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:V��2��������������4S<?���????��!�"�H>J>J>J>J>J>J>$�@�ACfn>Q6#6#6#n>??��>�&�&�&6#�??�4�	�&6#H>�&�&�&?�����@ꎮ�����,%��&~4�>0?�&�C�%L�C�&�&t�C22L6#6#�&6#6#6#6#6#n>n>&�6#6#6#?6#6#6#6#���������������������������������������������������������������������C6#6#6#6#6#6#6#6#6#�5�:	
The effect of late pregnancy date fruits consumption on delivery progress � a meta-analysis.
Short title: Dates fruits and delivery progress

Lena Sagi-Dain1, Shlomi Sagi2
1 �Obstetrics and Gynecology Department, Human Genetics institute, Carmel Medical Center, Haifa, Israel
2 � Obstetrics and Gynecology Department, Bnai Zion Medical Center, Haifa, Israel

Corresponding Author:  Lena Sagi-Dain, M.D.
                                     Genetics Institute, Department of Obstetrics and Gynecology                               
                                    Carmel Medical Center
                                     7 Michal St., Haifa, Israel
                                    Tel: +972-506265842, Fax: +972-48135823
                                    Email:  HYPERLINK "mailto:lena2303@gmail.com" lena2303@gmail.com

Abstract
Objective: Several studies have examined the influence of date fruits consumption during late pregnancy on delivery outcomes, and the aim of our review was to summarize the available evidence exploring this subject. 
Methods: A search was conducted in three databases for manuscripts in English, with no time restrictions. By independent screening of titles and abstracts, two investigators selected original researches examining the effects of late pregnancy consumption of date fruits on various delivery outcomes. 
Results: Four articles were eligible for inclusion, comparing the outcomes of date fruits consumption beginning at 36-38 weeks of gestational age in primiparous women to a control group (3 randomized controlled and one prospective observational study). Women consuming date fruits were admitted with higher cervical dilatation (mean difference (MD) 1.1 cm [95% confidence interval (CI) 0.2 to 1.99 cm, three studies, I� 93%, 450 women) and yielded a lower need for labor induction/augmentation (relative risk (RR) 0.6, 95% CI 0.43 to 0.83, three studies, I� 51%, 478 women). Date fruit consumption was associated with shorter latent phase (MD -4.6 hours, 95% CI -7.77 to -1.4, two studies, I� 47%, 268 women) and reduced second stage duration (MD -7.7 minutes, 95% CI -12.0 to -3.4, three studies, I� 13%, 450 women). The rate of cesarean sections did not yield statistical significance (RR 0.7, 95% CI 0.41-1.21, three studies, I� 38%, 478 women). Overall quality of evidence was rated as very low using Grading of Recommendations Assessment, Development and Evaluation criteria. 
Conclusions: The existing evidence suggests that date fruits may be beneficial in decreasing the need for induction of labor and shortening latent and second stages of labor. These findings might be related to the putative prostaglandin-stimulating and oxytocin-like activity of this product. It is exciting to examine these effects in further large-scale well-planned randomized controlled trials. 
Keywords: Date fruits; induction of labor; herbal medicine; labor stages; obstetrics
Introduction: 
Complementary and alternative medicine use during pregnancy is a well-known phenomenon. The motivation for such use is supported by the belief that these methods can be a safer alternative compared with pharmaceutical drugs, support a holistic approach, and impart a sense of control over childbearing experiences  ADDIN EN.CITE <EndNote><Cite><Author>Hall</Author><Year>2011</Year><RecNum>247</RecNum><DisplayText>(1)</DisplayText><record><rec-number>247</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">247</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hall, H. G.</author><author>Griffiths, D. L.</author><author>McKenna, L. G.</author></authors></contributors><auth-address>School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, Victoria 3199, Australia. helen.hall@monash.edu</auth-address><titles><title>The use of complementary and alternative medicine by pregnant women: a literature review</title><secondary-title>Midwifery</secondary-title><alt-title>Midwifery</alt-title></titles><periodical><full-title>Midwifery</full-title><abbr-1>Midwifery</abbr-1></periodical><alt-periodical><full-title>Midwifery</full-title><abbr-1>Midwifery</abbr-1></alt-periodical><pages>817-24</pages><volume>27</volume><number>6</number><edition>2011/01/21</edition><keywords><keyword>*Attitude to Health</keyword><keyword>Complementary Therapies/*utilization</keyword><keyword>Evidence-Based Practice</keyword><keyword>Female</keyword><keyword>Health Knowledge, Attitudes, Practice</keyword><keyword>Humans</keyword><keyword>Nursing Methodology Research</keyword><keyword>Phytotherapy/utilization</keyword><keyword>Pregnancy</keyword><keyword>Pregnancy Complications/*prevention &amp; control</keyword><keyword>Prenatal Care/methods</keyword><keyword>Safety</keyword><keyword>Self Care/*methods</keyword><keyword>*Women&apos;s Health</keyword></keywords><dates><year>2011</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1532-3099 (Electronic)&#xD;0266-6138 (Linking)</isbn><accession-num>21247674</accession-num><work-type>Review</work-type><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/21247674</url></related-urls></urls><electronic-resource-num>10.1016/j.midw.2010.08.007</electronic-resource-num><language>eng</language></record></Cite></EndNote>( HYPERLINK \l "_ENREF_1" \o "Hall, 2011 #247" 1). Prevalence of herbal medicine use during pregnancy varies across countries, from as low as 6-9% in Canada and the US, through about half in Eastern Europe and Australia, and up to 69% in Russia  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_2" \o "Kennedy, 2013 #240" 2). These products are used for numerous medical conditions in obstetrics and gynecology, including for induction of labor. According to a national survey, most common products advised by midwives for labor stimulation are blue and black cohosh, red raspberry leaves, castor oil, and evening primrose oil  ADDIN EN.CITE <EndNote><Cite><Author>McFarlin</Author><Year>1999</Year><RecNum>248</RecNum><DisplayText>(3)</DisplayText><record><rec-number>248</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">248</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>McFarlin, B. L.</author><author>Gibson, M. H.</author><author>O&apos;Rear, J.</author><author>Harman, P.</author></authors></contributors><auth-address>West Virginia University School of Medicine, Department of Obstetrics and Gynecology, Morgantown 26506-9186, USA.</auth-address><titles><title>A national survey of herbal preparation use by nurse-midwives for labor stimulation. Review of the literature and recommendations for practice</title><secondary-title>J Nurse Midwifery</secondary-title><alt-title>Journal of nurse-midwifery</alt-title></titles><periodical><full-title>J Nurse Midwifery</full-title><abbr-1>Journal of nurse-midwifery</abbr-1></periodical><alt-periodical><full-title>J Nurse Midwifery</full-title><abbr-1>Journal of nurse-midwifery</abbr-1></alt-periodical><pages>205-16</pages><volume>44</volume><number>3</number><edition>1999/06/25</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Complementary Therapies</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>*Labor, Induced</keyword><keyword>Middle Aged</keyword><keyword>*Midwifery/methods</keyword><keyword>*Phytotherapy</keyword><keyword>Plants, Medicinal/*therapeutic use</keyword><keyword>Pregnancy</keyword><keyword>Surveys and Questionnaires</keyword><keyword>United States</keyword></keywords><dates><year>1999</year><pub-dates><date>May-Jun</date></pub-dates></dates><isbn>0091-2182 (Print)&#xD;0091-2182 (Linking)</isbn><accession-num>10380441</accession-num><work-type>Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/10380441</url></related-urls></urls><language>eng</language></record></Cite></EndNote>( HYPERLINK \l "_ENREF_3" \o "McFarlin, 1999 #248" 3). 

Fruits of the date palm (Phoenix dactylifera L.) are a widely available product, which contains numerous macronutrients including a high content of sugar, minerals, vitamins and antioxidants  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_4" \o "Hamad, 2015 #250" 4). Studies have shown that date fruit extracts possess an antibacterial and antifungal properties, as well as anti-mutagenic and anti-atherogenic activity  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_4" \o "Hamad, 2015 #250" 4-6). In addition, Phoenix dactylifera might exert nephroprotective effects  ADDIN EN.CITE <EndNote><Cite><Author>Al-Qarawi AA</Author><Year>2008</Year><RecNum>260</RecNum><DisplayText>(7)</DisplayText><record><rec-number>260</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Al-Qarawi AA, Abdel-Rahman H, Mousa HM, Ali BH, El-Mougy SA. </author></authors></contributors><titles><title>Nephroprotective action of Phoenix dactylifera in gentamicin-induced nephrotoxicity.</title><secondary-title>Pharm Biol </secondary-title></titles><periodical><full-title>Pharm Biol</full-title></periodical><pages>227-230</pages><volume>4</volume><dates><year>2008</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_7" \o "Al-Qarawi AA, 2008 #260" 7), improve memory and learning abilities in Alzheimer's disease  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_8" \o "Subash, 2015 #258" 8), and enhance colon health  ADDIN EN.CITE <EndNote><Cite><Author>Eid N</Author><Year>2014</Year><RecNum>259</RecNum><DisplayText>(9)</DisplayText><record><rec-number>259</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">259</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Eid N, Enani S, Walton G, Corona G, Costabile A, Gibson G, Rowland I, Spencer JPE. </author></authors></contributors><titles><title>The impact of date palm fruits and their component polyphenols, on gut microbial ecology, bacterial metabolites and colon cancer cell proliferation.</title><secondary-title>Journal of Nutritional Science</secondary-title></titles><periodical><full-title>Journal of Nutritional Science</full-title></periodical><pages>1-9</pages><volume>3</volume><number>46</number><dates><year>2014</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_9" \o "Eid N, 2014 #259" 9).  Female reproductive system might also be favorably affected by date fruits  ADDIN EN.CITE <EndNote><Cite><Author>Saryono MDWI</Author><Year>2016</Year><RecNum>261</RecNum><DisplayText>(10)</DisplayText><record><rec-number>261</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">261</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Saryono MDWI, Eni R.</author></authors></contributors><titles><title>Effects of dates fruit (phoenix dactylifera l.) in the female reproductive process.</title><secondary-title>International Journal of Recent Advances in Multidisciplinary Research</secondary-title></titles><periodical><full-title>International Journal of Recent Advances in Multidisciplinary Research</full-title></periodical><pages>1630-1633</pages><volume>3</volume><number>7</number><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_10" \o "Saryono MDWI, 2016 #261" 10). Several studies have examined the influence of date fruit consumption during late pregnancy on delivery outcomes, yielding beneficial results. Thus, the aim of our review was to summarize the available evidence exploring this subject.

Methods:
Conduction of this systematic review of the literature and meta-analysis was performed based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The review protocol can be assessed at PROSPERO International prospective register of systematic reviews ( HYPERLINK "http://www.crd.york.ac.uk/PROSPERO" \t "_blank" http://www.crd.york.ac.uk/PROSPERO, registration number CRD42018106012).
The search was planned aiming to include all original researches examining the effect of dates fruit consumption on delivery progress. The searches were conducted by a researcher experienced in meta-analyses in PUBMED, Cochrane library and ClinicalTrials.gov databases, from inception to August 2018. The following search terms were used, including MeSH headings and free text: "dates fruit" AND (pregnancy OR labor OR delivery). We searched for manuscripts published in English language, with no restrictions with regard to year of publication, and no specific software was used. In addition, a hand search for relevant articles was performed through reference lists of all articles selected for inclusion in the meta-analysis, as well as of reviews on the subject. 
We aimed to include papers describing randomized controlled trials and observational studies such as case controlled studies, cohort and cross sectional studies. Case reports, case series, reviews, editorials, non-human studies, or abstracts of studies with no full published article were excluded. 

Papers for full-text assessment were selected based on title, keywords and abstract screening. Primary data collection was performed by two reviewers using a standardized data extraction procedure, with disagreements being settled by in depth discussion. The primary outcome was aimed at delivery characteristics, including the duration of various stages of labor, need for induction/augmentation of labor, and the rate of cesarean sections. In addition, patients' demographic and obstetric characteristics, and various neonatal outcomes were recorded. This data was used to construct evidence tables.  

The meta-analysis was performed with the use of RevMan 5.1 (Cochrane Collaboration, Oxford, UK), relying on guidelines described in the Cochrane Handbook for Systematic Reviews. The effect estimates were presented as Relative Risks (RR) or mean differences (MD) with 95% Confidence Intervals (CI). Categorical variables examined by a single study were analyzed by Fisher exact test calculator, while continuous variables were examined by an unpaired t-test. A two tailed p<0.05 was considered statistically significant. 
Statistical heterogeneity among studies was evaluated using the Chi-squared test (significant at p<0.1) and the I2 statistic (low level of heterogeneity defined as I-squared statistic< 25%, a moderate level � 25-50%, and a high level � above 50%). Pooling of the results was performed using either the Mantel�Haenszel fixed effects model (if neither the �2 analysis nor the I2 test indicated significant heterogeneity between the studies) or the Der Simonian Laird random-effects model (in cases of high statistical heterogeneity). Sensitivity analyses were performed by omitting one study at a time (including the outliers). 
Publication bias were not assessed, since less than 10 studies were finally included. Cochrane Collaboration's Risk of Bias tool was used to assess the quality of the trials. Trial quality was evaluated by two independent reviewers, with disagreements resolved through consensus adjudication. In addition, overall quality of the evidence was assessed using criteria recommended by the Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE)  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_11" \o "Meerpohl, 2012 #12" 11).

Results:
Of 45 initial references, four articles were eligible for inclusion (Table 1)  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_12" \o "Al-Kuran, 2011 #221" 12-15). Search results are presented in Supplementary Figure 1 and Supplementary Table 1. The studies were conducted in Jordan, Iran and Malaysia. Two papers represented overlapping populations  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_13" \o "Kordi M, 2014 #236" 13,  HYPERLINK \l "_ENREF_15" \o "Kordi, 2017 #238" 15); however, both were included due to analysis of different outcomes. One manuscript described the results of a prospective cohort study, in which the participants were offered to participate in one of two groups in open label fashion  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_12" \o "Al-Kuran, 2011 #221" 12). The remaining studies were conducted in a randomized controlled approach. 
All studies included nulli/primiparous women with singleton pregnancies (Kordi et al. restricted to vertex presentation). Women with chronic illnesses or antenatal complications, as well as women consuming dates before the trial, were excluded (Supplementary Table 2). Participants in the intervention group were instructed to consume 6 to 7 pieces of dates (60-80 gr) per day starting from 36-38 weeks of gestational age, while the control cohort were prohibited from consuming date fruits. Overall, 478 women were included in the analysis � 251 in dates consumption group, and 227 in the control cohort. The groups were comparable in terms of maternal age and body mass index (two studies  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_13" \o "Kordi M, 2014 #236" 13,  HYPERLINK \l "_ENREF_15" \o "Kordi, 2017 #238" 15)), gestational age at delivery (two studies  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_12" \o "Al-Kuran, 2011 #221" 12,  HYPERLINK \l "_ENREF_14" \o "Razali, 2017 #237" 14)) and birth weight  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_15" \o "Kordi, 2017 #238" 15). 

Women consuming date fruits were admitted with higher cervical dilatation (MD 1.1 cm [95% CI 0.2 to 1.99 cm, three studies, I� 93%, 450 women) and yielded a lower need for labor induction/augmentation (relative risk (RR) 0.6, 95% CI 0.43 to 0.83, three studies, I� 51%, 478 women) (Figure 1). 
Date fruit consumption was associated with shorter latent phase (MD -4.6 hours, 95% CI -7.77 to -1.4, two studies, I� 47%, 268 women), reduced second stage duration (MD -7.7 minutes, 95% CI -12.0 to -3.4, three studies, I� 13%, 450 women), and a non-statistically significant trend towards shorter active phase (MD -86.4 minutes, 95% CI -177.7 to 4.84, three studies, I� 84%, 450 women) and shortened third stage (MD -0.98 minutes, 95% CI -2.11 to 0.15, three studies, I� 0%, 450 women) (Figure 2). 
The rate of cesarean sections did not differ between the two groups (RR 0.7, 95% CI 0.41-1.21, three studies, I� 38%, 478 women). 
Additional outcomes, each examined by a single study, included vaginal delivery rates following induction of labor (47.6% in intervention group vs. 27.7% in controls, p=0.036, 210 women)  ADDIN EN.CITE <EndNote><Cite><Author>Kordi M</Author><Year>2014</Year><RecNum>236</RecNum><DisplayText>(13)</DisplayText><record><rec-number>236</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">236</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kordi M, Aghaei Meybodi F, Tara F, Nemati M, Shakeri MT.</author></authors></contributors><titles><title>The Effect of Late-Pregnancy Consumption of Date Fruit on Cervical Ripening in Nulliparous Women.</title><secondary-title>Journal of Midwifery and Reproductive Health.</secondary-title></titles><periodical><full-title>Journal of Midwifery and Reproductive Health.</full-title></periodical><pages>150-156</pages><volume>2</volume><number>3</number><dates><year>2014</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_13" \o "Kordi M, 2014 #236" 13), Bishop score at admission (7.67�2.28 vs. 5.12�2.77, respectively, p<0.001, 210 women)  ADDIN EN.CITE <EndNote><Cite><Author>Kordi M</Author><Year>2014</Year><RecNum>236</RecNum><DisplayText>(13)</DisplayText><record><rec-number>236</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">236</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kordi M, Aghaei Meybodi F, Tara F, Nemati M, Shakeri MT.</author></authors></contributors><titles><title>The Effect of Late-Pregnancy Consumption of Date Fruit on Cervical Ripening in Nulliparous Women.</title><secondary-title>Journal of Midwifery and Reproductive Health.</secondary-title></titles><periodical><full-title>Journal of Midwifery and Reproductive Health.</full-title></periodical><pages>150-156</pages><volume>2</volume><number>3</number><dates><year>2014</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_13" \o "Kordi M, 2014 #236" 13), presence of intact membranes on admission (82.6% vs. 60.0%, p=0.007, 114 women)  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_12" \o "Al-Kuran, 2011 #221" 12). In the study by Razali et al., no difference was found in 5-minute Apgar score, umbilical cord pH, Base excess, estimated blood loss and maternal hemoglobin levels prior and after the delivery  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_14" \o "Razali, 2017 #237" 14). In addition, the authors noted that random blood glucose was measured in all dates consumers during each antenatal visit, with normal blood glucose levels. 
Quality assessment of individual studies is presented in Supplementary Figure 2. Adequate sequence generation and allocation concealment was performed only by Razali et al, while Kordi et al. performed randomization by odd vs. even days of week, and in the study by Al-Kuran et al. the women were asked to participate in one of two groups in open label fashion. Blinding of personnel and outcome assessors was not addressed by any of the trials. 
Using Grading of Recommendations Assessment, Development and Evaluation criteria, overall quality of evidence was initially rated as "high" due to inclusion of mainly randomized controlled trials. However, due to serious risk of bias, possible publication bias, and serious inconsistency the quality was downgraded to "very low". 

Discussion:
Numerous scientific efforts are invested in exploring the potential ways that could benefit the labor process. Induction of labor involves up to 25% of all the deliveries  ADDIN EN.CITE <EndNote><Cite><Author>Osterman</Author><Year>2014</Year><RecNum>262</RecNum><DisplayText>(16)</DisplayText><record><rec-number>262</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">262</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Osterman, M. J.</author><author>Martin, J. A.</author></authors></contributors><titles><title>Recent declines in induction of labor by gestational age</title><secondary-title>NCHS Data Brief</secondary-title><alt-title>NCHS data brief</alt-title></titles><periodical><full-title>NCHS Data Brief</full-title><abbr-1>NCHS data brief</abbr-1></periodical><alt-periodical><full-title>NCHS Data Brief</full-title><abbr-1>NCHS data brief</abbr-1></alt-periodical><pages>1-8</pages><number>155</number><edition>2014/06/20</edition><keywords><keyword>Adult</keyword><keyword>Birth Certificates</keyword><keyword>Female</keyword><keyword>*Gestational Age</keyword><keyword>Humans</keyword><keyword>Labor, Induced/*trends/utilization</keyword><keyword>Pregnancy</keyword><keyword>United States</keyword><keyword>Vital Statistics</keyword><keyword>Young Adult</keyword></keywords><dates><year>2014</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1941-4927 (Electronic)&#xD;1941-4935 (Linking)</isbn><accession-num>24941926</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/24941926</url></related-urls></urls><language>eng</language></record></Cite></EndNote>( HYPERLINK \l "_ENREF_16" \o "Osterman, 2014 #262" 16), and common indications to stimulate labor are post-term pregnancy, prelabor rupture of membranes, and various maternal and fetal complications  ADDIN EN.CITE <EndNote><Cite><Year>2009</Year><RecNum>263</RecNum><DisplayText>(17)</DisplayText><record><rec-number>263</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">263</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors></contributors><titles><title>ACOG Practice Bulletin No. 107: Induction of labor</title><secondary-title>Obstet Gynecol</secondary-title><alt-title>Obstetrics and gynecology</alt-title></titles><periodical><full-title>Obstet Gynecol</full-title><abbr-1>Obstetrics and gynecology</abbr-1></periodical><alt-periodical><full-title>Obstet Gynecol</full-title><abbr-1>Obstetrics and gynecology</abbr-1></alt-periodical><pages>386-97</pages><volume>114</volume><number>2 Pt 1</number><edition>2009/07/23</edition><keywords><keyword>Cervical Ripening/*drug effects</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Labor, Induced/*methods</keyword><keyword>Oxytocics/*therapeutic use</keyword><keyword>Oxytocin/*therapeutic use</keyword><keyword>Pregnancy</keyword><keyword>Pregnancy Complications</keyword><keyword>Prostaglandins/therapeutic use</keyword><keyword>Terminology as Topic</keyword></keywords><dates><year>2009</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0029-7844 (Print)&#xD;0029-7844 (Linking)</isbn><accession-num>19623003</accession-num><work-type>Practice Guideline&#xD;Review</work-type><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/19623003</url></related-urls></urls><electronic-resource-num>10.1097/AOG.0b013e3181b48ef5</electronic-resource-num><language>eng</language></record></Cite></EndNote>( HYPERLINK \l "_ENREF_17" \o ", 2009 #263" 17). The most common and studied method of labor induction is intravenous administration of synthetic�oxytocin, while women with an unfavorable cervix�first need to undergo cervical ripening by mechanical methods (Foley catheter or double-lumen balloon catheter) or prostaglandins E1 and E2  ADDIN EN.CITE <EndNote><Cite><Author>Grobman</Author><Year>2018</Year><RecNum>264</RecNum><DisplayText>(18, 19)</DisplayText><record><rec-number>264</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">264</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>W Grobman </author></authors><secondary-authors><author>Lockwood CJ.</author></secondary-authors></contributors><titles><title>Induction of labor with oxytocin. </title><secondary-title>UpToDate</secondary-title></titles><dates><year>2018</year></dates><pub-location>Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on October 02, 2018)</pub-location><urls></urls></record></Cite><Cite><Author>Grobman</Author><Year>2018</Year><RecNum>265</RecNum><record><rec-number>265</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">265</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>W Grobman</author></authors><secondary-authors><author>Lockwood CJ</author></secondary-authors></contributors><titles><title>Techniques for ripening the unfavorable cervix prior to induction</title><secondary-title>UpToDate</secondary-title></titles><dates><year>2018</year></dates><pub-location>Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on October 02, 2018)</pub-location><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_18" \o "Grobman, 2018 #264" 18,  HYPERLINK \l "_ENREF_19" \o "Grobman, 2018 #265" 19). Induction of labor is associated with several adverse phenomena, including longer latent phase, excessive uterine activity, which, if prolonged, may result in fetal hypoxemia and academia, increased relative risk of uterine rupture (mostly in women after previous cesarean delivery), and possible increased risk for cesarean delivery (a controversial issue)  ADDIN EN.CITE <EndNote><Cite><Author>Grobman</Author><Year>2018</Year><RecNum>264</RecNum><DisplayText>(18, 19)</DisplayText><record><rec-number>264</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">264</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>W Grobman </author></authors><secondary-authors><author>Lockwood CJ.</author></secondary-authors></contributors><titles><title>Induction of labor with oxytocin. </title><secondary-title>UpToDate</secondary-title></titles><dates><year>2018</year></dates><pub-location>Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on October 02, 2018)</pub-location><urls></urls></record></Cite><Cite><Author>Grobman</Author><Year>2018</Year><RecNum>265</RecNum><record><rec-number>265</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">265</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>W Grobman</author></authors><secondary-authors><author>Lockwood CJ</author></secondary-authors></contributors><titles><title>Techniques for ripening the unfavorable cervix prior to induction</title><secondary-title>UpToDate</secondary-title></titles><dates><year>2018</year></dates><pub-location>Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on October 02, 2018)</pub-location><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_18" \o "Grobman, 2018 #264" 18,  HYPERLINK \l "_ENREF_19" \o "Grobman, 2018 #265" 19). Furthermore, induction of labor might be associated with possible inconvenience due to frequent fetal monitoring and restricted maternal mobility, as well as with significant financial burden  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_20" \o "Garcia-Simon, 2016 #266" 20). 
Duration of the delivery is also an important labor characteristic, related to several adverse outcomes. It has been demonstrated that in spontaneous delivery, the rates of chorioamnionitis and cesarean section increase significantly as�labor�duration�exceeds the median  ADDIN EN.CITE <EndNote><Cite><Author>Hoppe</Author><Year>2018</Year><RecNum>267</RecNum><DisplayText>(21)</DisplayText><record><rec-number>267</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">267</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hoppe, K. K.</author><author>Schiff, M. A.</author><author>Benedetti, T. J.</author><author>Delaney, S.</author></authors></contributors><auth-address>Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.&#xD;Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Seattle, Washington.&#xD;Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.</auth-address><titles><title>Duration of Spontaneous Active Labor and Perinatal Outcomes Using Contemporary Labor Curves</title><secondary-title>Am J Perinatol</secondary-title><alt-title>American journal of perinatology</alt-title></titles><periodical><full-title>Am J Perinatol</full-title><abbr-1>American journal of perinatology</abbr-1></periodical><alt-periodical><full-title>Am J Perinatol</full-title><abbr-1>American journal of perinatology</abbr-1></alt-periodical><pages>1186-1191</pages><volume>35</volume><number>12</number><edition>2018/04/26</edition><dates><year>2018</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>1098-8785 (Electronic)&#xD;0735-1631 (Linking)</isbn><accession-num>29695019</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/29695019</url></related-urls></urls><electronic-resource-num>10.1055/s-0038-1642045</electronic-resource-num><language>eng</language></record></Cite></EndNote>( HYPERLINK \l "_ENREF_21" \o "Hoppe, 2018 #267" 21). Thus, means aimed at decreasing the need for labor induction and avoiding prolonged delivery can be of great value worldwide.  

Our meta-analysis yields two prominent important benefits of date fruit consumption by primiparous women during several weeks prior the delivery. First, it can decrease the need for labor induction and/or augmentation by as much as one half of the cases. Second, dates might have a beneficial effect on labor duration, especially by 4-hour shortening of the latent phase. 

Several theories might explain these findings. Date fruits are enriched in saturated and unsaturated fatty acids, including oleic, linoleic and linolenic acids. Linoleic acid is a precursor of Arachidonate, which can be converted into Icosanoids, and thus to prostaglandins. In addition, serotonin contained in dates can contribute to smooth muscle contractions  ADDIN EN.CITE <EndNote><Cite><Author>Khadem N</Author><Year>2007</Year><RecNum>268</RecNum><DisplayText>(22)</DisplayText><record><rec-number>268</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">268</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Khadem N, Sharaphy A, Latifnejad R, Hammod N, Ibrahimzadeh S.</author></authors></contributors><titles><title>Comparing the efficacy of dates and oxytocin in the management of postpartum hemorrhage. </title><secondary-title>Shiraz E-Medical Journal</secondary-title></titles><periodical><full-title>Shiraz E-Medical Journal</full-title></periodical><pages>64�71</pages><volume>8</volume><dates><year>2007</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_22" \o "Khadem N, 2007 #268" 22). At 2007 Khadem et al. have executed a prospective clinical trial to examine the efficacy of dates fruit in prevention of postpartum hemorrhage  ADDIN EN.CITE <EndNote><Cite><Author>Khadem N</Author><Year>2007</Year><RecNum>268</RecNum><DisplayText>(22)</DisplayText><record><rec-number>268</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">268</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Khadem N, Sharaphy A, Latifnejad R, Hammod N, Ibrahimzadeh S.</author></authors></contributors><titles><title>Comparing the efficacy of dates and oxytocin in the management of postpartum hemorrhage. </title><secondary-title>Shiraz E-Medical Journal</secondary-title></titles><periodical><full-title>Shiraz E-Medical Journal</full-title></periodical><pages>64�71</pages><volume>8</volume><dates><year>2007</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_22" \o "Khadem N, 2007 #268" 22). Immediately following the delivery of the placenta, parturients in the intervention group consumed 50 gram of dates, while the control cohort were treated by intramuscular oxytocin (n=31 in each group). Weighting of perineal pads and sheets was performed hourly for 3 hours after the delivery. The investigators have found that mean blood loss was significantly lower in women consuming dates, both 1 hour (104 ml vs. 141.6 ml, p=0.043) and 3 hours (162.5 ml vs. 220.7 ml, p=0.02) following the delivery. Thus, dates might possess an oxytocin mimicking activity, even if given as a single dose. 

Additional explanation for labor shortening might be related to the high nutritional value of date fruits. Specifically, dates contain a high percentage of carbohydrate (total sugars, 44-88%, depending on the fruit type)  ADDIN EN.CITE <EndNote><Cite><Author>Al-Shahib</Author><Year>2003</Year><RecNum>272</RecNum><DisplayText>(23)</DisplayText><record><rec-number>272</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">272</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Al-Shahib, W.</author><author>Marshall, R. J.</author></authors></contributors><auth-address>London Metropolitan University, Department of Health &amp; Human Sciences, London, UK.</auth-address><titles><title>The fruit of the date palm: its possible use as the best food for the future?</title><secondary-title>Int J Food Sci Nutr</secondary-title><alt-title>International journal of food sciences and nutrition</alt-title></titles><periodical><full-title>Int J Food Sci Nutr</full-title><abbr-1>International journal of food sciences and nutrition</abbr-1></periodical><alt-periodical><full-title>Int J Food Sci Nutr</full-title><abbr-1>International journal of food sciences and nutrition</abbr-1></alt-periodical><pages>247-59</pages><volume>54</volume><number>4</number><edition>2003/07/10</edition><keywords><keyword>Crops, Agricultural/*chemistry</keyword><keyword>Dietary Fats/analysis</keyword><keyword>Dietary Fiber/analysis</keyword><keyword>Dietary Proteins/analysis</keyword><keyword>*Food</keyword><keyword>Humans</keyword><keyword>Minerals/analysis</keyword><keyword>Nutritive Value</keyword><keyword>Nuts/*chemistry</keyword><keyword>Oleic Acid/analysis</keyword><keyword>Vitamins/analysis</keyword></keywords><dates><year>2003</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>0963-7486 (Print)&#xD;0963-7486 (Linking)</isbn><accession-num>12850886</accession-num><work-type>Review</work-type><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/12850886</url></related-urls></urls><electronic-resource-num>10.1080/09637480120091982</electronic-resource-num><language>eng</language></record></Cite></EndNote>( HYPERLINK \l "_ENREF_23" \o "Al-Shahib, 2003 #272" 23). It is well established that labor is a high energy-consuming process, requiring up to 50-100 kcal per hour  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_15" \o "Kordi, 2017 #238" 15). Accumulation of ketone bodies during delivery process has been associated with prolonged labor and maternal psychological stress  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_24" \o "Singata, 2013 #273" 24). Previous studies have demonstrated an unexpectedly low energy charge of the uterine muscle  ADDIN EN.CITE <EndNote><Cite><Author>Wedenberg</Author><Year>1990</Year><RecNum>275</RecNum><DisplayText>(25)</DisplayText><record><rec-number>275</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">275</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wedenberg, K.</author><author>Ronquist, G.</author><author>Waldenstrom, A.</author><author>Ulmsten, U.</author></authors></contributors><auth-address>Department of Obstetrics and Gynecology, Uppsala University Hospital, Sweden.</auth-address><titles><title>Low energy charge in human uterine muscle</title><secondary-title>Biochim Biophys Acta</secondary-title><alt-title>Biochimica et biophysica acta</alt-title></titles><periodical><full-title>Biochim Biophys Acta</full-title><abbr-1>Biochimica et biophysica acta</abbr-1></periodical><alt-periodical><full-title>Biochim Biophys Acta</full-title><abbr-1>Biochimica et biophysica acta</abbr-1></alt-periodical><pages>31-4</pages><volume>1033</volume><number>1</number><edition>1990/01/29</edition><keywords><keyword>Abdominal Muscles/metabolism</keyword><keyword>Adenosine Monophosphate/metabolism</keyword><keyword>Adenosine Triphosphate/metabolism</keyword><keyword>*Energy Metabolism</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Lactates/metabolism</keyword><keyword>Lactic Acid</keyword><keyword>Phosphocreatine/metabolism</keyword><keyword>Pregnancy</keyword><keyword>Uterus/*metabolism</keyword></keywords><dates><year>1990</year><pub-dates><date>Jan 29</date></pub-dates></dates><isbn>0006-3002 (Print)&#xD;0006-3002 (Linking)</isbn><accession-num>2137351</accession-num><work-type>Comparative Study&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/2137351</url></related-urls></urls><language>eng</language></record></Cite></EndNote>( HYPERLINK \l "_ENREF_25" \o "Wedenberg, 1990 #275" 25). Also, it has been shown that glucose is the principal nutritive metabolite of uterine smooth muscle at term before labor, rather than triglycerides and free fatty acids, and that it has a critical role in Adenosine Triphosphate formation  ADDIN EN.CITE <EndNote><Cite><Author>Steingrimsdottir</Author><Year>1995</Year><RecNum>276</RecNum><DisplayText>(26)</DisplayText><record><rec-number>276</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">276</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Steingrimsdottir, T.</author><author>Ronquist, G.</author><author>Ulmsten, U.</author><author>Waldenstrom, A.</author></authors></contributors><auth-address>Department of Obstetrics and Gynecology, Uppsala University Hospital, Sweden.</auth-address><titles><title>Different energy metabolite pattern between uterine smooth muscle and striated rectus muscle in term pregnant women</title><secondary-title>Eur J Obstet Gynecol Reprod Biol</secondary-title><alt-title>European journal of obstetrics, gynecology, and reproductive biology</alt-title></titles><periodical><full-title>Eur J Obstet Gynecol Reprod Biol</full-title><abbr-1>European journal of obstetrics, gynecology, and reproductive biology</abbr-1></periodical><alt-periodical><full-title>Eur J Obstet Gynecol Reprod Biol</full-title><abbr-1>European journal of obstetrics, gynecology, and reproductive biology</abbr-1></alt-periodical><pages>241-5</pages><volume>62</volume><number>2</number><edition>1995/10/01</edition><keywords><keyword>Adult</keyword><keyword>Energy Metabolism/*physiology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Myometrium/*metabolism</keyword><keyword>Pregnancy/*metabolism</keyword><keyword>Pregnancy Trimester, Third</keyword><keyword>Rectus Abdominis/*metabolism</keyword></keywords><dates><year>1995</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>0301-2115 (Print)&#xD;0301-2115 (Linking)</isbn><accession-num>8582504</accession-num><work-type>Comparative Study&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/8582504</url></related-urls></urls><language>eng</language></record></Cite></EndNote>( HYPERLINK \l "_ENREF_26" \o "Steingrimsdottir, 1995 #276" 26). Several studies have demonstrated that parenteral dextrose solution is associated with reduction of total labor length compared to normal saline  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_27" \o "Ciardulli, 2017 #277" 27,  HYPERLINK \l "_ENREF_28" \o "Pare, 2017 #278" 28). In 2010, Kordi et al. published the results of a double-blind randomized clinical trial of 90 low-risk nulliparous women, consuming honey-date syrup vs. placebo vs. usual care, starting at a cervical dilatation of 4 cm  ADDIN EN.CITE <EndNote><Cite><Author>Kordi M</Author><Year>2010</Year><RecNum>283</RecNum><DisplayText>(29)</DisplayText><record><rec-number>283</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">283</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kordi M, Salek N, Safarian M, Smaeili H. </author></authors></contributors><titles><title>The Effect of Oral Honey- Date Syrup Intake during Labor on Labor Progress of Nulliparous Women.</title><secondary-title>The Iranian Journal of Obstetrics, Gynecology and Infertility</secondary-title></titles><periodical><full-title>The Iranian Journal of Obstetrics, Gynecology and Infertility</full-title></periodical><pages>23-30</pages><volume>13</volume><number>2</number><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_29" \o "Kordi M, 2010 #283" 29). The authors have demonstrated significantly shorter labor duration (of about two-hours shortening) in date-syrup treated group compared to two other groups.  

Although the use of dates fruit as a method to decrease the need for labor induction and to shorten the delivery seems intriguing and promising, numerous factors should be addressed in future trials. First, the principle "primum non nocere" must be followed, as many herbal remedies, marketed as natural and therefore non-harmful supplements, do not undergo preliminary testing for safety or any formal requirement for reporting serious adverse events  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_30" \o "Marcus, 2005 #279" 30). Adverse effects of date fruits have not been reported; however, the high levels of various nutritional components might not be strictly beneficial. In particular, daily intake of fruit with high glucose content for several weeks before the delivery might be somewhat worrisome, especially in women with gestational or pregestational diabetes mellitus. Nevertheless, studies have shown that date fruit consumption may be of benefit in glycaemic and lipid control of diabetic patients. For example, Miller et al. have examined the glycaemic responses of eleven healthy volunteers, consuming dates of the tamer (6-8 per meal) and rutab (8-10 per meal) variety. It was shown that dates have a low glycemic index of about 35.5 � 47.2, similar to those of fresh apples, bananas and oranges  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_31" \o "Miller, 2003 #256" 31). The authors stated that this is likely to be associated with the high date fruit fructose content, and suggested that diabetic patients can be reassured that dates consumption does not result in rapid and significant fluctuations in blood sugar. Rock et al. published the results of a 4-weeks follow-up of ten healthy subjects, consuming 100 gram of Medjool or Hallawi dates per day  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_32" \o "Rock, 2009 #282" 32). No significant effect was found in the body mass index, serum cholesterol (total and fractions), and fasting serum glucose levels. Furthermore, a significant decrease in triacylglycerol levels and in the basal serum oxidative status was found, while the activity of serum antioxidant enzyme paraoxonase 1 significantly increased following Hallawi date consumption. Thus, the authors suggested that dates can be considered an antiatherogenic nutrient.

Additional point worth discussing is the different chemical composition of various date cultivars  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_4" \o "Hamad, 2015 #250" 4). More than two hundred varieties of dates available worldwide, and the chemical composites differ depending on weather conditions, planting area, age of tree, and process of fruit growth  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_5" \o "Rahmani, 2014 #257" 5,  HYPERLINK \l "_ENREF_15" \o "Kordi, 2017 #238" 15). Looking into the articles included in our meta-analysis, it can be seen that Kordi et al. used Mazafati dates of Bam, while the remaining manuscripts did not mention the date fruit type. The abovementioned study of Khadem et al. describing the utility of dates fruit in prevention of postpartum hemorrhage used Deglet Noor dates  ADDIN EN.CITE <EndNote><Cite><Author>Khadem N</Author><Year>2007</Year><RecNum>268</RecNum><DisplayText>(22)</DisplayText><record><rec-number>268</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">268</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Khadem N, Sharaphy A, Latifnejad R, Hammod N, Ibrahimzadeh S.</author></authors></contributors><titles><title>Comparing the efficacy of dates and oxytocin in the management of postpartum hemorrhage. </title><secondary-title>Shiraz E-Medical Journal</secondary-title></titles><periodical><full-title>Shiraz E-Medical Journal</full-title></periodical><pages>64�71</pages><volume>8</volume><dates><year>2007</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_22" \o "Khadem N, 2007 #268" 22). Thus, future trials examining this issue should strive to evaluate the possible differences in various sorts of dates. 

The period of date fruit consumption starting from 36-38 weeks of gestation is also an intriguing choice. Al-Kuran et al., publishing the first trial on the subject, stated that the rationale for choosing the last 4 weeks of pregnancy was empirical. It is truly interesting to examine the effects of dates fruit consumption at several crucial points commonly requiring labor induction, such as in post-term pregnancies (for example, starting at 40 weeks of gestation), women with term prelabor rupture of membranes, as well as during prolonged labor. The exact amount of dates fruit needed to exert a beneficial effect on labor process also must be explored. The included studies examined the consumption of 6-7 dates fruits per day (about 60-80 gram), which are a roughly similar amounts to what many Middle Eastern Arabic people would normally consume at a single sitting  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_31" \o "Miller, 2003 #256" 31). Finally, future trials should be conducted in strict accordance with the accepted guidelines, such as CONSORT guidelines for Reporting Parallel Group Randomized Trials  ADDIN EN.CITE <EndNote><Cite><Author>Piaggio</Author><Year>2012</Year><RecNum>190</RecNum><DisplayText>(33)</DisplayText><record><rec-number>190</rec-number><foreign-keys><key app="EN" db-id="0fsfsdx2m9ew5he9sdaxw2dnrxzaxxa9rxar">190</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Piaggio, G.</author><author>Elbourne, D. R.</author><author>Pocock, S. J.</author><author>Evans, S. J.</author><author>Altman, D. G.</author><author>Consort Group</author></authors></contributors><auth-address>Statistika Consultoria, Sao Paulo, Brazil. gilda.piaggio@gmail.com</auth-address><titles><title>Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement</title><secondary-title>JAMA</secondary-title><alt-title>Jama</alt-title></titles><periodical><full-title>JAMA</full-title><abbr-1>Jama</abbr-1></periodical><alt-periodical><full-title>JAMA</full-title><abbr-1>Jama</abbr-1></alt-periodical><pages>2594-604</pages><volume>308</volume><number>24</number><keywords><keyword>Checklist</keyword><keyword>*Data Interpretation, Statistical</keyword><keyword>*Endpoint Determination</keyword><keyword>Quality Control</keyword><keyword>*Randomized Controlled Trials as Topic</keyword><keyword>Research Design</keyword><keyword>Sample Size</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2012</year><pub-dates><date>Dec 26</date></pub-dates></dates><isbn>1538-3598 (Electronic)&#xD;0098-7484 (Linking)</isbn><accession-num>23268518</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/23268518</url></related-urls></urls><electronic-resource-num>10.1001/jama.2012.87802</electronic-resource-num></record></Cite></EndNote>( HYPERLINK \l "_ENREF_33" \o "Piaggio, 2012 #190" 33). 

Nevertheless, the results of our meta-analysis point to beneficial effects of date fruit consumption on labor process, and it is exciting to examine these influences in further large-scale well-planned randomized controlled trials. 
 


 
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31.	Miller CJ, Dunn EV, Hashim IB. The glycaemic index of dates and date/yoghurt mixed meals. Are dates 'the candy that grows on trees'? European journal of clinical nutrition. 2003;57(3):427-30.
32.	Rock W, Rosenblat M, Borochov-Neori H, Volkova N, Judeinstein S, Elias M, et al. Effects of date ( Phoenix dactylifera L., Medjool or Hallawi Variety) consumption by healthy subjects on serum glucose and lipid levels and on serum oxidative status: a pilot study. Journal of agricultural and food chemistry. 2009;57(17):8010-7.
33.	Piaggio G, Elbourne DR, Pocock SJ, Evans SJ, Altman DG, Group C. Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. Jama. 2012;308(24):2594-604.
Table 1. Characteristics of the included studies.
First author (year)CountryStudy designStudy periodStudy group [n]Control group [n]Dosage (pieces)Gestational age Al-Kuran O (2011)  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_12" \o "Al-Kuran, 2011 #221" 12)JordanProspective cohort2007-2008694560�67 gr (6)e"36 weeksKordi M (2014)  ADDIN EN.CITE <EndNote><Cite><Author>Kordi M</Author><Year>2014</Year><RecNum>236</RecNum><DisplayText>(13)</DisplayText><record><rec-number>236</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">236</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kordi M, Aghaei Meybodi F, Tara F, Nemati M, Shakeri MT.</author></authors></contributors><titles><title>The Effect of Late-Pregnancy Consumption of Date Fruit on Cervical Ripening in Nulliparous Women.</title><secondary-title>Journal of Midwifery and Reproductive Health.</secondary-title></titles><periodical><full-title>Journal of Midwifery and Reproductive Health.</full-title></periodical><pages>150-156</pages><volume>2</volume><number>3</number><dates><year>2014</year></dates><urls></urls></record></Cite></EndNote>( HYPERLINK \l "_ENREF_13" \o "Kordi M, 2014 #236" 13)IranRCT201310510570-75 gr (6-7)37-38 weeksRazali N (2017)  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_14" \o "Razali, 2017 #237" 14)MalaysiaRCT2013-20147777~ 80 gr (7)]i�������	�	�	�	
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��3�4�5�L�M��������,�-�)�*����������ÿ�������w�g����T�g���$�jo5hc'�U^JmHnHuhc'�hc'�0J^JmHnHu$�j�4hc'�U^JmHnHuhc'�^JmHnHujhc'�U^JmHnHuhc'�hc'�^JmHnHujhSHyUhSHyh�h��h�Rh�{�mH	sH	h�Bh�Rh�y�h�y�Z�h�y�h�y�h�y�h�Bh�BmH	sH	h�RmH	sH	 ��]�K�=�l�}�#�4�K��#�&�������D���r�R�j�0�����9���������������������������������������$d��A$gd[]��P��_�)�\�p�x���������������M�T�g�q�t��������������������Ff�7$d��$�B�z&�#$/��A$Ifa$gd[]$d��$�B�z&�#$/��A$Ifgd[]$d��A$gd�i�$d��A$gd[]*�\�����������������
�����E�F�G�I�J�K�L�2�4�6�r�s�t�u����������������������������L�M�������������Ķĥ�Ķ�������ĶĔ�Ķ���������Ķ�x �jThc'�UmHnHu�j�Khc'�U �jUGhc'�UmHnHu �j&Chc'�UmHnHujhc'�UmHnHuhc'�mHnHu�j�:hc'�Ujhc'�Uhc'�h�h�Xh�5�\�h�h�X5�\�h�X/t�w�����������������������T�]�a�k�n�q�}�L���������������������Ff)I$d��$�B�z&�#$/��A$Ifgd[]Ff�D$d��$�B�z&�#$/��A$Ifa$gd[]M�N�P�Q�R�S�q�r��L4L6L8LVLXL�L�L�L�L�L�L�L�L�L�L�L�L\M�M�M�M�M�M*NPNvN�N�N�NOO�O�O�OP��������������ɾ���������ک��������y������rh�hh�`�h�hmH	sH	h�hh�hmH	sH	h�hh�hh�`�h�hh�f�h�h5�\�h�Xh�f� �j�`hc'�UmHnHu�j7Xhc'�Uhc'�Uh�h�XOJQJh�h�Xjhc'�Uhc'�mHnHujhc'�UmHnHu,e"36  weeksKordi M (2017)  ADDIN EN.CITE  ADDIN EN.CITE.DATA ( HYPERLINK \l "_ENREF_15" \o "Kordi, 2017 #238" 15)IranRCT2013919170-75 gr (6-7)37-38  weeks

RCT   randomized controlled trialFigure legends:
Figure 1. The effect of date fruit consumption on cervical dilatation at admission, need for labor induction/augmentation and rate of cesarean deliveries
Figure 2. The effect of date fruit consumption on the duration of various labor stages. 
Supplementary Figure 1. PRISMA flow diagram.
Supplementary Figure 2. Risk of bias summary.

LL�LMMMM"M@MZM\M^M`M�M�N�OP`PbP������������������$d��A$gd[]Ff�b$d��$�B�z&�#$/��A$Ifa$gd[]$d��$�B�z&�#$/��A$Ifgd[]Ff�UPP P.P0P4P`PbP�������h�/h�/hZthZth�hh�`�h�hh�`�Z�81�h:p�3:��. ��A!�"�#��$��%�������(2*2sD���y������K�	_ENREF_1	D<EndNote><Cite><Author>Kennedy</Author><Year>2013</Year><RecNum>240</RecNum><DisplayText>(2)</DisplayText><record><rec-number>240</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">240</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kennedy, D. A.</author><author>Lupattelli, A.</author><author>Koren, G.</author><author>Nordeng, H.</author></authors></contributors><auth-address>The Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, M5G 1X8 Ontario, Canada. deborah.kennedy@sickkids.ca.</auth-address><titles><title>Herbal medicine use in pregnancy: results of a multinational study</title><secondary-title>BMC Complement Altern Med</secondary-title><alt-title>BMC complementary and alternative medicine</alt-title></titles><periodical><full-title>BMC Complement Altern Med</full-title><abbr-1>BMC complementary and alternative medicine</abbr-1></periodical><alt-periodical><full-title>BMC Complement Altern Med</full-title><abbr-1>BMC complementary and alternative medicine</abbr-1></alt-periodical><pages>355</pages><volume>13</volume><edition>2013/12/18</edition><keywords><keyword>Adult</keyword><keyword>Complementary Therapies/*methods/*statistics &amp; numerical data</keyword><keyword>Cross-Sectional Studies</keyword><keyword>Female</keyword><keyword>Fruit/chemistry</keyword><keyword>Humans</keyword><keyword>Internationality</keyword><keyword>Internet</keyword><keyword>Plant Extracts/*therapeutic use</keyword><keyword>Plants/chemistry</keyword><keyword>Pregnancy</keyword><keyword>Pregnancy Complications/*drug therapy</keyword></keywords><dates><year>2013</year><pub-dates><date>Dec 12</date></pub-dates></dates><isbn>1472-6882 (Electronic)&#xD;1472-6882 (Linking)</isbn><accession-num>24330413</accession-num><work-type>Multicenter Study&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/24330413</url></related-urls></urls><custom2>4029224</custom2><electronic-resource-num>10.1186/1472-6882-13-355</electronic-resource-num><language>eng</language></record></Cite></EndNote>sD���y������K�	_ENREF_2sD���y������K�	_ENREF_3*
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_ENREF_11�D<EndNote><Cite><Author>Al-Kuran</Author><Year>2011</Year><RecNum>221</RecNum><DisplayText>(12-15)</DisplayText><record><rec-number>221</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">221</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Al-Kuran, O.</author><author>Al-Mehaisen, L.</author><author>Bawadi, H.</author><author>Beitawi, S.</author><author>Amarin, Z.</author></authors></contributors><auth-address>Jordan University of Science and Technology, Irbid, Jordan. oqba@yahoo.com</auth-address><titles><title>The effect of late pregnancy consumption of date fruit on labour and delivery</title><secondary-title>J Obstet Gynaecol</secondary-title><alt-title>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</alt-title></titles><periodical><full-title>J Obstet Gynaecol</full-title><abbr-1>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</abbr-1></periodical><alt-periodical><full-title>J Obstet Gynaecol</full-title><abbr-1>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</abbr-1></alt-periodical><pages>29-31</pages><volume>31</volume><number>1</number><edition>2011/02/02</edition><keywords><keyword>Adult</keyword><keyword>Amnion</keyword><keyword>*Arecaceae</keyword><keyword>Feeding Behavior</keyword><keyword>Female</keyword><keyword>*Fruit</keyword><keyword>Gestational Age</keyword><keyword>Humans</keyword><keyword>*Labor Stage, First</keyword><keyword>Pregnancy</keyword><keyword>*Pregnancy Trimester, Third</keyword><keyword>*Prenatal Nutritional Physiological Phenomena</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>2011</year></dates><isbn>1364-6893 (Electronic)&#xD;0144-3615 (Linking)</isbn><accession-num>21280989</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/21280989</url></related-urls></urls><electronic-resource-num>10.3109/01443615.2010.522267</electronic-resource-num><language>eng</language></record></Cite><Cite><Author>Kordi M</Author><Year>2014</Year><RecNum>236</RecNum><record><rec-number>236</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">236</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kordi M, Aghaei Meybodi F, Tara F, Nemati M, Shakeri MT.</author></authors></contributors><titles><title>The Effect of Late-Pregnancy Consumption of Date Fruit on Cervical Ripening in Nulliparous Women.</title><secondary-title>Journal of Midwifery and Reproductive Health.</secondary-title></titles><periodical><full-title>Journal of Midwifery and Reproductive Health.</full-title></periodical><pages>150-156</pages><volume>2</volume><number>3</number><dates><year>2014</year></dates><urls></urls></record></Cite><Cite><Author>Razali</Author><Year>2017</Year><RecNum>237</RecNum><record><rec-number>237</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">237</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Razali, N.</author><author>Mohd Nahwari, S. H.</author><author>Sulaiman, S.</author><author>Hassan, J.</author></authors></contributors><auth-address>a Department of Obstetrics and Gynaecology , University Malaya , Kuala Lumpur , Malaysia.&#xD;b Department of Obstetrics and Gynaecology, Faculty of Medicine , University Malaya , Kuala Lumpur , Malaysia.</auth-address><titles><title>Date fruit consumption at term: Effect on length of gestation, labour and delivery</title><secondary-title>J Obstet Gynaecol</secondary-title><alt-title>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</alt-title></titles><periodical><full-title>J Obstet Gynaecol</full-title><abbr-1>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</abbr-1></periodical><alt-periodical><full-title>J Obstet Gynaecol</full-title><abbr-1>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</abbr-1></alt-periodical><pages>595-600</pages><volume>37</volume><number>5</number><edition>2017/03/14</edition><keywords><keyword>Adult</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Labor, Induced/*utilization</keyword><keyword>*Labor, Obstetric</keyword><keyword>*Phoeniceae</keyword><keyword>Pregnancy</keyword></keywords><dates><year>2017</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1364-6893 (Electronic)&#xD;0144-3615 (Linking)</isbn><accession-num>28286995</accession-num><work-type>Randomized Controlled Trial</work-type><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/28286995</url></related-urls></urls><electronic-resource-num>10.1080/01443615.2017.1283304</electronic-resource-num><language>eng</language></record></Cite><Cite><Author>Kordi</Author><Year>2017</Year><RecNum>238</RecNum><record><rec-number>238</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">238</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kordi, M.</author><author>Meybodi, F. A.</author><author>Tara, F.</author><author>Fakari, F. R.</author><author>Nemati, M.</author><author>Shakeri, M.</author></authors></contributors><auth-address>Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.&#xD;Center for Women&apos;s Health Research, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.&#xD;Students Research Committee, Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.&#xD;Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.&#xD;Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.</auth-address><titles><title>Effect of Dates in Late Pregnancy on the Duration of Labor in Nulliparous Women</title><secondary-title>Iran J Nurs Midwifery Res</secondary-title><alt-title>Iranian journal of nursing and midwifery research</alt-title></titles><periodical><full-title>Iran J Nurs Midwifery Res</full-title><abbr-1>Iranian journal of nursing and midwifery research</abbr-1></periodical><alt-periodical><full-title>Iran J Nurs Midwifery Res</full-title><abbr-1>Iranian journal of nursing and midwifery research</abbr-1></alt-periodical><pages>383-387</pages><volume>22</volume><number>5</number><edition>2017/10/17</edition><dates><year>2017</year><pub-dates><date>Sep-Oct</date></pub-dates></dates><isbn>1735-9066 (Print)&#xD;1735-9066 (Linking)</isbn><accession-num>29033994</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/29033994</url></related-urls></urls><custom2>5637148</custom2><electronic-resource-num>10.4103/ijnmr.IJNMR_213_15</electronic-resource-num><language>eng</language></record></Cite></EndNote>uD���y������K�
_ENREF_12�D<EndNote><Cite><Author>Kordi M</Author><Year>2014</Year><RecNum>236</RecNum><DisplayText>(13, 15)</DisplayText><record><rec-number>236</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">236</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kordi M, Aghaei Meybodi F, Tara F, Nemati M, Shakeri MT.</author></authors></contributors><titles><title>The Effect of Late-Pregnancy Consumption of Date Fruit on Cervical Ripening in Nulliparous Women.</title><secondary-title>Journal of Midwifery and Reproductive Health.</secondary-title></titles><periodical><full-title>Journal of Midwifery and Reproductive Health.</full-title></periodical><pages>150-156</pages><volume>2</volume><number>3</number><dates><year>2014</year></dates><urls></urls></record></Cite><Cite><Author>Kordi</Author><Year>2017</Year><RecNum>238</RecNum><record><rec-number>238</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">238</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kordi, M.</author><author>Meybodi, F. A.</author><author>Tara, F.</author><author>Fakari, F. R.</author><author>Nemati, M.</author><author>Shakeri, M.</author></authors></contributors><auth-address>Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.&#xD;Center for Women&apos;s Health Research, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.&#xD;Students Research Committee, Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.&#xD;Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.&#xD;Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.</auth-address><titles><title>Effect of Dates in Late Pregnancy on the Duration of Labor in Nulliparous Women</title><secondary-title>Iran J Nurs Midwifery Res</secondary-title><alt-title>Iranian journal of nursing and midwifery research</alt-title></titles><periodical><full-title>Iran J Nurs Midwifery Res</full-title><abbr-1>Iranian journal of nursing and midwifery research</abbr-1></periodical><alt-periodical><full-title>Iran J Nurs Midwifery Res</full-title><abbr-1>Iranian journal of nursing and midwifery research</abbr-1></alt-periodical><pages>383-387</pages><volume>22</volume><number>5</number><edition>2017/10/17</edition><dates><year>2017</year><pub-dates><date>Sep-Oct</date></pub-dates></dates><isbn>1735-9066 (Print)&#xD;1735-9066 (Linking)</isbn><accession-num>29033994</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/29033994</url></related-urls></urls><custom2>5637148</custom2><electronic-resource-num>10.4103/ijnmr.IJNMR_213_15</electronic-resource-num><language>eng</language></record></Cite></EndNote>uD���y������K�
_ENREF_13uD���y������K�
_ENREF_15�D<EndNote><Cite><Author>Al-Kuran</Author><Year>2011</Year><RecNum>221</RecNum><DisplayText>(12)</DisplayText><record><rec-number>221</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">221</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Al-Kuran, O.</author><author>Al-Mehaisen, L.</author><author>Bawadi, H.</author><author>Beitawi, S.</author><author>Amarin, Z.</author></authors></contributors><auth-address>Jordan University of Science and Technology, Irbid, Jordan. oqba@yahoo.com</auth-address><titles><title>The effect of late pregnancy consumption of date fruit on labour and delivery</title><secondary-title>J Obstet Gynaecol</secondary-title><alt-title>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</alt-title></titles><periodical><full-title>J Obstet Gynaecol</full-title><abbr-1>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</abbr-1></periodical><alt-periodical><full-title>J Obstet Gynaecol</full-title><abbr-1>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</abbr-1></alt-periodical><pages>29-31</pages><volume>31</volume><number>1</number><edition>2011/02/02</edition><keywords><keyword>Adult</keyword><keyword>Amnion</keyword><keyword>*Arecaceae</keyword><keyword>Feeding Behavior</keyword><keyword>Female</keyword><keyword>*Fruit</keyword><keyword>Gestational Age</keyword><keyword>Humans</keyword><keyword>*Labor Stage, First</keyword><keyword>Pregnancy</keyword><keyword>*Pregnancy Trimester, Third</keyword><keyword>*Prenatal Nutritional Physiological Phenomena</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>2011</year></dates><isbn>1364-6893 (Electronic)&#xD;0144-3615 (Linking)</isbn><accession-num>21280989</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/21280989</url></related-urls></urls><electronic-resource-num>10.3109/01443615.2010.522267</electronic-resource-num><language>eng</language></record></Cite></EndNote>uD���y������K�
_ENREF_12�D<EndNote><Cite><Author>Kordi M</Author><Year>2014</Year><RecNum>236</RecNum><DisplayText>(13, 15)</DisplayText><record><rec-number>236</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">236</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kordi M, Aghaei Meybodi F, Tara F, Nemati M, Shakeri MT.</author></authors></contributors><titles><title>The Effect of Late-Pregnancy Consumption of Date Fruit on Cervical Ripening in Nulliparous Women.</title><secondary-title>Journal of Midwifery and Reproductive Health.</secondary-title></titles><periodical><full-title>Journal of Midwifery and Reproductive Health.</full-title></periodical><pages>150-156</pages><volume>2</volume><number>3</number><dates><year>2014</year></dates><urls></urls></record></Cite><Cite><Author>Kordi</Author><Year>2017</Year><RecNum>238</RecNum><record><rec-number>238</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">238</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kordi, M.</author><author>Meybodi, F. A.</author><author>Tara, F.</author><author>Fakari, F. R.</author><author>Nemati, M.</author><author>Shakeri, M.</author></authors></contributors><auth-address>Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.&#xD;Center for Women&apos;s Health Research, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.&#xD;Students Research Committee, Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.&#xD;Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.&#xD;Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.</auth-address><titles><title>Effect of Dates in Late Pregnancy on the Duration of Labor in Nulliparous Women</title><secondary-title>Iran J Nurs Midwifery Res</secondary-title><alt-title>Iranian journal of nursing and midwifery research</alt-title></titles><periodical><full-title>Iran J Nurs Midwifery Res</full-title><abbr-1>Iranian journal of nursing and midwifery research</abbr-1></periodical><alt-periodical><full-title>Iran J Nurs Midwifery Res</full-title><abbr-1>Iranian journal of nursing and midwifery research</abbr-1></alt-periodical><pages>383-387</pages><volume>22</volume><number>5</number><edition>2017/10/17</edition><dates><year>2017</year><pub-dates><date>Sep-Oct</date></pub-dates></dates><isbn>1735-9066 (Print)&#xD;1735-9066 (Linking)</isbn><accession-num>29033994</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/29033994</url></related-urls></urls><custom2>5637148</custom2><electronic-resource-num>10.4103/ijnmr.IJNMR_213_15</electronic-resource-num><language>eng</language></record></Cite></EndNote>uD���y������K�
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_ENREF_15�D<EndNote><Cite><Author>Al-Kuran</Author><Year>2011</Year><RecNum>221</RecNum><DisplayText>(12, 14)</DisplayText><record><rec-number>221</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">221</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Al-Kuran, O.</author><author>Al-Mehaisen, L.</author><author>Bawadi, H.</author><author>Beitawi, S.</author><author>Amarin, Z.</author></authors></contributors><auth-address>Jordan University of Science and Technology, Irbid, Jordan. oqba@yahoo.com</auth-address><titles><title>The effect of late pregnancy consumption of date fruit on labour and delivery</title><secondary-title>J Obstet Gynaecol</secondary-title><alt-title>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</alt-title></titles><periodical><full-title>J Obstet Gynaecol</full-title><abbr-1>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</abbr-1></periodical><alt-periodical><full-title>J Obstet Gynaecol</full-title><abbr-1>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</abbr-1></alt-periodical><pages>29-31</pages><volume>31</volume><number>1</number><edition>2011/02/02</edition><keywords><keyword>Adult</keyword><keyword>Amnion</keyword><keyword>*Arecaceae</keyword><keyword>Feeding Behavior</keyword><keyword>Female</keyword><keyword>*Fruit</keyword><keyword>Gestational Age</keyword><keyword>Humans</keyword><keyword>*Labor Stage, First</keyword><keyword>Pregnancy</keyword><keyword>*Pregnancy Trimester, Third</keyword><keyword>*Prenatal Nutritional Physiological Phenomena</keyword><keyword>Prospective Studies</keyword></keywords><dates><year>2011</year></dates><isbn>1364-6893 (Electronic)&#xD;0144-3615 (Linking)</isbn><accession-num>21280989</accession-num><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/21280989</url></related-urls></urls><electronic-resource-num>10.3109/01443615.2010.522267</electronic-resource-num><language>eng</language></record></Cite><Cite><Author>Razali</Author><Year>2017</Year><RecNum>237</RecNum><record><rec-number>237</rec-number><foreign-keys><key app="EN" db-id="wad9t0fe2wvrxjeafz7pdp54fafe0pvx25st">237</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Razali, N.</author><author>Mohd Nahwari, S. H.</author><author>Sulaiman, S.</author><author>Hassan, J.</author></authors></contributors><auth-address>a Department of Obstetrics and Gynaecology , University Malaya , Kuala Lumpur , Malaysia.&#xD;b Department of Obstetrics and Gynaecology, Faculty of Medicine , University Malaya , Kuala Lumpur , Malaysia.</auth-address><titles><title>Date fruit consumption at term: Effect on length of gestation, labour and delivery</title><secondary-title>J Obstet Gynaecol</secondary-title><alt-title>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</alt-title></titles><periodical><full-title>J Obstet Gynaecol</full-title><abbr-1>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</abbr-1></periodical><alt-periodical><full-title>J Obstet Gynaecol</full-title><abbr-1>Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology</abbr-1></alt-periodical><pages>595-600</pages><volume>37</volume><number>5</number><edition>2017/03/14</edition><keywords><keyword>Adult</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Labor, Induced/*utilization</keyword><keyword>*Labor, Obstetric</keyword><keyword>*Phoeniceae</keyword><keyword>Pregnancy</keyword></keywords><dates><year>2017</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1364-6893 (Electronic)&#xD;0144-3615 (Linking)</isbn><accession-num>28286995</accession-num><work-type>Randomized Controlled Trial</work-type><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/28286995</url></related-urls></urls><electronic-resource-num>10.1080/01443615.2017.1283304</electronic-resource-num><language>eng</language></record></Cite></EndNote>uD���y������K�
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Electronic address: josianne.pare@usherbrooke.ca.&#xD;Division of Obstetrics and Gynecology, Universite de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.</auth-address><titles><title>Reduction of total labor length through the addition of parenteral dextrose solution in induction of labor in nulliparous: results of DEXTRONS prospective randomized controlled trial</title><secondary-title>Am J Obstet Gynecol</secondary-title><alt-title>American journal of obstetrics and gynecology</alt-title></titles><periodical><full-title>Am J Obstet Gynecol</full-title><abbr-1>American journal of obstetrics and gynecology</abbr-1></periodical><alt-periodical><full-title>Am J Obstet Gynecol</full-title><abbr-1>American journal of obstetrics and gynecology</abbr-1></alt-periodical><pages>508 e1-508 e7</pages><volume>216</volume><number>5</number><edition>2017/02/06</edition><keywords><keyword>Apgar Score</keyword><keyword>Delivery, Obstetric</keyword><keyword>Double-Blind Method</keyword><keyword>Female</keyword><keyword>Fetal Blood/chemistry</keyword><keyword>Glucose/*administration &amp; dosage</keyword><keyword>Humans</keyword><keyword>Hydrogen-Ion Concentration</keyword><keyword>Infusions, Intravenous</keyword><keyword>*Labor, Induced</keyword><keyword>*Labor, Obstetric</keyword><keyword>Oxytocics/administration &amp; dosage</keyword><keyword>Oxytocin/administration &amp; dosage</keyword><keyword>Parity</keyword><keyword>Pregnancy</keyword><keyword>Prospective Studies</keyword><keyword>Sweetening Agents/*administration &amp; dosage</keyword><keyword>Time Factors</keyword></keywords><dates><year>2017</year><pub-dates><date>May</date></pub-dates></dates><isbn>1097-6868 (Electronic)&#xD;0002-9378 (Linking)</isbn><accession-num>28153654</accession-num><work-type>Randomized Controlled Trial&#xD;Research Support, Non-U.S. Gov&apos;t</work-type><urls><related-urls><url>http://www.ncbi.nlm.nih.gov/pubmed/28153654</url></related-urls></urls><electronic-resource-num>10.1016/j.ajog.2017.01.010</electronic-resource-num><language>eng</language></record></Cite></EndNote>uD���y������K�
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