Pregnant Japanese Women Research Articles

Impact of vaccination policy on changes in rubella virus antibody in Japanese pregnant women

AimAs a result of the 2012–2013 rubella epidemics in Japan, many cases of congenital rubella syndrome have been reported. Given the frequent changes to rubella vaccination policy in Japan, we investigated antibody prevalence among pregnant women according to birth year.Subjects and methodsParticipants comprised 55,400 pregnant Japanese women for whom rubella-specific hemagglutination inhibition antibody had been measured during early pregnancy in our institute from 1987 to 2016. Birth year was considered for the 47,978 cases for which age was known.ResultsThe ratio of rubella antibody-negative cases among pregnant women born after 1962 decreased significantly with mandatory vaccination. In the transition phase, during which the administration target was changed from schoolgirls to children of both sexes (born 1979–1987) as temporary vaccination, the ratio of rubella antibody-negative pregnant women started increasing in the latter period of this phase. For generations born in or after 1988, the ratio of rubella antibody-negative pregnant women clearly increased when the vaccination target changed to non-mandatory vaccination of children of both sexes.ConclusionsPrevalence of antibody titers depends on vaccine coverage rates. Suitable information needs to be provided prior to conception to all women, their husbands, and family members.

Concentration of folic acid (FA) in serum of Japanese pregnant women.

Objectives Exposure to inorganic arsenic (iAs) is a world-wide health concern. We reported that Japanese children and pregnant women are exposed to moderate levels of iAs through food. Reducing iAs contamination from foods of high iAs is an important issue unique in Japan. Integrated iAs is methylated to less toxic organic forms, and S-adenosyl-L-methyonine (SAM), a common methyl-donor of DNA and histones, is utilized in this process. Chronic consumption of SAM by iAs metabolism due to exposure to iAs might alter the epigenetic modification of genome. The SAM biosynthesis pathway is dependent on folate cycle, and it is possible that ingestion of sufficient folic acid (FA) is protective to iAs induced toxicity. Methods In the course of our cross-sectional body burden analyses of Pb and iAs in Japanese children and pregnant women, termed "PbAs study", FA concentration in serum of 104 pregnant women was measured. Results Mean (±SEM) of serum FA concentration was 15.8 ± 1.3 (ng/mL). There are significant number of people showing very high FA (>30 ng/ mL), and large fraction of them were taking supplements daily. Conclusions These results suggested that level of FA ingestion of Japanese pregnant women is high for supporting normal fetal development.

Association of Dietary Change during Pregnancy with Large-for-Gestational Age Births: A Prospective Observational Study.

Being born with large birthweight is considered as a risk of non-communicable diseases later in life. However, it is not fully understood what kind of maternal dietary intake during pregnancy affect large birthweight. Therefore, we examined the association of dietary intakes and its changes during pregnancy with large-for-gestational-age (LGA) births in Japanese pregnant women. In the prospective study, 245 pregnant women who visited Kyoto Medical Center were enrolled. Nutrition survey using brief-type self-administered diet history questionnaire (BDHQ) at all trimester was completed in 171 pregnant women. Based on birthweight and gestational age, participants were divided into three groups, such as small-for-gestational-age (<10th, SGA, n=17), appropriate-for-gestational-age (≥10th and <90th, AGA, n=144), and LGA (≥90th, n=10) groups. Compared with those without LGA births, mothers with LGA births showed: 1) greater weight gain during pregnancy (LGA: 14.0±3.2 kg, AGA: 9.9±3.9 kg, SGA: 8.4±3.1 kg, p<0.05); 2) higher energy intake throughout pregnancy (LGA: 310±368 kcal, AGA: 7±490 kcal, SGA: -97±293 kcal, ptrend<0.05); 3) larger changes in plant oil and sucrose consumptions from the 1st to 2nd trimester, probably due to the results of greater consumption of bread, Western confectionery, Japanese confectionery, and mayonnaise and dressing during the same period (ptrend<0.05, respectively). Our results suggest that higher energy intake throughout pregnancy, as well as greater consumption of plant oil and sucrose from the first to second trimester could be associated with LGA births.

Distribution of 5-Methyltetrahydrofolate and Folic Acid Levels in Maternal and Cord Blood Serum: Longitudinal Evaluation of Japanese Pregnant Women.

“Total” folate in blood has usually been measured to evaluate the folate status of pregnant women. However, folate is composed of many metabolites. The main substrate is 5-methyltetrahydrofolate (5-MTHF), with folic acid (FA) representing a very small component as an unmetabolized species in blood. We longitudinally evaluated 5-MTHF, FA and total homocysteine in maternal and cord blood from Japanese pregnant women. Subjects were 146 pregnant women who participated in the Chiba study of Mother and Child Health (C-MACH) prospective cohort study. Sera were obtained in early and late pregnancy, at delivery, and from cord blood. Species levels were measured by isotope-dilution mass spectrometry. Both 5-MTHF and FA levels were lower than reported levels from pregnant women in populations from countries with mandatory FA fortification. As gestational age progressed, serum 5-MTHF levels decreased, whereas serum FA levels were slightly reduced only at delivery compared to early pregnancy. A significant negative association between serum 5-MTHF and total homocysteine was shown at all examined times, but no associations with FA were evident. At delivery, cord 5-MTHF was significantly higher than maternal levels, while FA again showed no significant correlation. These results suggest that 5-MTHF is actively transported to the fetus through placental transporters and may reflect folate status during pregnancy as a physiologically important species.

0849 Association Of Sleep Disturbance With Neck Circumference, Body Mass Index & Blood Pressure In Pregnant Japanese Women

Abstract Introduction Snoring is one of the symptoms of sleep-disordered breathing. Sleep-disordered breathing is associated with blood pressure in pregnant women. However, studies reporting this association have been conducted overseas, and there is a lack of research in the Japanese context, where women have different lifestyles and physical attributes. The aim of this study is to clarify the association of sleep disturbance with physical factors in pregnant Japanese women. Methods A cross-sectional study was conducted with 80 pregnant Japanese women. The assessments for statistical analysis included the Japanese versions of the Pittsburgh Sleep Quality Index (J-PSQI) and Epworth Sleepiness Scale (JESS), as well as snoring frequency, blood pressure, and body mass index (BMI) before and during pregnancy. Results Participants’ average gestational age was 26.23±7.56 weeks, and the J-PSQI and JESS scores were 5.5±2.6 and 9.7±4.2, respectively. The average neck circumference was 33.4±2.6cm, and BMI before and during pregnancy was 21.0±2.9cm and 23.1±3.1cm, respectively. Among the participants, 42.5% displayed habitual snoring. These women had significantly higher BMI and weight before and during pregnancy than those who did not snore habitually. Participants with lower diastolic blood pressure and pre-pregnancy weight had significantly higher JESS scores. Participants with thick necks (neck circumference≥33.4cm) had significantly higher BMI and weight before and during pregnancy, as well as lower J-PSQI scores, than those with thin necks. Conclusion In pregnant Japanese women, neck circumference and BMI before and during pregnancy were lower than among pregnant women from other countries. However, Japanese women displayed a greater tendency toward snoring during pregnancy compared to women from other countries. Snoring was associated with obesity before and during pregnancy. However, the results suggest that thinness of physique prior to pregnancy is a risk factor for sleep disturbance during pregnancy. Support

0848 The Relationship Between Sleep Disturbance &amp; Sleep Hygiene In Japanese Pregnant Women

Abstract Introduction Pregnant women are more likely to develop sleep disorders due to poor sleep quality. Sleep hygiene has been reported as a method for dealing with sleep disorders. However, studies on the relationship between sleep hygiene and sleep disorders in Japanese pregnant women remain insufficient. This study aimed to clarify the actual state of sleep disorders during pregnancy and the relationship between sleep disorders and sleep hygiene. Methods A cross-sectional study was conducted on 147 Japanese pregnant women. We used the Japanese versions of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (JESS) for evaluation of sleep. We used 32 items of habitual behavior important for sleep improvement for evaluation of sleep hygiene; these items were self-selected. Results The average PSQIG scores of women in their first, second, and third trimesters were 5.6 ± 4.3, 5.4 ± 2.4, and 6.6 ± 2.8, respectively; 22.2%, 46.4%, and 62.2% of women in their first, second, and third trimesters, respectively, exceeded the cut-off score. The average JESS scores were 12.2 ± 4.5, 9.9 ± 4.1, and 10.0 ± 4.6 for first, second, and third trimester women, respectively; 55.6%, 35.7%, and 41.9% of first, second, and third trimester women, respectively, slept excessively during the day (JESS score≥11). Following factor analysis, sleep hygiene was categorized into four factors: ”thinking positively,” ”adding rhythm to the day,” “avoiding going out and caffeine before bedtime,” and “avoiding eye irritation.” Pregnant women who “added rhythm to their day” had lower PSQI scores, and sleep hygiene was not related to JESS scores in the multiple regression analysis of sleep hygiene and sleep disorders. Conclusion Sleep disorders in pregnancy are related to habitual behavior such as being active during the day, eating and sleeping regularly, and basking in the sunlight every morning. Support

Differences in fetal fractional limb volume changes in normal and gestational diabetic pregnancies: an exploratory observational study.

Fetal fractional limb volume has been proposed as a useful measure for quantifying fetal soft tissue development. The aim of this study was to investigate the growth of fractional arm volume (AVol) and fractional thigh volume (TVol) of fetuses with maternal gestational diabetes (GDM) compared with those of fetuses with normal glucose tolerance (NGT). We hypothesised fetal fractional limb volume would be larger in the GDM group than in the NGT group in late gestation. Exploratory observational study. Saitama Municipal Hospital. A total of 165 (125 NGT and 40 GDM) singleton Japanese pregnant women. AVol and TVol were assessed between 20 and 37weeks' gestation as cylindrical limb volumes based on 50% of the fetal humeral or femoral diaphysis length. Women were diagnosed as GDM based on the criteria of the Japan Society of Obstetrics and Gynecology. AVol and TVol were compared between women with NGT and those with GDM at each gestational age period (2-week intervals from 20 to 37weeks' gestation). Overall, 287 ultrasound scans were performed (NGT group, 205 scans; GDM group, 82 scans). There was no significant difference of AVol between the groups before 32weeks' gestation. AVol was significantly larger in the GDM group than in the NGT group after 32weeks' gestation (P<0.05). TVol was not statistically different between the groups across gestation. Detection of variations in fetal AVol may provide greater insight into understanding the origins of altered fetal body proportion in GDM. AVol, but not TVol, is significantly larger in fetuses with GDM than in those with NGT after 32weeks' gestation.

The periodontopathic bacteria in placenta, saliva and subgingival plaque of threatened preterm labor and preterm low birth weight cases: a longitudinal study in Japanese pregnant women.

This study determined the quantity of periodontopathic bacteria in saliva, subgingival plaque, and placenta on the threatened preterm labor (TPL) and preterm low birth weight (PLBW) subjects in order to identify specific periodontal pathogens with high association to adverse pregnancy outcomes. We used real-time PCR with TaqMan probe and ELISA to detect the amount of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, and Prevotella intermedia in subgingival plaque, saliva, and placenta tissue, in addition to serum IgG titers against these bacteria in 28 patients with TPL and 36 healthy pregnant women. Thirteen of 64 births delivered PLBW infants. All 6 periodontopathic bacteria were detected in the placenta samples. The amount of F. nucleatum and detection frequency of T. denticola in placental samples was significantly higher in the TPL group than in the healthy group. Meanwhile, the age, anti-P. gingival IgG in serum, amount of P. gingivalis and T. forsythia in plaque samples, detection frequency of P. intermedia in saliva, and percentage of pocket probing depth ≥ 5mm were higher in TPL-PLBW births than those in TPL-Healthy delivery (HD) group and/or in H-HD group. Ordinal logistic regression analysis revealed that the presence of F. nucleatum in placental tissues was significantly associated with TPL, while the maternal age was significantly associated with PLBW in TPL. Our findings suggested all 6 bacteria may access the placenta. The increased presence of F. nucleatum in placenta might be related to TPL, while advanced maternal age might be associated with PLBW in TPL. Periodontal therapy should be applied to reduce the deep periodontal pocket sites and the colonization of periodontal pathogens in high-risk population.

Maternal total energy, macronutrient and vitamin intakes during pregnancy associated with the offspring's birth size in the Japan Environment and Children's Study.

Maternal diet during pregnancy can influence fetal growth; however, the available evidence is controversial. We aimed to assess whether maternal diet of Japanese women in mid-pregnancy can affect their offspring's birth size via collection of questionnaire and medical record data. The studied sample was a large cohort of paired mothers and their singleton offspring (n 78 793) from fifteen areas all over Japan who participated in the Japan Environment and Children's Study. The mid-pregnancy intakes of total energy, macronutrients and vitamins were lower than the recommended intakes for pregnant Japanese women. Maternal total energy intake was positively associated with the offspring's birth weight; there was a 10-g mean difference in the offspring's birth weight of mothers in the lowest (3026 g) v. highest (3036 g) quartiles of energy intake. Carbohydrate intake was positively associated with the offspring's birth length (mean difference of 0·7 cm) and inversely associated with the ponderal index (mean difference of 0·8 g/cm3). Offspring of mothers in the highest v. lowest quartiles of total dietary fibre intake were on average 9 g heavier and had 0·3 cm longer birth length and 0·2 cm longer head circumference. The highest in reference to lowest intake quartile of vitamin C was associated with 13 g and 0·7 cm mean differences in the offspring's birth weight and length, respectively. Several other associations were evident for maternal intakes of vitamins and the offspring's birth size. In conclusion, maternal dietary intakes of energy, dietary fibre, carbohydrate and vitamins during pregnancy were associated with the offspring's birth size.

Left ventricular hypertrophy in Japanese pregnant women with chronic hypertension predicts blood pressure elevation during pregnancy

Left ventricular hypertrophy in Japanese pregnant women with chronic hypertension predicts blood pressure elevation during pregnancy

Characteristics of sleep/wake problems and delivery outcomes among pregnant Japanese women without gestational complications

BackgroundFrequently observed sleep/wake problems among pregnant women need comprehensive evaluation. This study was conducted to clarify the sleep/wake problems among pregnant women without gestational complications during the second and third trimester and the effects of sleep/wake problems on delivery outcomes.MethodsA total of 88 Japanese pregnant women participated in this study. In their second and third trimester, subjective sleep quality, insomnia severity, excessive daytime sleepiness (EDS), and restless legs syndrome/Willis-Ekbom disease (RLS/WED) were assessed using questionnaires; also, sleep disordered breathing (SDB) was screened using a pulse oximeter.ResultsFrom the second to the third trimester, an increasing tendency of sleep/wake problems was observed. During the third trimester, the percentages of women experiencing decreased subjective sleep quality, difficulty maintaining sleep (DMS), EDS, RLS/WED, and 3% oxygen desaturation index (ODI) values ≥5/h were 62.5, 45.5, 48.9, 9.1, and 29.5%, respectively. In a logistic regression analysis for EDS in the third trimester, the adjusted odds ratio (95% confidence interval) of total sleep duration < 6 h, moderate to severe DMS, and 3% ODI values ≥5/h were 3.25 (1.16–9.10), 4.74 (1.60–14.00), and 0.90 (0.28–2.89), respectively. Although short sleep durations, decreased subjective sleep quality, EDS, and SDB did not affect delivery outcomes or the infant’s condition, the percentage of women undergoing cesarean sections in the severe insomnia group was significantly higher (p = 0.008).ConclusionsSleep/wake problems were frequent during pregnancy, especially during the third trimester. EDS among pregnant women was associated with shorter sleep durations and DMS rather than SDB. The effect of factors related to insomnia on delivery outcomes should thus be considered a crucial problem among pregnant Japanese women without gestational complications in clinical practice.

Evaluating folic acid supplementation among Japanese pregnant women with dietary intake of folic acid lower than 480 µg per day: results from TMM BirThree Cohort Study

Objective In Japan, supplementation with 400 µg of folic acid per day is recommended for women who are planning to get pregnant to decrease the risk of their babies getting neural tube defects (NTD). However, the proportion of women who have taken folic acid supplements before conception is low among Japanese pregnant women. In addition, the dietary intake of folic acid has not yet reached the government recommended dietary intake levels (480 µg per day). This study aimed to clarify the prevalence and determinants of adequate folic acid supplements among Japanese pregnant women with dietary folic acid intake lower than 480 µg per day. Methods This cross-sectional study was a part of the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. We collected information on folic acid supplements before conception, sociological/lifestyle characteristics, and food consumption. The primary outcome was the use of folic acid supplements (adequate or inadequate, based on the timing of initiation of folic acid supplements). Multiple logistic regression analysis was used to examine the association between sociological/lifestyle characteristics and the adequate intake of folic acid supplements. Results Among the 11,562 pregnant women who took lower than 480 µg per day of folic acid from food, the prevalence of adequate users was 18.0%. Pregnant women who reported adequate use of folic acid supplements were more likely to be older and educated; and reported higher household income, and history of fertility treatment. Conversely, they were less likely to be ever or current smokers and multipara. Conclusion This study found that the prevalence of folic acid supplements use for the prevention of NTD among Japanese pregnant women was still low.

Infant car seat use in Japan after the antepartum distribution of an educational leaflet: A prospective, nonrandomized controlled trial with a questionnaire survey

Objective: To determine whether an antepartum educational leaflet distributed to parents before infant delivery affected the rate of infant car-seat (ICS) use 1 month after delivery, because to the best of our knowledge, only few reports have evaluated systematic attempts to improve the rate of always ICS use by mothers driving infantsMethods: A multicenter questionnaire survey targeting pregnant Japanese women seeking antenatal care at the outpatient clinics of eight hospitals was designed. Women enrolled during the first half of the study period did not receive leaflets describing ICS safety guidelines (control group). Women enrolled during the latter half of the study period received the leaflet between gestational week 35 and 37 (intervention group). All women were requested to anonymously respond to the questionnaires within 1 month postpartum. The rates of ICS use, position, and direction after delivery were compared between both groups.Results: Of the 3534 women who responded to the questionnaire survey (response rate, 81.9%), 1772 women (50.1%) were assigned to the intervention group and 1762 (49.9%) women to the control group. The rates of ICS attachments (86.8% vs. 82.4% in the intervention and control groups, respectively, p = 0.0003), always ICS use (80.5% vs. 76.2%, respectively, p = 0.0019), ICS placement on the rear seat (78.6% vs. 74.1%, respectively, p = 0.0020), and ICS placement in a rear-facing position (62.2% vs. 56.7%, respectively, p = 0.0008) were significantly higher in the intervention group than those in the control group. The motor vehicle accident (MVA) rates within 1 month postpartum were similar between the intervention and control groups (0.51% vs. 0.57%, respectively, p = 0.8229).Conclusions: Antepartum minimal intervention via the distribution of an educational leaflet recommending ICS safety guidelines was associated with increased rates of ICS attachments, always ICS use, and ICS placement on the rear seat and in rear-facing positions; however, it did not contribute to reduced MVA rates after delivery.

Pathophysiology of gestational diabetes mellitus in lean Japanese pregnant women in relation to insulin secretion or insulin resistance

To determine the pathophysiology of gestational diabetes (GDM) in lean Japanese pregnant women in relation to insulin secretion or insulin resistance. The 75-g oral glucose tolerance test (OGTT) was performed in case of positive results of universal screening of a 50-g glucose challenge test at 24-28weeks' gestation in Japanese pregnant women. These women were treated in our hospital between 2012 and 2016. Among these women, 30 with a body mass index of < 18.5kg/m2 were selected as lean subjects. Nine women were diagnosed with GDM (GDM group) and the remaining 21 had normal glucose tolerance (control group). For evaluating insulin secretion or resistance, the following parameters were compared between the two groups together with a family history of diabetes mellitus (DM) among first-degree relatives: (1) plasma glucose and immnunoreactive insulin (IRI) levels after glucose loading, (2) insulinogenic index (I.I), (3) homeostasis model assessment of β-cell function (HOMA-β), (4) homeostasis model assessment of insulin resistance (HOMA-IR), and (5) insulin sensitivity index (ISI) composite. The percentage of having a family history of DM was significantly higher in the GDM group (3/9, 33.3%) than in the control group (0/21, 0.0%, P < 0.001). Serum glucose levels at 30, 60, and 120min after glucose loading were significantly higher in the GDM group than in the control group (all P < 0.05). IRI levels at 60 and 120min were significantly higher in the GDM group than in the control group (both P < 0.05), and they showed persistent insulin secretion patterns. Values of the I.I. and ISI composite were significantly lower in the GDM group than in the control group (both P < 0.05), with no differences in HOMA-β, HOMA-IR and HbA1c levels between the groups. Lean Japanese pregnant women with GDM have impaired β-cell function, which is in part associated with hereditary traits.

Transcultural Reliability and Validity of the Japanese-Language Version of the Pelvic Girdle Questionnaire

ObjectiveThe purpose of this study was to validate a Japanese version of the Pelvic Girdle Questionnaire (PGQ) and to confirm that the Japanese version of the PGQ (PGQ-J) was as valid as the original version. MethodsThis study involves 2 phases: (1) a cross-cultural adaptation study and (2) a cross-sectional study. The English PGQ was translated referring to the cross-cultural adaptation study process. Forty healthy pregnant or postpartum Japanese women participated. Women with pelvic girdle pain (PGP) completed the PGQ-J and 5 other instruments. Internal consistency, construct validity, test–retest reliability, ceiling and floor effects, and discrimination validity of the PGQ-J were analyzed. ResultsThe PGQ-J showed high internal consistency with a Cronbach α of .968, and an interclass correlation coefficient of .79. The content validity showed a high positive correlation with the Oswestry Disability Index and Disability Rating Scale. ConclusionThe PGQ-J was reliable and valid with high internal consistency and content validity for assessing disability owing to PGP in Japanese pregnant and postpartum women. The PGQ-J is expected to facilitate research and clinical practice for PGP in Japan and contribute to the welfare of postpartum women.

Association between gut microbiota composition and glycoalbumin level during pregnancy in Japanese women: Pilot study from Chiba Study of Mother and Child Health.

Aims/IntroductionGut microbiota have various effects on human health. Some previous reports have shown that gut microbiota change during pregnancy and affect metabolism, but others have shown that microbiota do not change. Here, we examined the gut microbiota and glycoalbumin levels of 45 healthy Japanese women during pregnancy.Materials and MethodsWe carried out 16S rRNA gene sequencing analyses of maternal stool samples and compared the gut microbiota composition of samples from women in early and late pregnancy. We also examined the association between gut microbiota and maternal characteristics, including glycoalbumin.ResultsMicrobiota composition in early and late pregnancy did not differ, according to principal coordinate analysis of weighted and unweighted UniFrac distances. Shannon indices were not different between early and late pregnancy. The proportion of one phylum, TM7, significantly decreased in late pregnancy compared with early pregnancy, but the proportions of other major phyla did not change. The Shannon index of late pregnancy was negatively associated with pregestational body mass index and positively correlated with glycoalbumin level, with adjustment of covariates.ConclusionsWe concluded that Japanese women did not show obvious differences in gut microbiota during pregnancy, except for TM7, and that the diversity of gut microbiota might affect maternal metabolism. As this study had limited statistical power, further large‐scale studies are required.

Prenatal tobacco smoking is associated with postpartum depression in Japanese pregnant women: The japan environment and children's study

IntroductionPrevious studies in Western countries have examined the association between prenatal smoking and risk for Postpartum depression (PPD). However, evidence from Japan is lacking, despite the high prevalence of smoking among pregnant women. Therefore, we examined the association between prenatal smoking and PPD among pregnant Japanese women. MethodsWe analyzed data for up to 1 month after childbirth from the Japan Environment and Children's Study (JECS), a nationwide birth cohort study. Among the 103,070 pregnant women recruited, 80,872 eligible participants were included in the analysis. PPD was defined as a score of ≥9 on the Edinburgh Postnatal Depression Scale (EPDS). Prenatal smoking and length of smoking cessation among ex-smokers were obtained using self-administered questionnaires at second/third trimester. ResultsAmong 80,872 pregnant women, 9.0% reported PPD. Multivariable-adjusted odds ratios (OR) (95% confidence intervals) for PPD (reference: never smoked) were 1.24 (1.12–1.37) for women who quit smoking after becoming pregnant, and 1.38 (1.21–1.56) for those who smoked during pregnancy. Compared with women who had never smoked, those who quit smoking ≤5 years before childbirth had a higher occurrence of PPD, with a multivariable-adjusted OR of 1.10 (1.00–1.22). LimitationsQuestionnaire data was self-reported by participants, thus smoking status might be under-reported. ConclusionsWomen who smoked during pregnancy, quit smoking after becoming pregnant, and quit smoking ≤5 years before childbirth are more likely to experience PPD than those who had never smoked.

How to promote ‘discipline without tough love’ during pregnancy: a randomized controlled trial

Background: In Japan, the effect of education using the leaflet ‘Discipline Without Tough Love’ on mothers during caring for their infants have been reported. We examined the effect of this education on pregnant Japanese women. Methods: The present study was a prospective investigation of all Japanese women with singleton pregnancies who visited our hospital for a perinatal visit at 20-23 weeks’ gestation between November 2017 and March 2018 and gave birth at ≥ 37 weeks’ gestation at our hospital. We examined the maternal feelings (bonding situation) to babies of women who received the leaflet in comparison with that in women who did not receive it during the health check-up performed routinely at one month after delivery using the Japanese version of the Mother-to-Infant Bonding Scale. Results: There were no significant differences in maternal feelings for their babies between the two groups of women. Conclusions: We did not identify any effect of health consultations cased on ‘Discipline Without Tough Love’ during pregnancy on maternal feelings toward babies at one month after delivery. A further study to enlighten pregnant women about parenting without corporal punishment will be needed in Japan. Registration: Japan Registry of Clinical Trials 1030190112; registered on 5 October 2019.

Experience of Japanese pregnant women with cancer in decision-making regarding cancer treatment and obstetric care.

Women who are diagnosed with cancer during pregnancy must make difficult, life-changing decisions that affect their own life and that of their fetus. The psychological impact of distress and anxiety resulting from facing often conflicting choices can greatly influence survival in these women. We conducted this study to clarify the experience of pregnant women with cancer in decision-making and to consider the role of nurses in providing care to pregnant women with cancer during their decision-making. This qualitative study included post-partum Japanese women diagnosed with cancer who had made any treatment or pregnancy decisions. Data collection was conducted using semi-structured interviews and medical record review. Data were analyzed using qualitative content analysis and classified into subcategories, categories, themes, and phases. Participants comprised eight women with leukemia and cervical, breast, and digestive cancers. The decision-making experiences of these eight pregnant women with cancer were categorized into three phases: the interaction between the woman and her fetus, family members, and medical staff; confrontation with dilemma and uncertainty; and redefinition of the women's own decisions. The experience of Japanese pregnant women with cancer in decision-making has two aspects: verbal and nonverbal communication with their surroundings and reflection. The role of a nurse is to guarantee these women continuous communication channels and frank dialogue, to empower them in expressing their thoughts and informational needs to medical staff and family members.

Association of the maternal microbiome in Japanese pregnant women with the cumulative prevalence of dermatitis in early infancy: A pilot study from the Chiba study of Mother and Child Health birth cohort

BackgroundThe prenatal maternal microbiome, including the gut microbiota, has been suggested to influence the incidence of allergies in offspring. Moreover, epidermal barrier dysfunction in early infancy has been attributed to the development of subsequent allergies. We hypothesized that the prenatal microbiome may affect the gut microbiota, acting as an initial trigger to alter immune development in the foetus. The maternal microbial composition may be linked to the prevalence of dermatitis in early infancy (DEI) of the offspring, leading to subsequent allergic symptoms. MethodsThis study was conducted as part of the Chiba Study of Mother and Child Health (C-MACH) birth cohort that was initiated in 2013; 434 healthy pregnant women at < 13 weeks of gestation were recruited. DEI was assessed for up to 4 months after birth, and allergic symptoms were determined in 10-month-old infants using questionnaires. Other information related to the maternal microbiome was obtained from questionnaires filled out during pregnancy. Stool samples were collected from pregnant women at 12 (n = 59) and 32 weeks (n = 58) of gestation, which were used for gut microbiota analysis using barcoded 16S rRNA gene sequencing. ResultsSymptoms of allergy, especially of inherited allergies, show a higher prevalence at 10 months after birth in the DEI group. DEI occurrence was negatively correlated with family size and cat ownership. The diversity of Proteobacteria at 12 weeks of gestation and the relative abundance of Actinobacteria at 32 weeks of gestation in maternal feces were lower at both time points of gestation in the DEI group. In addition, the diversity of Proteobacteria in prenatal feces was negatively correlated with family size at 12 weeks, and with dog ownership at both gestational time points. ConclusionsThe composition of the maternal microbiome may influence the risk of allergies in offspring, even before birth. Furthermore, the diversity of Proteobacteria and the relative abundance of Actinobacteria in maternal feces were negatively associated with DEI, which may be associated with the risk of allergy development in infancy. This early trigger may be a good predictor of allergy development during infancy and childhood.