https://jimpc.ssu.ac.ir/ Journal of Integrated Maternal and Pediatric Care en daily 1 Wed, 01 Jul 2026 00:00:00 +0330 Wed, 01 Jul 2026 00:00:00 +0330 https://jimpc.ssu.ac.ir/article_512.html Human breast milk is recognized as a living, cell-rich fluid that provides viable maternal cells along with supplementary nutrients and soluble immunomodulators. It contains heterogeneous populations of mesenchymal, hematopoietic, epithelial and pluripotent-like stem/progenitor cells that can differentiate into derivatives of all three germ layers in vitro. Preclinical studies have shown that milk-derived cells can survive gastrointestinal passage, enter the neonatal circulation, and reside in multiple organs, such as the brain, liver, and immune tissues. These cells express organ-specific markers and contribute to maternal microchimerism. Studies on the neonatal gut and blood-brain barrier show that a narrow early-life window exists in which breast milk stem cells can access systemic and, in experimental models, central nervous system compartments. This window is established by immature intestinal barrier properties, age-dependent differences in neurovascular interfaces, and homing cues induced by injury or inflammation. It has been suggested that these cells may contribute to organ maturation and tissue repair. Maternal cell transfer during lactation has been associated with the expansion of regulatory T cells, tolerance to non-inherited maternal antigens, stronger vaccine-induced T-cell responses, and, in certain circumstances, improved infection control. These results collectively support the idea that maternal cellular transfer contributes to the development of infant immunity during the early stages of life. This review provides a concise summary of the phenotype and origin of breast milk stem cells, their trafficking and contribution to maternal microchimerism, and neonatal immune development, and the clinical implications for the health of both infants and mothers. https://jimpc.ssu.ac.ir/article_511.html Background: Preterm birth (PTB) remains a leading cause of neonatal morbidity and mortality worldwide. Conventional prediction methods have limited accuracy, highlighting the need for precision prevention strategies that integrate molecular, clinical, and digital health data.Methods: A structured narrative review was conducted using PubMed, Scopus, and Web of Science to identify relevant studies published between 2010 and 2024. A total of 21 relevant studies were included and narratively synthesized into three thematic areas: multi-omics technologies, artificial intelligence (AI)-based prediction models, and digital health approaches for PTB prevention.Results: Multi-omics technologies, including genomics, transcriptomics, proteomics, metabolomics, and microbiome profiling, improved understanding of PTB pathophysiology and identified biomarkers associated with inflammation, immune dysregulation, oxidative stress, extracellular matrix remodeling, and placental dysfunction. AI models integrating clinical, imaging, laboratory, and molecular data demonstrated promising predictive performance, with reported area under the receiver operating characteristic curve (AUC) values ranging from approximately 0.61 to 0.94 where available. Ensemble machine learning and deep learning algorithms generally outperformed conventional statistical approaches. Digital health technologies, including wearable devices and remote monitoring systems, supported continuous maternal assessment and facilitated earlier identification of women at increased risk. However, limited external validation, heterogeneous datasets, model interpretability, and data privacy remain important challenges to clinical implementation. Conclusion: The integration of multi-omics technologies, AI, and digital health represents a promising strategy for precision prevention of PTB. Future research should prioritize multicenter validation, standardized data integration, and the development of transparent and clinically applicable AI models to facilitate translation into routine obstetric care. https://jimpc.ssu.ac.ir/article_513.html Unsafe abortion remains one of the major challenges facing health systems worldwide, and unintended pregnancy is a common precursor to unsafe abortion. One of the most important and serious consequences of unsafe abortion is the increased maternal morbidity and mortality. Evidence indicates that in developing countries, approximately 13% of maternal deaths are attributable annually to unsafe abortion, and in Iran, more than 5% of maternal deaths have been reported to be related to abortion and its complications. Given that one of the major goals of reproductive health is to prevent complications and promote women’s health, it is essential to consider preventive interventions and programs at both individual and societal levels as important global strategies. Studies have shown that women’s knowledge and awareness are important factors, alongside access to reproductive health services, contraception counseling, and supportive social policies. In this regard, commonly reported interventions include: awareness programs (including counseling approaches such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT)), I-change model-based program, school- and college-based educational programs, peer education, youth-friendly services, premarital education programs, preconception care program, male participation, greater couple responsibility regarding pregnancy, self-care program, social support, social networks and mass media, non-governmental organizations (NGOs), prenatal genetic counseling program,  and interpersonal communication. Therefore, health policymakers should scale up these programs to effectively prevent unsafe abortions and enhance women’s health at individual, societal, and global levels. Although prevention programs are effective in reducing unsafe abortions, their implementation remains limited and demands specialized expertise. https://jimpc.ssu.ac.ir/article_519.html Background: Pediatric retroperitoneal lesions are rare and heterogeneous, often presenting with nonspecific symptoms that complicate early diagnosis. Understanding their clinical and pathological characteristics is essential for improving their management and outcomes. This study evaluated the clinical, pathological, and survival features of pediatric retroperitoneal lesions.Methods: This retrospective cross-sectional study evaluated 14 patients younger than 18 years with histologically confirmed retroperitoneal lesions treated at Shahid Sadoughi Hospital, Yazd, Iran, from 2016 to 2021. The research data collected included demographics, clinical presentation, tumor origin, pathological diagnosis, metastasis, recurrence, and survival. The statistical analyses included descriptive statistics, Chi-square tests, and Kaplan-Meier survival analysis.Results: The patients’ mean age was 13.9 ± 3.38 years, with an equal sex distribution. Secondary tumors were the most common lesions (64.3%), followed by primary malignant tumors (21.4%) and primary benign tumors (14.3%). The retroperitoneum was the most frequent site of origin (50%). Common presentations included nausea and vomiting (64.3%), abdominal pain (50%), and urinary symptoms (50%). Recurrence was observed in 21.4% of the patients. Five-year survival rates were 100% for primary benign tumors, 73.9% for primary malignant tumors, and 67.5% for secondary tumors. Recurrence was significantly associated with poorer survival (P = 0.027).Conclusion: In this small cohort, pediatric retroperitoneal lesions were predominantly secondary tumors, while lymphoma was the most common primary malignancy. Their nonspecific presentation highlights the importance of imaging and pathological evaluation. Tumor recurrence was associated with reduced survival, suggesting prognostic significance and emphasizing the need for long-term follow-up. These findings are preliminary and require validation in larger studies. https://jimpc.ssu.ac.ir/article_516.html Background: Chest X‑ray (CXR) patterns in pediatric COVID‑19 are not well described. We aimed to characterize CXR findings in hospitalized children and to examine their associations with clinical and laboratory features.Methods: This cross‑sectional study included all children (<18 years) with PCR‑confirmed or clinically/radiologically diagnosed COVID‑19 admitted to Shahid Sadoughi Hospital, Yazd, Iran, between February 2020 and March 2021. Admission CXRs were interpreted by a single radiologist and scored (0–18) across six lung zones. Clinical, laboratory, and outcome data were retrieved from a registry. Associations were tested with Chi‑square, Mann–Whitney U, or Kruskal–Wallis tests.Results: Among 108 children (61.1% male; mean age 5.7 ± 4.8 years), 68 (62.9%) had an abnormal CXR. The most frequent patterns were ground‑glass opacity (86.8%), peribronchial thickening (54.4%), and consolidation (45.6%). Lesions were predominantly peripheral (50.0%), bilateral (82.4%), and involved the right lower zone (52.2%). Pleural effusion (14.7%) strongly predicted mortality (risk difference 32.5%, P<0.001). Consolidation was more common with shortness of breath (68.0% vs. 20.0%, P=0.001) but less common in respiratory distress (36.7% vs. 64.7%, P=0.045). Higher CXR severity scores were associated with underlying comorbidities, hypoxia, PICU admission, and critical illness in previously healthy children (P=0.002).Conclusion: Bilateral peripheral ground‑glass opacity and peribronchial thickening are common in pediatric COVID‑19. Consolidation, pleural effusion, and high radiographic scores correlate with severe disease and poor outcomes, supporting CXR as a useful adjunct for risk stratification in moderate‑to‑severe cases, rather than universal screening. https://jimpc.ssu.ac.ir/article_518.html Background: Multisystem inflammatory syndrome in children (MIS-C) is a documented complication arising from SARS-CoV-2 infection. Even pediatric patients who present with mild initial COVID-19 symptoms may subsequently experience severe morbidity or mortality due to MIS-C; therefore, early identification and prompt clinical management are essential for achieving favorable outcomes. This study aimed to assess the clinical characteristics, therapeutic strategies, and patient outcomes among children diagnosed with MIS-C in Yazd, Iran.Methods: This study included all pediatric patients admitted to Shahid Sadoughi Hospital in Yazd, Iran, who presented with either suspected or confirmed MIS-C between March 2020 and March 2021. Comprehensive data were extracted from medical records, including demographics, clinical symptoms, laboratory biomarkers, imaging results, and treatment modalities.Results: The study included 40 children (52.5% males, 47.5% females, median age 7.3 years). Fever was the predominant symptom (87.5%), followed by gastrointestinal complaints (57.5%) and mucocutaneous abnormalities (20%). The digestive, respiratory, and neurological systems were most frequently involved. Hospitalisation lasted 1–7 days in 75% and 8–14 days in 22.5% of patients. Disease severity was severe in 25%, moderate in 47.5%, and mild in 27.5%. Remdesivir (40%), corticosteroids (52.5%), and intravenous immunoglobulin (47.5%) were used as treatment. Notably, the overall mortality rate was 22.5% (9/40), substantially higher than the rates reported in most international studies. Conclusion: This elevated mortality underscores the urgent need for enhanced early detection, rapid referral systems, and timely immunomodulatory therapy. Previous studies have reported that COVID-19 vaccination is associated with a reduced incidence of MIS-C.  https://jimpc.ssu.ac.ir/article_520.html Background: COVID-19 affects the respiratory system, but GI manifestations are recognized in children. These symptoms may precede or accompany respiratory manifestations, making their recognition important for diagnosis. This study aimed to investigate the frequency of GI manifestations and their association with characteristics and disease severity among hospitalized children with COVID-19.Methods: This retrospective cross-sectional study included 191 children <18 years with COVID-19 hospitalized at a referral hospital in Yazd, between 2020 and 2021. Demographic, laboratory, radiological, and GI data were extracted from the COVID-19 registry and medical records. Disease severity was classified per WHO criteria. Statistical analysis was performed using the Chi-square test.Results: Among 191 children, 78 (40.8%) had ≥1 GI manifestation. Common symptoms were diarrhea (26.5%), vomiting (25.4%), and abdominal pain (13.6%). No significant associations were found between GI manifestations and sex, underlying conditions, ALT levels, prognosis, ICU admission, or hospitalization length (p > 0.05). Nausea showed a significant association with age (p = 0.01), being prevalent among adolescents aged 13–16 years (16.7%), while weight loss was associated with elevated AST (p = 0.04). Diarrhea was the only GI symptom associated with severity, occurring more frequently in non-severe vs. severe disease (34.4% vs. 18.7%, p = 0.01).  Conclusion: GI manifestations are common in hospitalized children with COVID-19 and may facilitate early recognition. Although diarrhea was associated with severity, it was more frequent in non-severe cases and should not be considered an independent marker of severe illness. Severity assessment should be based on clinical presentation rather than GI manifestations alone.                                                    https://jimpc.ssu.ac.ir/article_532.html The launch of the Journal of Integrated Maternal and Pediatric Care (JIMPC) marks the formal transition from the World Journal of Peri & Neonatology and reflects a broader scientific vision centered on the continuum of maternal–child health. This editorial describes the rationale for expanding the journal’s scope from a primarily perinatal and neonatal focus to an integrated platform covering preconception, pregnancy, infancy, childhood, and adolescence. It underscores the importance of the developmental origins of health and disease framework and highlights current global challenges including environmental exposures, climate change, armed conflict, and persistent health inequities. The editorial also outlines JIMPC’s commitment to rigorous double-blind peer review, adherence to ethical standards, diamond open access publishing, and the pursuit of Scopus/PubMed indexing. By bridging disciplines and emphasizing evidence that matters to clinicians, researchers, and policymakers, JIMPC aims to serve as a transformative venue for advancing maternal, fetal, neonatal, and pediatric health. The editorial concludes by inviting authors and readers to contribute to this integrated vision of care across generations. https://jimpc.ssu.ac.ir/article_533.html Background: Psychological stress is common among individuals with infertility or undergoing treatment, but its relationship with reproductive outcomes remains uncertain, with heterogeneous human findings and complementary animal evidence on possible mechanisms. This review synthesized human and animal evidence on psychological stress and reproductive outcomes, focusing on ART outcomes, gamete/embryo parameters, reproductive endocrine pathways, dyadic/psychosocial effects, and psychological interventions.Methods: PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to September 5, 2026, for human studies examining psychological, perceived, infertility-related, or physiological stress, plus relevant reviews and meta-analyses, alongside animal studies on stress and reproductive, gamete, embryo, endocrine, or fertility outcomes. Given heterogeneity, findings were synthesized narratively, with human and animal evidence analyzed separately.Results: Human evidence showed no consistent association between female stress and definitive ART outcomes (pregnancy, embryo-related outcomes), though some stage-specific associations during IVF emerged. In men, stress was linked to adverse semen/sperm parameters, potentially via oxidative and neuroendocrine pathways. Dyadic stress affected relationship functioning, coping, and treatment persistence. Interventions generally improved stress, anxiety, depression, and coping, but effects on reproductive outcomes were inconsistent. Animal studies showed stress can alter ovarian function, folliculogenesis, oocyte competence, uterine function, implantation, spermatogenesis, and endocrine regulation.Conclusion: Human evidence does not support a simple causal link between stress and ART success; associations vary by sex, timing, stress measurement, endpoint, and study design. Animal models support biological plausibility but cannot establish human causality. Interventions consistently benefit well-being, while reproductive effects remain uncertain. https://jimpc.ssu.ac.ir/article_534.html Background: Invasive fungal infections (IFIs) cause significant morbidity and mortality in very-low-birth-weight (VLBW) infants, but the benefit of routine fluconazole prophylaxis in units with low baseline IFI rates is unclear. We evaluated the efficacy and safety of intravenous fluconazole prophylaxis on clinical outcomes of VLBW infants.Methods: In this randomized, open-label, controlled trial, 80 infants with birth weight <1500 g and gestational age ≥25 weeks admitted to a NICU in Yazd, Iran, were randomly assigned to intravenous fluconazole (3 mg/kg twice weekly for 4 weeks; n=40) or standard care (n=40). The primary outcome was IFI (positive blood culture at week 4). Secondary outcomes included respiratory, gastrointestinal, neurological, hematological, and mortality outcomes.Results: IFI occurred in one infant (2.5%) in the fluconazole group versus none in controls (P=1.000); the overall prevalence was 1.25%. In unadjusted comparisons, fluconazole was associated with higher bronchopulmonary dysplasia (40% vs. 17.5%, P=0.047), apnea (45% vs. 20%, P=0.031), necrotizing enterocolitis (40% vs. 17.5%, P=0.047), longer respiratory support (28.18 vs. 19.72 days, P=0.047), and third-week neutropenia (15% vs. 0%, P=0.026). However, fluconazole infants had lower gestational age (29.1 vs. 30.6 weeks; P=0.0036) and birth weight (1082 vs. 1222 g; P=0.0035). Mortality, intraventricular hemorrhage, retinopathy of prematurity, and length of stay did not differ. No hepatotoxicity occurred.Conclusion: In a NICU with low IFI prevalence (≤2%), routine fluconazole prophylaxis did not reduce infection. The unadjusted excess morbidity was confounded by baseline differences in gestational age and birth weight. These findings do not support routine prophylaxis in similar low-endemicity settings. https://jimpc.ssu.ac.ir/article_535.html Background: Although COVID-19 is primarily considered a respiratory infection, accumulating evidence indicates that the kidneys may also be vulnerable to injury, particularly in pediatric patients. Renal dysfunction in children with COVID-19 is often overlooked but may carry important long-term consequences. This study aimed to evaluate kidney function abnormalities in hospitalized children with confirmed COVID-19.Methods: In this retrospective cross-sectional study, 191 children with confirmed COVID-19 admitted to Shahid Sadoughi Hospital, Yazd, Iran, were evaluated. Key renal function indicators, including serum creatinine, blood urea nitrogen (BUN), and urinalysis findings, were extracted and compared across age groups and disease severity categories.Results: Abnormal serum creatinine was observed in 13.1% (25/191) of children, with significantly higher prevalence among children aged ≤3 years (26.1%, 24/92, p < 0.001). Among the 111 patients with documented disease severity, abnormal creatinine was more common in non-severe cases (25.3%, 24/95) than in severe/critical cases (6.3%, 1/16), although this difference did not reach statistical significance (p = 0.092).Conclusion: Renal abnormalities are common in hospitalized children with COVID-19, even in non-severe cases. These findings highlight the importance of routine kidney function assessment in pediatric COVID-19 patients to enable early detection and appropriate management, potentially preventing long-term renal sequelae. https://jimpc.ssu.ac.ir/article_536.html Background: Necrotizing enterocolitis (NEC) is a serious inflammatory gastrointestinal condition that impacts premature infants. Breastfeeding can lower the chances of NEC and might aid in preventing intestinal obstruction by encouraging the correct alignment of proteins such as ZO-1 and Occludin (OCLN) in the intestinal wall. This study investigated whether human breast milk alters expression of ZO-1 (TJP1) and OCLN in intestinal epithelial cells.Methods: In this in vitro experimental study, Caco-2 cells were treated for 48 hours with 0%, 1%, or 5% (v/v) human breast milk in low-serum medium (0.5% FBS). Gene expression was measured by real-time PCR, and protein levels were confirmed by Western blot.Results: No significant changes in ZO-1 or OCLN mRNA or protein expression were observed between treated and control groups (P > 0.05).Conclusion: Under these experimental conditions, 1% and 5% breast milk for 48 hours did not alter ZO-1 or OCLN expression in Caco-2 cells, suggesting the protective effects of breast milk are unlikely to be mediated through these tight junction proteins. Further studies should explore alternative barrier-associated pathways, particularly under inflammatory conditions. https://jimpc.ssu.ac.ir/article_537.html Background: Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting approximately 18% of reproductive-aged women. Given the crucial role of estrogen in regulating folliculogenesis and ovulation, estrogen receptor (ER) genes, particularly ESR2, are considered primary candidates for investigating the genetic basis of this syndrome. This study was designed to evaluate the frequency distribution of the ESR2 rs4986938 (+1730 G/A) polymorphism in an Iranian population and determine its potential association with PCOS risk and related hormonal/metabolic parameters.Methods: A case–control genetic association analysis was conducted to compare genotype frequencies of the ESR2 rs4986938 polymorphism between women diagnosed with PCOS and healthy controls. Anthropometric and hormonal variables, including BMI, PRL, LH, and FSH, were assessed across genotypes.Results: The GA genotype was significantly more prevalent in the PCOS group compared with controls (83% vs. 58%, p < 0.05), indicating a strong association with increased susceptibility. Significant correlations were also observed between the rs4986938 polymorphism and BMI, PRL, LH, and FSH levels.Conclusion: Our results suggest that the ESR2 rs4986938 polymorphism, and potentially adjacent regulatory regions, may contribute to the etiology of PCOS and its metabolic and reproductive complications. Identification of such genetic variants could support early risk prediction and inform preventive strategies for managing PCOS-related outcomes. https://jimpc.ssu.ac.ir/article_538.html Postpartum breast cancer (PPBC) is associated with poorer survival, higher metastatic rates, and distinct tumor biology versus breast cancer in nulliparous women or those with a longer delivery interval. Lactation, weaning, and postpartum mammary involution may create a pro-metastatic microenvironment, but evidence linking these exposures to prognosis and tumor-immune-stromal features has not been synthesized. The review will follow PRISMA and MOOSE guidelines. PubMed/MEDLINE, Embase, Scopus, and Web of Science will be searched from inception using terms for breast cancer, postpartum status, lactation, involution, prognosis, and tumor microenvironment. Eligible studies will be observational (cohort, case–control, cross-sectional) studies of women with breast cancer defining a postpartum subgroup (by time since last childbirth, parity, lactation, or weaning), including a comparator (nulliparous women or longer birth interval), and reporting at least one prognostic outcome (overall, distant metastasis-free, or disease-free survival, or recurrence), an aggressive clinicopathological feature, molecular/immune profile, or a treatment response. We will exclude experimental studies without human endpoints, risk-factor/incidence studies, reviews, and case reports. Two reviewers will independently screen, extract data, and assess risk of bias using the Newcastle–Ottawa Scale. If ≥3 studies report comparable estimates for the same exposure–outcome pairing, we will perform a random-effects meta-analysis using restricted maximum likelihood; random-effects models were pre-specified because of anticipated clinical and methodological heterogeneity. If <3 studies are available, findings will be synthesized narratively. Sensitivity analyses may fit a fixed-effect model, but this will not replace the primary random-effects analysis. Heterogeneity will be assessed with I² and Cochran’s Q, with I² informing interpretation rather than model choice. https://jimpc.ssu.ac.ir/article_539.html Background: Primary ciliary dyskinesia (PCD) is a rare inherited disorder caused by abnormalities of motile cilia and is characterized by marked genetic heterogeneity. Although pathogenic variants in more than 60 genes have been associated with PCD, their distribution varies considerably among populations. This review will assess the reported genetic spectrum of PCD in Iran and the available evidence on genotype–phenotype relationships.Methods: A systematic search will be performed in PubMed/MEDLINE, Scopus, Web of Science, Embase, and relevant Iranian databases. Studies reporting Iranian patients with PCD and genetic findings will be eligible, including case reports, case series, and observational studies. Information on patient characteristics, clinical manifestations, diagnostic methods, affected genes, genetic variants, zygosity, inheritance patterns, and genotype–phenotype associations will be extracted. The methodological quality of case reports and case series will be assessed using the Joanna Briggs Institute critical appraisal tools. The Newcastle–Ottawa Scale will be used for eligible cohort and case-control studies.Results: The review will describe the genes and pathogenic variants reported in Iranian patients with PCD, with particular attention to recurrent variants and reported genotype–phenotype associations. Where sufficient information is available, genetic findings will be examined in relation to clinical and demographic characteristics.Conclusion: This systematic review will provide a comprehensive summary of the currently available evidence on the genetic spectrum of PCD in Iranian patients. The findings may help identify recurrent variants, improve molecular diagnostic approaches, support genetic counseling, and highlight priorities for future genetic research in Iran.