Neonatal Health Research Center, Institute of Family Health, Tehran University of Medical Sciences, Tehran, Iran Fatemeh Fatahi Department of Clinical and Health Psychology, Shahid Beheshti University, Tehran, Iran 2021 06 13 2022 11 20 Objective: This study aimed to investigate and identify the psychosocial factors that are associated with paternal postpartum depression. Materials and methods: A longitudinal correlation study with 150 fathers was performed with three time frames (late pregnancy, postpartum, and four weeks postpartum). The Edinburgh Postnatal Depression Scale assessed those with depression (38.7%; n=58) and those without depressive symptoms (61.3%; n=92). Psychological variables related to paternal depression were also assessed through questionnaires. Results: Psychological variables such as marital adjustment and stress had a significant relationship with paternal depression. In addition, depressed fathers experienced less marital compatibility and more tension than non-depressed fathers. Conclusion: These findings emphasize the importance of considering the psychosocial variables that affect paternal psychological health. Mental health professionals may be able to reduce mental disorders, stress, psychological distress, and marital maladjustment in fathers with appropriate psychological interventions. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/1808 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/1808/624

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 16 4 2022 12 13 282 289 Elahe Rezayof Department of Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Setareh Akhavan Department of Gynecology Oncology, Vali-E-Asr Hospital, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Tehran, Iran Leila Afshar Department of Medical Ethics, Shahid Beheshti University of Medical Sciences, Tehran, Iran Marjan Ghaemi Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Leyla Sahebi Maternal-Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran Somayeh Akbari Farmad Department of Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2022 09 06 2022 11 20 Objective: Breaking bad news to the patient is challenging, especially for the physicians and the residents, due to the lack of structured and practical training. This study aimed to design and evaluate a novel virtual instructional design for improving obstetrics and gynecology (Ob/Gyn) residents breaking bad news skills. Materials and methods: Virtual instructional design was performed based on the ADDIE model (Analysis, Design, Development, Implementation and Evaluation) from September 2020 to July 2021 at the Department of Ob/Gyn, a referral hospital affiliated with Tehran University of Medical Sciences, Tehran. Iran. The five steps of ADDIE virtual instructional design were applied sequentially. Results: Totally 33 of the Ob/Gyn residents included in the study that 77% needed specific training. The awareness of the performance of the residents in seven areas including interview context, strategy, planning, professionalism, empathy, knowledge, and receiving information needed to be trained for breaking bad news. The content of the virtual training package was designed based on the prior assessment needs in four multimedia lectures of professors, one short educational video, a 65-page file that combines text and images in 4 parts. The pre-test and post-test mean scores (SD) were 9.45 (2.0) and 10.67 (1.7), respectively (p-value≤0.001) in the cognitive and attitudinal domain. In the final step, the final corrections were made in the virtual training package. Interestingly, the satisfaction of residents' attitudes was 96.5%. Conclusion: Most Ob/Gyn residents do not have the necessary perception and skills to deliver bad news to the patients. Designing an appropriate virtual training package for improving communication skills is associated with satisfaction. Thus, the efficacy of the training program should be implemented for all Ob/Gyn residents. https://jfrh.tums.ac.ir/index.php/jfrh/article/view/2167 https://jfrh.tums.ac.ir/index.php/jfrh/article/download/2167/625

Tehran University of Medical Sciences Journal of Family and Reproductive Health 1735-8949 16 4 2022 12 13 290 295 Azadeh Shabani Department of Obstetrics and Gynecology, Shahid Taleghani Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Amene Abiri Department of Obstetrics and Gynecology, Arash Women’s Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Seyedeh Noushin Ghalandarpoor-Attar Department of Obstetrics and Gynecology, Baqyiatallah Hospital, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran Alireza Hadizadeh School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Seyedeh Mojgan Ghalandarpoor-Attar Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran AND Department of Obstetrics and Gynecology, Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2022 04 06 2022 07 17 Objective: This descriptive-analytic cross-sectional study aimed to figure out whether maternal serum vitamin D concentration correlates with cervical length measurement in mid-gestation or not. Materials and methods: During Jun-Jan 2021, 213 pregnant women at 18-22 weeks of gestation were investigated. First, demographic features were obtained then, maternal serum vitamin D concentration was measured by enzyme-linked immunoassay and cervical length was measured via transvaginal sonography according to fetal maternal foundation guideline and appropriate statistical test was used to analyze the correlation between maternal vitamin D level and cervical length in mid-pregnancy. Results: It was shown that 29.6% and 25.4% of participants had vitamin D deficiency and insufficiency, respectively. Spearman’s test found no significant correlation between maternal vitamin D level and cervical length in mid-pregnanc