Function In Pregnant Women Research Articles

Search for new diagnostic markers of renal function in pregnant women

Over the past few years, the prevalence of chronic kidney disease in pregnant women has been increasing rapidly, which is one of the most important problems of obstetrics, urology, and nephrology. The severity of the disease is assessed by a decrease in glomerular filtration rate (GFR). However, modern formulas of GFR give errors, therefore, it is necessary to search for new diagnostic markers of renal function in pregnant women. It is believed that elimination of cystatin C from the circulation by more than 99% is carried out by the kidneys. In an intact form, this molecule is not thought to undergo either tubular reabsorption or secretion. In this sense, cystatin C can be considered an almost ideal marker of GFR. This article discusses the possibilities of using cystatin C as a marker of renal function in pregnant women.

Speckle Tracking Echocardiography in Hypertensive Pregnancy Disorders: A Systematic Review.

Hypertensive pregnancy disorders (HPDs) are associated with an increased risk of long-term cardiovascular disease. Speckle tracking echocardiography (STE) might be useful in the early detection of preclinical cardiac changes in women with HPDs. The aim of this study was to study whether STE is a suitable method to detect differences in cardiac function in pregnant women with HPD compared with normotensive pregnant women or between women with a history of a pregnancy complicated by HPD compared with women with a history of an uncomplicated pregnancy. The databases Medline, EMBASE, and Central were systematically searched for studies comparing cardiac function measured with STE in pregnant women with HPD or women with a history of HPD and women with a history of normotensive pregnancies. The search identified 16 studies, including 870 women with a history of HPD and 693 normotensive controls. Most studies during pregnancy (n = 12/13) found a decreased LV-GLS (left ventricular global longitudinal strain) in HPD compared with normotensive pregnant controls. LV-GRS (left ventricular global radial strain) and LV-GLCS (left ventricular global circumferential strain) are decreased in women with early-onset and severe preeclampsia. Women with a history of early-onset preeclampsia show lasting myocardial changes, with significantly decreased LV-GLS, LV-GLCS, and LV-GRS. LV-GLS is significantly decreased in pregnant women with HPD compared with normotensive pregnant women. Other deformation values show a significant decrease in women with severe or early-onset preeclampsia, with lasting myocardial changes after early-onset preeclampsia.

Possible mechanisms involved in improved beta cell function in pregnant women with type 1 diabetes

Pregnancy is known to be associated with an increased demand for insulin that is normally compensated by an increased beta cell mass and insulin secretion. Recent studies have suggested enhanced beta cell function during pregnancy in women with type 1 diabetes (T1D). To explore the possible mechanisms behind enhanced beta cell function during pregnancy in women with T1D we investigated the impact of circulating factors in serum from nine women from each group of pregnant women with and without T1D, after pregnancy and non-diabetic non-pregnant women on rat islet cell proliferation and apoptosis, and on T-lymphocyte activation. In addition, circulating levels of pancreatic hormones and selected cytokines and adipokines were measured. Rat islet cell proliferation was higher in serum from pregnant women with T1D (p < 0.05) compared to T1D women after pregnancy. Apoptosis in INS-1E cell was lower (p < 0.05) in serum from pregnant women with T1D compared to T1D women after pregnancy. T-lymphocyte cell (Jurkat) proliferation was reduced by serum from pregnant women without T1D only (p < 0.05). Higher C-peptide levels and lower levels of ghrelin, IL-6, MCP-1, IL-8 and adipsin were observed in pregnant women with T1D compared to T1D women after pregnancy. In conclusion, the improved beta cell function in women with T1D during pregnancy may be due to lower levels of proinflammatory cytokines and/or higher levels of pregnancy-associated growth factors.

Study on the relationship of iodine nutritional status with thyroid function and autoantibodies in pregnant women in Baotou

Objective: To investigate the relationship of iodine nutritional status with thyroid function in pregnant women in Baotou, and provide a scientific basis for the guide of reasonable iodine supplementation.Methods: By use of As-Ce catalysis spectrophotometry, the urinary iodine concentration was determined in 90 women during different periods of pregnancy admitted to Baogang Hospital of Inner Mongolia from January 2017 to December 2017. The determination of thyroid function and the autoantibody level was carried out by electro-chemiluminescence immunoassay (ECLIA).Results: In the early trimester of pregnancy, pregnant women with iodine deficiency, iodine sufficiency and iodine excess accounted for 36.67%, 40.00% and 23.33% respectively; in the middle trimester of pregnancy, they accounted for 66.67%, 26.67% and 6.66% respectively; they made up 40.00%, 40.00% and 20.00% respectively in the late trimester of pregnancy. The rate of iodine deficiency in women in the middle trimester of pregnancy was significantly higher than that in women in the early and the late trimesters of pregnancy respectively, and the difference was statistically significant (p &lt; .05). The rate of iodine deficiency in pregnant women was positively correlated to the positivity of thyroid peroxidase antibody. Moreover, it had no relationship with the positivity of thyroglobulin antibody. No matter in the pregnant women with iodine deficiency or with iodine excess, the abnormality rate of thyroid function and autoantibodies was significantly higher than that in the pregnant women with iodine sufficiency. The difference was statistically significant (p &lt; .05).Conclusions: The iodine deficiency in the women in the middle trimester of pregnancy is more severe than that in the women in the early and the late trimesters of pregnancy. Iodine deficiency during pregnancy is positively correlated with the positivity of thyroid peroxidase antibody. Pregnant women with iodine deficiency and iodine excess show a higher abnormality rate of thyroid function and autoantibodies. It is recommended to advocate health education on iodine nutrition to pregnant women, and conduct the dynamic monitoring of urinary iodine concentration and the screening of thyroid function and autoantibodies during pregnancy.

Trimester-Specific Thyroid Function in Pregnant Women with Different Iodine Statuses

Objectives: To explore trimester-specific thyroid function changes under different iodine statuses throughout pregnancy. Methods: A cross-sectional study was conducted to assess the pregnancy iodine status, and 2,378 healthy pregnant women covering all 3 trimesters were recruited. Urinary iodine concentration (UIC) was measured by collecting spot urine samples. Blood samples were collected to evaluate thyroid function. Thyroid B-ultrasonography was conducted to measure the thyroid volume (Tvol). Results: The median UIC was 168 μg/L (111–263 μg/L). The UIC, free triiodothyronine (FT3), and free thyroxine (FT4) were significantly decreased as the pregnancy progressed (p < 0.001, p for trend <0.001), while Tvol increased (p < 0.001, p for trend <0.001). Thyrotropin (TSH) was significantly different between the 3 trimesters and showed an upward trend (p < 0.001), but the p for trend was not significant (p for trend = 0.88). After stratification by UIC, there were no significant differences in serum TSH, FT4, or FT3 level between UIC groups. Tvol was significantly higher in the UIC ≥500 μg/L group in the first trimester (β: 2.41, 95% CI: 1.09–3.72, p <0.001), as well as in the 250 ≤ UIC < 500 μg/L group (β: 1.65, 95% CI: 0.61–2.70, p < 0.001) and UIC ≥500 μg/L group (β: 3.35, 95% CI: 1.96–4.74, p < 0.001) in the third trimester. Conclusions: No difference was observed in TSH, FT3, or FT4 among the different iodine status groups throughout pregnancy. Tvol increased as the pregnancy progressed, and it was especially higher in the UIC ≥500 μg/L group in the first and third trimesters.

Association between sociodemographic, anthropometric variables, life habits and postural balance of pregnant women: a cross-sectional study

Background: Researchers have sought to evaluate the relationship between sociodemographic characteristics and life habits in maintaining the postural balance of specific populations. However, studies based on analyzing in detail the influence of these factors on this body function in pregnant women are scarce. Objective: To analyze the association between sociodemographic, obstetric, anthropometric and lifestyle characteristics and changes in postural balance in pregnant women. Method: Cross-sectional study carried out from February 2012 to March 2015 at the Federal University of Rio Grande do Norte (UFRN). The sample consisted of 263 pregnant women. Balance Master System® (NeuroCom, Clackamas, USA) was used for balance evaluation. The bivariate analysis was performed by applying the chi-square test (x2 ). Results: The results suggest that the absence of alterations in the variables related to static postural balance is associated with higher levels of education, higher income and age over 29 years (x2 = 4.73, P = 0.03). In addition, during the evaluation of the dynamic balance, it was verified that the absence of abnormalities is related to income higher than 4 minimum wages (x2 = 3.98, P = 0.04), while changes in lateral displacement were associated with lower body weight (up to 68 kg) (x2 = 12.2, P = 0.03). Conclusion: There is an association between sociodemographic characteristics, life habits and changes in the postural balance of pregnant women.

A comprehensive echocardiographic study of the right ventricular systolic function in pregnant women with inherited thrombophilia.

Impact of the gestational changes on cardiac contractility is not clearly defined. Our aim was to evaluate subtle changes of the right ventricular systolic function during pregnancy, assessed by new echocardiographic techniques, in a population tested for inherited thrombophilia. 87 pregnant women, with a mean age of 32±4years, genetically tested for inherited thrombophilia (22 with high-risk inherited thrombophilia and 65 control group) were included. All participants had four echocardiographic assessments, three during pregnancy (one in each trimester) and the forth at 6months after giving birth. The right ventricular (RV) systolic function was assessed by fractional area change, ejection fraction (EF) by 3D echocardiography, tricuspid annular velocity by tissue Doppler, tricuspid annular plane systolic excursion, and strain by speckle tracking. Pulmonary artery pressure was estimated using the pressure gradient between right atrium and RV. Parameters of RV systolic function, at visits 2-4, had lower values compared with the first visit and were significantly lower in the high-risk thrombophilia group. Tricuspid regurgitation and pressure gradient between the right atrium and the RV had a significant increase during pregnancy for all subjects. At visit 1, there were no differences between groups, but at the next three visits there were higher values of the gradient in the high-risk thrombophilia group. High-risk inherited thrombophilia impacts the RV contractility, with higher pulmonary artery pressure. Further studies are needed to assess long-term impact on RV of high-risk inherited thrombophilia.

Fine particulate matter exposure and renal function: A population-based study among pregnant women in China

BackgroundFine particulate matter (PM2.5) is the most serious environmental threat worldwide. The nephrotoxicity of PM2.5 has been demonstrated in older adults, but no study has addressed the impacts of PM2.5 exposure on renal function in pregnant women, who are recognized to be vulnerable and susceptible to PM2.5 exposure. ObjectiveTo evaluate whether exposures to PM2.5 total mass and its chemical constituents were associated with reduced renal function among pregnant women in China. MethodsWe measured serum concentrations of urea nitrogen (UN), uric acid (UA) and creatinine for 10,052 pregnant women in Shanghai, China. Exposures to PM2.5 total mass and its 5 key chemical constituents during the whole pregnancy and each trimester of pregnancy was represented by satellite-based models. ResultsExposures to PM2.5 total mass and its chemical constituents of organic matter (OM), black carbon (BC), nitrate (NO3−) and ammonium (NH4+) were positively associated with serum levels of UN and UA, and negatively associated with estimated glomerular filtration rate (eGFR). An interquartile rang (IQR) increase in PM2.5 total mass, OM, BC, NO3– and NH4+ exposure in third trimester was associated with 1.33 (β = -1.33, 95% CI, −1.79, −0.87), 1.67 (β = -1.67, 95% CI, −2.26, −1.07), 1.29 (β = -1.29, 95% CI,-1.89, −0.70), 1.16 (β = -1.16, 95% CI,-1.66, −0.65) and 0.76 (β = -0.76, 95% CI, −1.08, −0.44) mL/min/1.73 m2 decrease in eGFR, respectively. ConclusionWe concluded that exposures to PM2.5 during pregnancy were associated with decreased renal function among pregnant women.

The immediate effects of pelvic compression belt with a textured sacral pad on the sacroiliac function in pregnant women with lumbopelvic pain: A cross-over study

BackgroundPelvic belt is being used to alleviate the symptoms of lumbopelvic pain. ObjectiveTo investigate the immediate effects of a pelvic belt with a textured sacral pad in pregnant women with lumbopelvic pain. MethodsTwenty-eight pregnant women participated in a randomized crossover study. Hip joint position sense, maximum hip flexion force, and perceived effort during the active straight leg raising test were measured in twenty-eight pregnant women with lumbopelvic pain. Outcomes were measured in three randomized conditions including no pelvic belt (control), with a pelvic belt, and while a sacral pad was used with the pelvic belt. Data were analyzed using a one-way repeated measures analysis of variance for each variable. ResultsImprovements in all study outcomes have been shown with a pelvic belt compared with the control condition. The addition of a textured sacral pad to the pelvic belt improved all study outcomes compared with the pelvic belt: hip joint position sense (p < 0.001; 95% confidence interval:1.3to2.3), perceived effort (p = 0.003; 95% confidence interval: 0.35 to 1.86), and maximum flexion force (p < 0.001; 95% confidence interval:2.77to6.47) in the active straight leg raising. ConclusionFurther improvements were noted with the addition of the textured pad for all outcome measures. This finding may inform new benefits in adding a textured sacral pad to pelvic compression belts.

Cognitive function of pregnant women: the problem of postoperative cognitive dysfunction in women after labor

The problem of postoperative cognitive dysfunction is relevant in obstetrics due to the initial psychophysiological state of a pregnant woman and the high frequency of abdominal delivery everywhere. When choosing the optimal method of anesthesia for a cesarean section, which would minimally affect cognitive functions, it is necessary to consider the impact of anesthesia on the memory and attention of puerperas, as well as their initial cognitive status. To assess memory and attention in women of reproductive age, in our opinion, the most appropriate tests are the MoCA-test, Benton test, Wechsler test, hospital anxiety and depression scale, and a self-assessment questionnaire. These tests are recommended by psychophysiologists and have proven themselves to be well applied in daily clinical practice. Standard test kits with a formalized (quantitative) evaluation of the results allow a rapid assessment of several cognitive functions in a limited time. This review article presents the problem of the cognitive function of pregnant women and postoperative cognitive dysfunction during pregnancy.

Endothelial function in pregnant women with chronic hypertension and abdominal obesity

Objective. To evaluate endothelial function in pregnant women with chronic hypertension and abdominal obesity. Material and Methods. We studied 30 pregnant women with chronic hypertension and abdominal obesity (group I), 28 pregnant women with chronic hypertension and normal body mass index (group IIa), 27 pregnant women with abdominal obesity without chronic hypertension (group IIb), and 33 pregnant women without chronic hypertension and abdominal obesity (control group). We performed reactive hyperemia tests, assessed the serum levels of endothelin-1 and homocysteine, and analyzed the outcomes of pregnancy and delivery. Results. The values of endothelium-dependent vasodilation (EDVD) in pregnant women of groups I, IIa, and IIb were comparable and were 6.7 (3.2–9.1)%, 7.0 (3.9–11.4)%, and 7.2 (4.4–10.8)%, respectively. Significant differences were found in EDVD values between the groups mentioned above and the control group, where the EDVD value was 12.5 (10.5–13.9)%, p &lt; 0.05. The endothelin-1 concentration in group I was 14.0 (10.3–17.5) pg/mL, which significantly exceeded the corresponding values in group IIa ( p &lt; 0.05) and the control group ( p &lt; 0.05). The endothelin-1 level in patients with abdominal obesity was twice higher than the corresponding value in the control group ( p &lt; 0.05). Significant differences were observed between patients with chronic hypertension (groups I and IIa) and control group ( p &lt; 0.05). The level of homocysteine in control group [6.1 (3.9; 8.0) µmol/L] significantly differed from the corresponding values in group I [9.3 (7.8; 10.5) µmol/L, p &lt; 0.05], group IIa [7.8 (6.8; 9.8) µmol/L, p &lt; 0.05], and group IIb [7.8 (6.8; 9.8) µmol/L, p &lt; 0.05]. Conclusions. This study showed the presence of endothelial dysfunction in pregnant women with chronic arterial hypertension and abdominal obesity. This observation was confirmed by the lower values of EDVD, higher frequency of attenuated and paradoxical responses to the reactive hyperemia test, and the elevated serum levels of homocysteine and endothelin-1 in this category of patients. The endothelial dysfunction contributed to the development of pregnancy complications and adverse outcomes of pregnancy compared with the control group and women who had isolated manifestations of chronic hypertension and abdominal obesity.

Atmospheric Pollution and Thyroid Function of Pregnant Women in Athens, Greece: A Pilot Study.

Exposure to air pollution and, in particular, to nitrogen dioxide (NO2) or particulate pollutants less than 2.5 μm (PM2.5) or 10 μm (PM10) in diameter has been linked to thyroid (dys)function in pregnant women. We hypothesized that there may be a dose—effect relationship between air pollutants and thyroid function parameters. We retrospectively evaluated thyrotropin (TSH) in 293 women, NO2, PM2.5 and PM10 levels in Athens. All the women were diagnosed with hypothyroidism for the first time during their pregnancy. Exposure to air pollution for each woman was considered according to her place of residence. Statistical analysis of age, pregnancy weight change, and air pollutants versus TSH was performed with ordinary least squares regression (OLS-R) and quantile regression (Q-R). A positive correlation for logTSH and PM2.5(r = +0.13, p = 0.02) was found, using OLS-R. Further analysis with Q-R showed that each incremental unit increase (for the 10th to the 90th response quantile) in PM2.5 increased logTSH(±SE) between +0.029 (0.001) to +0.025 (0.001) mIU/L (p < 0.01). The other parameters and pollutants (PM10 and NO2) had no significant effect on TSH. Our results indeed show a dose—response relationship between PM2.5 and TSH. The mechanisms involved in the pathophysiological effects of atmospheric pollutants, in particular PM2.5, are being investigated.

Features of blood oxygen transport function of pregnant women with community-acquired pneumonia (review)

Features of blood oxygen transport function of pregnant women with community-acquired pneumonia (review)

Pool walking may improve renal function by suppressing the renin-angiotensin-aldosterone system in healthy pregnant women

This study aimed to examine the effect of pool walking on renal function in pregnant women. Fifteen pregnant women (mean gestational age, 37.8 weeks) walked in a pool (depth 1.3 m) for 1 h. A few days later, they walked on a street for 1 h. Within each activity, the starting and ending levels of plasma renin activity were measured. The total urine volume, creatinine clearance, and change in plasma renin activity levels between each activity were compared by Wilcoxon rank-sum test. The renin-angiotensin-aldosterone level was suppressed during pool walking: the mean starting and ending values of plasma renin activity and serum aldosterone were 6.8 vs. 5.5 ng/mL/h (p = 0.002) and 654 vs. 473 pg/mL (p = 0.01), respectively. The decreases in plasma renin activity and serum aldosterone levels were more evident in pool walking than in land walking (plasma renin activity, −1.27 vs. 0.81 ng/mL/h, p = 0.002; serum aldosterone, −180.9 vs. 3.1 ng/mL/h, p = 0.03), resulting in higher total urine volume (299 vs. 80 mL, p < 0.001) and creatinine clearance (161.4 vs. 123.4 mL/min, p = 0.03) in pool walking. Pool walking may improve renal function in pregnant women partly through the suppressed renin-angiotensin-aldosterone system.

Associations between urine phthalate metabolites and thyroid function in pregnant women and the influence of iodine status

BackgroundHuman populations, including susceptible subpopulations such as pregnant women and their fetuses, are continuously exposed to phthalates. Phthalates may affect the thyroid hormone system, causing concern for pregnancy health, birth outcomes and child development. Few studies have investigated the joint effect of phthalates on thyroid function in pregnant women, although they are present as a mixture with highly inter-correlated compounds. Additionally, no studies have investigated if the key nutrient for thyroid health, iodine, modifies these relationships. MethodsIn this study, we examined the cross-sectional relationships between concentrations of 12 urinary phthalate metabolites and 6 plasma thyroid function biomarkers measured mid-pregnancy (~17 week gestation) in pregnant women (N = 1072), that were selected from a population-based prospective birth cohort, The Norwegian Mother, Father and Child Cohort study (MoBa). We investigated if the phthalate metabolite-thyroid function biomarker associations differed by iodine status by using a validated estimate of habitual dietary iodine intake based on a food frequency questionnaire from the 22nd gestation week. We accounted for the phthalate metabolite mixture by factor analyses, ultimately reducing the exposure into two uncorrelated factors. These factors were used as predictors in multivariable adjusted linear regression models with thyroid function biomarkers as the outcomes. ResultsFactor 1, which included high loadings for mono-iso-butyl phthalate (MiBP), mono-n-butyl phthalate (MnBP), and monobenzyl phthalate (MBzP), was associated with increased total triiodothyronine (TT3) and free T3 index (fT3i). These associations appeared to be driven primarily by women with low iodine intake (<150 µg/day, ~70% of our sample). Iodine intake significantly modified (p-interaction < 0.05) the association of factor 1 with thyroid stimulating hormone (TSH), total thyroxine (TT4) and free T4 index (fT4i), such that only among women in the high iodine intake category (≥150 µg/day, i.e. sufficient) was this factor associated with increased TSH and decreased TT4 and FT4i, respectively. In contrast, factor 2, which included high loadings for di-2-ethylhexyl phthalate metabolites (∑DEHP) and di-iso-nonyl phthalate metabolites (∑DiNP), was associated with a decrease in TT3 and fT3i, which appeared fairly uniform across iodine intake categories. ConclusionWe find that phthalate exposure is associated with thyroid function in mid-pregnancy among Norwegian women, and that iodine intake, which is essential for thyroid health, could influence some of these relationships.

Thyroid function abnormalities and thyroid autoantibodies in Danish pregnant women.

Abnormal thyroid function in pregnant women is a matter of concern. Knowledge on the occurrence of known and unidentified thyroid function abnormalities in a large unselected cohort of pregnant women is warranted as part of the debate on benefits and risks of routine testing. Cohort study. A total of 14323 pregnant women in the North Denmark Region, who had a blood sample drawn as part of the prenatal screening program in early pregnancy (2011-2015). TSH, free thyroxine, thyroid peroxidase and thyroglobulin antibodies were measured in the stored blood samples using an automatic immunoassay (ADVIA Centaur XPT, Siemens Healthineers). Cohort-, method- and week-specific reference ranges were used for classification of maternal thyroid function, and a cut-off of 60U/mL was used for thyroid autoantibodies. Information in Danish nationwide registers was used to identify diagnosed and treated maternal thyroid disease. Overall, 15.2% had thyroid function abnormalities in the early pregnancy and 14.9% were thyroid peroxidase and/or thyroglobulin antibody positive. Among women with known thyroid disease (n=365), the frequency of abnormal thyroid function was 45.7%, and 62.8% in women (n=172) who received current treatment in the pregnancy. When maternal thyroid disease was diagnosed in the years following pregnancy (n=313), 46.7% had abnormal thyroid function and 54.3% were thyroid peroxidase and/or thyroglobulin antibody positive in the early pregnancy. Thyroid function abnormalities and thyroid autoantibodies were common in Danish pregnant women, particularly in women with known or later diagnosed thyroid disease, which raises concern about inadequately treated and unidentified abnormal thyroid function.

ارتباط نگرش و عملکرد جنسی زنان باردار مراجعه کننده به مراکز جامع خدمات سلامت شهرستان همدان

ارتباط نگرش و عملکرد جنسی زنان باردار مراجعه کننده به مراکز جامع خدمات سلامت شهرستان همدان

Right ventricular function in pregnant women with or without preeclampsia

Background Preeclamsia (PE) is a multisystem disorder that affects maternal and fetal outcomes. We aimed to assess right heart function in PE by echocardiography using conventional, tissue Doppler techniques, and 2D and 4D strain. Patients and methods This study comprised 100 pregnant women aged between 32 and 41 weeks divided into two groups: group 1 included 50 pregnant women with PE, who were compared with 50 age-matched normotensive pregnant women as a control group (group 2). They were subjected to proteinuria detection, pelviabdominal ultrasound, conventional echo, tissue Doppler imaging, and 2D and 4D speckle tracking echocardiography for measurement of right ventricular (RV) dimensions and RV systolic and diastolic function indices. Results The higher percentages of cesarean delivery, low birth weight, and need for NICU were present in group 1 compared with group 2. There were significantly increased RV dimensions in group 1 compared with group 2. TAPSE (2D and 4D), RV FAC (2D and 4D), average RV Sa, 4D-RV EF, 2D-RV strain, 4D septal strain, and 4D-RV free wall strain were significantly lower in group 1. RV MPI (PW and TDI) was higher in group 1 patients. Both tricuspid E/A and RV E/Ea were significantly higher in group 1. There was a positive correlation between proteinuria and mean arterial pressure, 2D-TAPSE, RV PW-MPI, and RV TD-MPI, whereas there was a negative correlation with 2D and 4D-RV strain, 4D RVEF, 4D-FAC, and T E/A. Conclusion Women with PE had significant RV structural and functional changes. Assessment of RV by newer echocardiographic modalities such as speckle tracking echocardiography and 4D-echocardiography can detect subtle cardiac changes that may help in early diagnosis of maternal and fetal complications.

The Relationship between Attitudes and Sexual Function in Pregnant Women Referred to Health Centers - Medical City of Hamadan

The Relationship between Attitudes and Sexual Function in Pregnant Women Referred to Health Centers - Medical City of Hamadan

Pool walking may improve renal function in pregnant women: a short-term effect

Pool walking may improve renal function in pregnant women: a short-term effect