Changes in Body Mass Index across Age Groups in Iranian Women: Results from the National Health Survey

Introducing an Antenatal Care Electronic Health System for Low and Middle Income Countries: A Cross-Sectional Study on 1217 Iranian Pregnant Women

Objective

Maternal health care is one of the main challenges worldwide, especially in low- and middle-income countries (LMICs) such as Iran. In this cross-sectional study, we introduce an electronic health software for maternal care that is active under the supervision of the Valiasr Reproductive Health Research Center of Tehran University of Medical Sciences in providing maternal health education to Iranian pregnant women. In addition to describing the details of this open-source software and encouraging LMICs health policymakers to develop such software, this manuscript also provides a cross-sectional report and statistical analysis on anonymous Iranian pregnant women who registered in this system.

Materials and methods

Since 2015, we have launched an electronic health software in Iran called "niniMED Pregnancy Calendar" in Persian. This system has multiple educational and motivational features for pregnant women, including momentary weight recommendations based on pregnancy week and recommended dates for common tests during pregnancy according to the first day of the last menstrual period in Jalali calendar format. Additionally, we measured user satisfaction with this system using a questionnaire.

Results

From 2015 to 2017, 1,217 anonymous Iranian pregnant women registered in this system. The average age of pregnant Iranian women was 30.67 years (30 years and 8 months). Users had a body mass index (BMI) of 24.68 kg.m-2, which had a significant direct relationship with their gestational age (P=5.81e-05) and indicated an improvement in appropriate weight for Iranian women compared to previous studies. We showed that there was a significant direct relationship between the age of Iranian pregnant women and the likelihood of a high-risk pregnancy (P=0.008). We also observed a significant inverse relationship between pregnancy week and their tendency to receive pregnancy-related education (P=0.018). Finally, we found that more than 88% of pregnant Iranian women assessed membership in such systems as completely useful for pregnancy.

Conclusion

The development of such electronic health systems for informing pregnant women can provide low-cost maternal education to LMICs pregnant women and potentially assist in managing weight gain during pregnancy and reducing associated risks. It can also be widely accepted by pregnant women.

Comparison of health-promoting behaviours, eating behaviour patterns and perceived social support in normal-weight and overweight pregnant women: An unmatched case-control study

Aim

The interventions based on adopting a healthy lifestyle during pregnancy have conflicting results. This study aimed to compare health-promoting, dietary patterns and social support in normal and overweight pregnant women.

Design

An unmatched case-control design was used.

Methods

A total of 360 pregnant women were selected using multistage cluster sampling and divided into two groups of normal and overweight cases. Data were collected using demographic and obstetrics characteristics, health-promoting lifestyle, perceived social support and eating behaviour questionnaires.

Results

The evaluation of the health-promoting behaviours and dietary patterns demonstrated a significant difference between the mean of total scores and their subdomains including self-actualization, nutrition, consumption of healthy and low-fat foods, fast food and sweets, as well as emotional eating and accidental planning. There was no significant difference between the two groups about social support.

The complications of overweight and obesity according to obesity indicators (body mass index and waist circumference values) in a population of Tangier (northern Morocco): A cross-sectional study

AIM

The aim of this work was to study overweight and obesity and their associated complications according to obesity indicators in a population of Tangier.

METHODS

A total of 480 overweight and obese patients were included in this study, referred to hospital Duc Tovar of Tangier during a period of 12 months. The collection of data has been done through a questionnaire which included anthropometric, clinical and biochemical characteristics of each patient. Statistical analyses included chi2 test, student's t-test, ANOVA, and multiple linear regression analyses.

RESULTS

The mean age of our patients was 45.56 ± 12.23 years, the mean body mass index (BMI) was 33.97 ± 5.84 Kg/m² and the average waist circumference (WC) was 109.78 ± 15.42 cm. Overweight affected 25.2% and obesity 74.8%, whose 88.8% of subjects had abdominal obesity. All the metabolic abnormalities were significantly associated with abdominal obesity (measured by WC). However, only total cholesterol (p₌0.001) and triglycerides (p₌0.000) were significantly associated with different classes of obesity (measured by BMI). The most common complications of obesity and overweight were: type 2 diabetes (56.8%), arterial hypertension (52%), dyslipidaemia (43.9%), and cardiovascular disease (CVD) (24.3%). Hypertension and hyperglycaemia were the major risk factors for developing CVD with OR = 3.81 (95% CI:1.363-10.698; p < 0.05) and OR = 2.610 (95% CI:1.648-4.133; p < 0.001) respectively.

CONCLUSION

Obesity exposes to several chronic complications, the most important in our study were type 2 diabetes and hypertension; these complications increased significantly with abdominal obesity that has constituted important risk factors of CVD.

The association between pre-pregnancy obesity and screening results of depression for all trimesters of pregnancy, postpartum and 1 year after birth: a cohort study

OBJECTIVE

To determine the relationship between pre-pregnancy obesity and screening results of gestational and post-delivery depression in women referred to the health centers of Tabriz, Iran.

METHODS

In this cohort study, 62 and 245 pregnant women with class 2-3 obesity [body mass index (BMI)≥35 kg/m2] and normal-weight (BMI 18.5-24.9 kg/m2) were enrolled, respectively, in the first trimester of pregnancy from December 2012 to January 2016. For matching of groups, nulliparous and multiparous mothers aged 18-35 years were selected with the ratio of 1:4 in obese and normal BMI groups from the same recruitment center and to controlling the confounder factors, inclusion criteria were considered. The Edinburgh Postnatal Depression Scale (EPDS) was completed in five time points, the first, second, third trimester of pregnancy, 6-8 weeks and 12 months after delivery. Independent t-test, Mann-Whitney, chi-square, Fisher's exact tests and multivariate logistic and linear regression adjusted for confounders were used. P<0.05 was considered as statistically significant.

RESULTS

Based on the EPDS, 12.7% of normal weight women in first, 13.5% in second, 10.2% in third trimester of pregnancy, 7.8% in 6-8 weeks of postpartum and 10.6% in 1 year after delivery screened positive for depression. This proportion was greater in class 2-3 obese women (32.3%, 33.3%, 28.8% in trimesters of pregnancy and 35.4%, 19.4% in postpartum period, respectively) (P<0.05). The results of multivariate logistic regression adjusted for confounding factors showed that the risk of depression in the first trimester of pregnancy for class 2-3 obesity was 3.25-fold greater than normal weight group [adjusted odds ratio (aOR) 3.25, 95% confidence interval (CI) 1.68-6.28]. This risk was 3.29-fold in the second (aOR 3.29, 95% CI 1.67-6.47), 4-folds in the third trimester (aOR 4.003, 95% CI 1.84-8.70 for third), 7.5-fold in the 6-8 weeks of postpartum (aOR 7.46, 95% CI 3.30-16.89) and 1.83-fold (aOR 7.46, 95% CI 3.30-16.89) for 1 year after birth.

CONCLUSIONS

Pre-pregnancy obesity was associated with probability of gestational and post-delivery depression. Therefore, training and planning to conduct required interventions to resolve obesity seem be helpful in this regard.

Changes in Obesity Odds Ratio among Iranian Adults, since 2000: Quadratic Inference Functions Method

Background. Monitoring changes in obesity prevalence by risk factors is relevant to public health programs that focus on reducing or preventing obesity. The purpose of this paper was to study trends in obesity odds ratios (ORs) for individuals aged 20 years and older in Iran by using a new statistical methodology. Methods. Data collected by the National Surveys in Iran, from 2000 through 2011. Since responses of the member of each cluster are correlated, the quadratic inference functions (QIF) method was used to model the relationship between the odds of obesity and risk factors. Results. During the study period, the prevalence rate of obesity increased from 12% to 22%. By using QIF method and a model selection criterion for performing stepwise regression analysis, we found that while obesity prevalence generally increased in both sexes, all ages, all employment, residence, and smoking levels, it seems to have changes in obesity ORs since 2000. Conclusions. Because obesity is one of the main risk factors for many diseases, awareness of the differences by factors allows development of targets for prevention and early intervention.

Thyroperoxidase antibodies and polycystic ovarian morphology

OBJECTIVE

To evaluate the association between polycystic ovarian morphology (PCOM) and thyroperoxidase antibody level.

METHODS

A cross-sectional study was undertaken of women aged 15-49years living in one of four provinces in Iran recruited between February 2009 and November 2010. Eligible women did not have hirsutism and were eumenorrheic. All participants underwent a comprehensive interview, clinical examination, blood sampling, and ultrasonographic assessment. The serum concentration of thyroperoxidase antibodies was compared between women with and without PCOM.

RESULTS

Among 491 participants, 74 (15.1%) had PCOM. In total, 11 (14.9%) women with PCOM and 61 (14.6%) women with normal morphology tested positive for thyroperoxidase antibodies. The serum concentration of thyroperoxidase antibodies was higher among women with PCOM (48.45±135.74IU/mL) than among those with normal ovarian morphology (37.99±96.49IU/mL), but the difference was not significant (P=0.42).

CONCLUSION

Thyroperoxidase antibody levels were higher in Iranian women with PCOM than in women with normal morphology, although the difference was not significant. Larger longitudinal studies are needed to investigate whether the treatment of thyroid disorders can prevent the development of PCOM.

Assessing factors related to waist circumference and obesity: application of a latent variable model

Background. Because the use of BMI (Body Mass Index) alone as a measure of adiposity has been criticized, in the present study our aim was to fit a latent variable model to simultaneously examine the factors that affect waist circumference (continuous outcome) and obesity (binary outcome) among Iranian adults. Methods. Data included 18,990 Iranian individuals aged 20–65 years that are derived from the third National Survey of Noncommunicable Diseases Risk Factors in Iran. Using latent variable model, we estimated the relation of two correlated responses (waist circumference and obesity) with independent variables including age, gender, PR (Place of Residence), PA (physical activity), smoking status, SBP (Systolic Blood Pressure), DBP (Diastolic Blood Pressure), CHOL (cholesterol), FBG (Fasting Blood Glucose), diabetes, and FHD (family history of diabetes). Results. All variables were related to both obesity and waist circumference (WC). Older age, female sex, being an urban resident, physical inactivity, nonsmoking, hypertension, hypercholesterolemia, hyperglycemia, diabetes, and having family history of diabetes were significant risk factors that increased WC and obesity. Conclusions. Findings from this study of Iranian adult settings offer more insights into factors associated with high WC and high prevalence of obesity in this population.

Obesity and Related Factors in Iran: The STEPS Survey, 2011

Background:

To date, no study has addressed the association between race/ethnicity and obesity considering other sociodemographic and lifestyle factors in Iran.

Objectives:

The current study aimed to study lifestyle and the environmental factors affecting obesity in the Iranian subjects of the STEPS Survey, 2011.

Patients and Methods:

The study was conducted on 8639 subjects (aged ≥ 20 years) in the STEPS Survey 2011 in Iran under supervision of the World Health Organization (WHO). Height and body weight were measured following the standardized procedures. Generalized Estimating Equations (GEE) method was used to examine factors associated with obesity. The examined variables were age, gender, race/ethnicity, place of residence, employment status, physical activity, smoking status, and educational level.

Results:

Overall, 22.3% of the subjects were obese. In a GEE model, a healthy weight status among adults was associated with being younger, male, in a rural residence, employees, spending more time engaged in physical activity, being a smoker and having a moderate or high level of education. These associations were statistically significant after adjusting for other variables.

Conclusions:

The study results suggest a need for targeted interventions and continued surveillance for the Iranian adults.

Factors associated with the age of the onset of diabetes in women aged 50 years or more: a population-based study

OBJECTIVE

Investigate factors associated with the onset of diabetes in women aged more than 49 years.

DESIGN AND METHODS

Cross-sectional, population-based study using self-reports with 622 women. The dependent variable was the age of occurrence of diabetes using the life table method. Cox multiple regression models were adjusted to analyse the onset of diabetes according to predictor variables. Sociodemographic, clinical and behavioural factors were evaluated.

RESULTS

Of the 622 women interviewed, 22.7% had diabetes. The mean age at onset was 56 years. The factors associated with the age of occurrence of diabetes were self-rated health (very good, good) (coefficient=-0.792; SE of the coefficient=0.215; p=0.0001), more than two individuals living in the household (coefficient=0.656, SE of the coefficient=0.223; p=0.003), and body mass index (BMI) (kg/m(2)) at 20-30 years of age (coefficient= 0.056, SE of the coefficient=0.023; p=0.014).

CONCLUSIONS

Self-rated health considered good or very good was associated with a higher rate of survival without diabetes. Sharing a home with two or more other people and a weight increase at 20-30 years of age was associated with the onset of type 2 diabetes.

Health-promoting behaviors and social support in Iranian women of reproductive age: a sequential explanatory mixed methods study

OBJECTIVES

The aim of this study was to determine health-promoting behaviors and their determinants including social support and sociodemographic characteristics as well as to explore women's experience of health-promoting behaviors.

METHODS

This sequential explanatory mixed methods study was conducted in two phases. The first phase was a cross-sectional study conducted on 1,359 women. Questionnaires, including items on sociodemographic characteristics, the HPLP-II and the PRQ85-Part2, were completed by interview. In the second phase, 15 women who were identified as extreme cases participated in individual in-depth interviews.

RESULTS

The results of the quantitative phase showed that women obtained the highest scores on interpersonal relations and the lowest scores on physical activity. Scores on the HPLP-II and all its subscales correlated significantly with the level of social support. In the qualitative phase, factors affecting health-promoting behaviors were explored and grouped into four main categories that included personal and socio-environmental barriers as well as personal and socio-environmental facilitators.

CONCLUSIONS

The findings from this study confirm the importance of social support and modifiable variables (sociodemographic) that play a role in the health-promoting behaviours of women. These results will be useful in designing suitable interventions and strategies for the promotion of women's health.

Facilitators and Inhibitors of Health-promoting Behaviors: The Experience of Iranian Women of Reproductive Age

BACKGROUND

There is scant information on the facilitators and inhibitors of health-promoting behaviors among reproductive-aged Iranian women. This study aims to explore the experience of factors influencing health-promoting behaviors among Iranian women of reproductive age from a qualitative perspective.

METHODS

This study was performed in Tehran in 2011, over about 8 months. Qualitative methods, specifically in-depth interviews, were used to gather data on 15 women of reproductive age. Data continued to be collected until introduction of new information ceased. The interviews were recorded, transcribed verbatim, and analyzed by conventional content analysis.

RESULTS

The reported factors were categorized into four main groups and 12 subgroups: (1) personal barriers (lack of time, school or work duties, lack of preparation or motivation, physical disability); (2) socio-environmental barriers (family responsibilities, environmental pressures, high-costs and financial pressures); (3) personal facilitators (personal interest and motivation, experience of disease); and (4) socio-environmental facilitators (family and social support networks, encouraging and motivating environment, media, and public education).

CONCLUSIONS

In these women's experience, factors influencing health-promoting behaviors were either facilitators or inhibitors; most were inhibitors. The findings of this study show that, in addition to personal factors, the pursuit of health-promoting behaviors is affected by socio-environmental factors. These results will be useful in designing interventions and plans for women's health promotion that focus on the improvement of their environment and the modification of social factors.

Low back pain prevalence and associated factors in Iranian population: findings from the national health survey

Background. There are very few studies that had a sample size sufficient to explore the association between factors related to low back pain in a representative sample of the Iranian population. Objective. To examine the relationship between sociodemographic factors, smoking, obesity, and low back pain in Iranian people. Methods. We used Iranian adults respondents (n = 25307) from the National Health Survey. Adjusted odds ratios and 95% confidence intervals were estimated by using logistic regression. Results. The prevalence of low back pain was found in 29.3% of the studied sample. High age, female sex, being married, obesity, low-economic index, being smoker, in a rural residence, and low educational attainment, all increased the odds of low back pain. Conclusions. Our findings add to the evidence on the importance of obesity in relation to low back pain. These results can be used as a basis to reinforce health programs to prevent obesity.