Abstract

Background: Secondary tokophobia, or the fear of subsequent pregnancy and childbirth often linked to post-traumatic stress disorder (P-PTSD), can result from a negative prior experience and lead to avoidance of childbearing. Given the importance of maintaining a young population in Iran, this study aimed to compare the effectiveness of commitment and acceptance-based counseling versus motivational counseling via telemedicine on P-PTSD in single-child women with tokophobia.

Methods: This three-group randomized controlled trial, conducted from January 2024 to March 2025 in Mashhad health centers, involved 94 single-child women with secondary tokophobia. Following ethics committee approval, participants were randomly assigned using six blocks to either a commitment-acceptance counseling group, a motivation-based counseling group, or a control group. The two counseling groups received four telemedicine sessions, while the control group received routine care. Data were collected using the research unit selection form, demographic and obstetric characteristics questionnaire, Childbirth Attitudes Questionnaire and Impact of Event Scale. Research units completed these instruments at three time points: before the intervention, and one- and two-months post-intervention. Data were coded, entered into a computer, and analyzed using SPSS version 25 software. One-way analysis of variance and chi-square tests were performed with a significance level of 0.05.

Results: Pre-intervention, mean scores were similar across, indicating a uniform initial state. Four weeks post-intervention, P-PTSD scores significantly decreased in the acceptance (24.36±4.07) and motivational (26.59±3.2) groups, while increasing in the control group (34.13±6.11). This difference between groups was statistically significant (p < 0.001), suggesting a positive effect of the interventions. At the eight-week follow-up, the improvement continued in the acceptance (22.36±3.30) and motivational (23.62±2.58) groups, while the control group remained high (33.65±5.84), with a significant difference between groups (p < 0.001).

Conclusion: Telemedicine-based motivational and commitment-based counseling effectively and significantly reduces postnatal PTSD scores in single-child women with secondary tokophobia at two follow up time points.

Abstract

Menstruation is a natural process that signifies sexual development in women, yet it is often surrounded by social stigma and taboos. While some cultures celebrate menstruation as a rite of passage, many others view it negatively, which can adversely impact women’s physical andu mental health, sexuality, and social standing.

This study aimed to assess adolescent boys’ knowledge and perceptions of menstruation and related issues within the context of cultural and family beliefs in the Volta region of Ghana.

A sample of 384 adolescent boys from five mixed senior high schools in various municipalities was recruited using probability sampling. Data analysis was conducted with STATA version 17.0, with significance inferred at p-values < 0.05.

The findings revealed that 57.8% of respondents had moderate knowledge about menstruation, while 36.6% had low knowledge. A majority (53.9%) held positive cultural and family beliefs regarding menstruation, and 61.52% expressed a positive perception of menstrual issues. Notably, there was a significant association between perception and age (p=0.003), indicating younger students tended to have more negative views. Additionally, perception varied significantly with study program (p<0.0001). Knowledge correlated positively with cultural/family beliefs (p=0.039), suggesting that those with positive beliefs had better knowledge. A strong association was also found between cultural/family beliefs and perception (p<0.0001), where positive beliefs led to favorable perceptions.

The study underscores the necessity of addressing socio-cultural implications surrounding menstruation through multi-sectoral interventions that promote education, awareness, access to menstrual hygiene products, and enhance intergenerational communication. By fostering positive attitudes towards menstruation, we can mitigate stigma and improve the overall well-being of adolescents in the Volta region and nationwide.

Abstract

Vitamin supplementation is commonly used for peri-conceptual consumption, but the long-term impacts are not yet understood. We examined the effects of adding vitamins riboflavin (B2) and pyridoxine (B6) to culture medium on embryo quality produced from in vitro fertilization (IVF) and in vivo fertilization (IVV). At the two-cell stage, IVF and IVV embryos were cultured in a standard medium, Chatot-Ziomel-Bavister (CZB) with (IVV_B2B6 and IVF_B2B6) or without adding vitamins B2 and B6 (IVV_CZB and IVF_CZB). For IVV_B2B6, vitamin supplementation presented lowered total cell numbers by an elevated inner cell mass (ICM) and reduced trophectoderm (TE) cells. In contrast, the IVF_B2B6 group showed an inverse response by increased TE cells and reduced placental efficiency after embryo transfer. The distinct differences between cell lineages are suggested to be a consequence of major metabolic pertubations and an indicator of nutritional stress. The long-term effects were significantly seen by the oral glucose tolerance test which indicated an increased incremental area under the curve (iAUC) in IVV_B2B6 at the early adult stage. To investigate the relationship of vitamin B2 and B6 with one-carbon metabolism as a regulatory mechanism, immunostaining of the heterochromatin methylation levels with H3K27me3 were observed and showed significantly increased intensities in the IVV_B2B6 group but not in the IVF_B2B6. Our findings suggest that embryo development trajectory with vitamin supplementation is influenced by the method of fertilization, leading to diverse responses.

Abstract

Phenylketonuria is an autosomal recessive disorder caused by a deficiency in phenylalanine hydroxylase enzyme.  Infants with PKU are normal but if not treated they have an intellectual disability since elevated phenylalanine levels are neurotoxic.  Nutritional treatment is limiting natural dietary protein and treating with phenylalanine free protein from specially formulated medical foods. . Early and lifelong maintenance of blood phenylalanine levels of less than 360 µmol/L is recommended. Most patients with PKU are are unsuccessful in following the stringent  dietary restrictions as adults and adolescents that are required. Pregnant females with PKU are at high risk for the embryopathy of maternal PKU syndrome if they did not maintain phenylalanine levels in the recommended range from conception throughout pregnancy.  Features of maternal PKU include intrauterine growth restriction, and increased frequency of spontaneous abortions, microcephaly, congenital heart disease, and a moderate to severe intellectual disability.

Pegvaliase is a subcutaneously administered PEGlated recombinant phenylalanine ammonia lyase enzyme that was approved in 2018.  Pegvaliase was not initially studied in pregnant females but since approval multiple successful pregnancies have been reported.  We have treated 3 pregnancies with pegvaliase successfully with normal outcomes.  These women were unable to maintain phenylalanine levels in the desired range with medical food.  With enzyme therapy they were able to maintain phenylalanine levels in the desired range.  Given with PKU who desired pregnancy were advised to protect from pregnancy until phenylalanine levels were within the desired range and checked blood phenylalanine levels every 1 to 2 weeks throughout the pregnancy.  Pegvaliase dose and diet adjustments were made as needed.