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Background: The feeding behavior of newborns is influenced by the conditions of both the mother and newborn before and after birth. Aims: This study aimed to investigate the factors associated with newborn feeding behavior, focusing on skin-to-skin contact (SSC) as a promoting factor and epidural analgesia as an inhibiting factor, using the Japanese version of the Infant Breastfeeding Assessment Tool (IBFAT). Study Design: Prospective observational study conducted in Japan. Participants: A total of 176 pairs of healthy mothers and their healthy full-term newborns. Outcome Measures: The primary outcome was newborn feeding behaviors measured using the Japanese version of IBFAT within about one day of birth. Stepwise multiple regression analysis was performed to explore the relationship between IBFAT scores and variables that might influence newborn feeding behavior. Results: Multiple regression analysis revealed that lower IBFAT scores were associated with a higher dose of epidural fentanyl (β = −0.40), and higher IBFAT scores were associated with a longer duration of SSC (β = 0.26), even after adjusting for gestational weeks and Apgar scores. The dose and duration of synthetic oxytocin administration were not associated with IBFAT scores in the multivariate analysis. Conclusions: Our study showed a dose-dependent relationship between fentanyl and SSC, suggesting that consistently implementing SSC for the maximum duration possible may enhance newborn feeding behaviors, which are reduced by fentanyl administration.

Perinatal cohort studies with a prospective longitudinal design are critical for determining the effects of early-life exposures on offspring’s health outcomes. The Sri Lanka Mother and Newborn Growth cohort study aims to investigate the impact of maternal nutritional and psychosocial factors on newborns’ birth weight in the Sri Lankan context. This paper presents the methodology of participant recruitment, follow-ups, an overview of measurements, and planned data analyses. This study included a nationally representative sample of Sri Lankan pregnant women recruited in their first trimester of pregnancy. Follow-up assessments were conducted once during the second and third trimesters of pregnancy and after the baby’s birth, prospectively tracking the women’s dietary intake, mental health, hemoglobin concentrations, and gestational weight gain data. Once the participants delivered their babies, the data on gestational age, sex of the newborn, birth weight, length and occipitofrontal circumference at birth, and mode of delivery were collected. Between August 2022 and August 2023, we recruited 2000 first-trimester pregnant women to the cohort and continued to follow up with them until the baby’s birth. The response rates were 90.4%, 81.4%, and 75.2% in the first, second, and third follow-ups. We plan to analyze the data in July 2024. We expect this study to provide valuable insights into various early-life exposures affecting neonatal birth weight. The study’s findings will serve as a valuable information resource for a broader scientific community, enabling the development of effective policies to prevent low-birth-weight deliveries in low-resource settings.

Background: Low dietary nutrient intake may be associated with depressive symptoms. However, few such studies have been conducted among postpartum women and results have been controversial. Purpose: To investigate the association between dietary nutrient intake and depressive symptoms among Japanese one-month postpartum women. Methods: This cross-sectional study was conducted at a university hospital in Tokyo from June 2015 to September 2016. We recruited healthy women with healthy babies at their postpartum check-up. Dietary nutrient intake was assessed using a validated, brief-type, self-administered diet history questionnaire. Depressive symptoms were defined as a score of ? 9 on the Edinburgh Postnatal Depression Scale. Multiple logistic regression analysis was performed to identify if dietary nutrient intake was associated with depressive symptoms. Variables with P-values < 0.10 in the bivariate analysis and factors identified as important, based on the literature review, were included. P < 0.05 was considered significant. Results: Data from 246 participants were analyzed. Depressive symptom prevalence was 19.5%. Participants with an educational level above university level comprised 69.1%, and 68.3% of participants had a household income of ? 7 million Japanese yen. In the multivariate analysis, dietary nutrient intake was not significantly associated with depressive symptoms. However, higher educational level and need for emotional support as assessed by midwives or nurses were significantly associated with an increased risk of depressive symptoms. Conclusion: Dietary nutrient intake was not significantly associated with depressive symptoms in this high socioeconomic status population. Further research is needed to identify the relationship between dietary intake and depressive symptoms among more socioeconomically diverse postpartum women. Additionally, it may be important for postpartum depression support systems to pay attention to highly-educated women and to undertake continued follow-up for women who are assessed by midwives or nurses as needing emotional support either during pregnancy or while in the hospital.

Abstract This cross-sectional study aimed to estimate the daily salt intake of medical professionals working in public health facilities in Darkhan-Uul Province, Mongolia. We conducted a multiple logistic regression analysis to identify factors associated with their consumption of salt exceeding the recommended daily salt intake (≥ 5 g/day). A self-administered questionnaire and 24-h urine samples were used to obtain data on the participants’ salt intake. Of 338 participants, 159 completed the 24-h urine collection. The mean sodium excretion into urine was 122.3 mmol/day, which was equivalent to a mean salt intake of 7.7 g/day when the urinary excretion rate was considered as 93%. Body mass index was positively correlated with excess salt intake (adjusted odds ratio [AOR]: 1.27; 95% confidence interval [CI] 1.10–1.46), while age was negatively correlated with excess salt intake (AOR: 0.95; 95% CI 0.91–1.00). Participants who consumed ≥ 2 cups of salted suutei tsai (Mongolian milk tea) daily had a higher risk of consuming ≥ 5 g/day of salt than those who consumed ≤ 1 cup/day. The average estimated salt intake of the participants was higher than the recommended value. Medical professionals should be aware of factors associated with excessive salt consumption and make appropriate adjustments to minimize it.

Abstract Infantile skin problems not only cause temporary pain and discomfort, but also have a long-term impact on health. Hence, the purpose of this cross-sectional study was to clarify the relationship between inflammatory cytokines and Malassezia fungal facial skin problems in infants. Ninety-six 1-month-old infants were examined. Facial skin problems and the presence of inflammatory cytokines in the forehead skin were assessed using the infant facial skin visual assessment tool (IFSAT) and the skin blotting method, respectively. Malassezia, a fungal commensal, was detected using forehead skin swabs, and its percentage in the total fungal population was analyzed. Infants with positive interleukin-8 signals were more likely to have severe facial skin problems (p = 0.006) and forehead papules (p = 0.043). No significant association between IFSAT scores and Malassezia was found, but infants with forehead dryness had a lower percentage of M. arunalokei in the total fungal population (p = 0.006). No significant association was observed between inflammatory cytokines and Malassezia in the study participants. Longitudinal studies on the development of facial skin problems in infants are warranted to investigate the involvement of interleukin-8 and devise preventive strategies in the future.

Abstract Background Severe infant eczema on the face should be treated early because it may lead to allergic diseases in the future. However, caregivers find it difficult to assess. A visual tool for caregivers is needed to easily determine infants’ facial skin condition severity based on the tool’s scores. We developed an infant facial skin assessment tool (IFSAT) and evaluated its reliability and validity. Methods The IFSAT draft was developed based on results of a previous literature review and qualitative sketch. Panels including medical professionals and a caregiver checked the draft’s content and face validity, and the IFSAT was finalized. To test the IFSAT’s reliability and validity, caregivers and one-month-old infants were recruited. Two scoring methods were additionally created based on the relation between the items and cure period. The relationships between scores and cure period, and the ability to predict whether the infant needed medical treatment were examined by each scoring method. For the predictive validity, scores for infants requiring medical treatment and those for infants who did not were also compared. For the intra-examiner reliability analysis, two pediatricians rated the scores separately twice using photographs. Inter-rater reliabilities were analyzed among pediatricians, nurses, and caregivers. Results Altogether, 113 infant-caregiver pairs participated in the testing phase. Of the two scoring methods created (versions 1 and 2), pediatricians’ and caregivers’ scores using versions 1 and 2 were related to the cure period. These scores predict whether the infant needed medical treatment. We then selected version 2 based on the medical professionals’ opinions. The scores of caregivers of infants requiring medical treatment were higher than those of caregivers of infants not requiring treatment (p

Tokophobia is regarded as the intensive fear of childbirth that some pregnant women have. However, little is known about the psychopathological details of tokophobia (fear of childbirth). Between 2020 and 2021, a total of 10 pregnant women (nine nulliparae and one multipara) with a strong fear of childbirth were referred by obstetricians. Semi-structured psychopathological interviews were conducted, and two cases were judged to have obsession, three an overvalued idea, and one secondary delusion. Three were characterised by both obsession and overvalued idea and one by both obsession and secondary delusion. In total, six cases had features of an overvalued idea. All of the participants except one had a lifetime history of a specific phobia. In addition, their history included social phobia in two cases, panic disorder in one case, obsessive–compulsive disorder (other than tokophobia) in two cases, depressive disorder in two cases, bipolar disorder in two cases, and PTSD in six cases. To conclude, this study showed that tokophobia was not a phobic disorder but a kind of overvalued idea that requires specific assessment and treatment.

Gestational anemia (GA) is a global health concern with a remarkably high prevalence in Japan, which is associated with various maternal and neonatal outcomes. This study aimed to explore whether GA and non-anemic iron deficiency (NAID) during the third trimester is associated with maternal characteristics, nutrient intake, low birth weight (LBW), and preterm birth. Participants were categorized into GA, NAID, and normal groups, based on serum ferritin and hemoglobin levels. Nutrient intake was assessed using the Brief Diet History Questionnaire. Data from 317 pregnant women were analyzed, including 110 (34.7%), 151 (47.6%), and 56 (17.6%) women in the GA, NAID, and normal groups, respectively. Factors associated with GA included being multipara (p < 0.001) and not taking any type of iron supplements in the third trimester (p = 0.043). The normal group had a significantly higher proportion of preterm birth and LBW than the GA and NAID groups. The GA group had a significantly higher energy intake than the normal group (p = 0.044). Overall, energy and micronutrient intake were significantly below the estimated average requirement in the dietary reference intakes for Japanese. Health care professionals need to consider nutritional advice that can prevent GA by focusing on overall micronutrients, not just energy intake.

This study examined the association of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake during the second trimester with low birth weight (LBW) in pregnant Japanese women and was conducted in conjunction with the Japan Pregnancy Eating and Activity Cohort (J-PEACH) study. The study included 504 pregnant women from four Japanese sites. During the second trimester (14–27 weeks), the participants filled out a self-administered questionnaire assessing the frequency of DHA and EPA supplement intake in the past month, as well as a brief-type self-administered diet history questionnaire (BDHQ). The analysis involved data from two time points: responses to the BDHQ and infant data at birth. In total, 471 and 33 participants were classified into the normal birth weight and LBW groups, respectively. The participants were divided into high-, medium-, and low-intake groups based on their total dietary and EPA and DHA supplementary intakes. The Cochran–Armitage trend test was used to analyze the data; the prevalence of LBW was higher in the low-intake group (p = 0.04). There was no significant sex-based trend (p = 0.27 and p = 0.35). In Japanese women, low dietary and supplementary EPA and DHA intake until the second trimester were risk factors for LBW.

This study aimed to determine the association of serum docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) levels with dietary intakes and supplement use during pregnancy. This prospective observational study was conducted at a university hospital in Tokyo, Japan. Participants in their second and third trimesters were given a self-administered questionnaire assessing the frequency of DHA and EPA supplement use in the past month and a brief-type self-administered diet history questionnaire. Non-fasting serum DHA and EPA levels were analysed using gas chromatography. Differences in biomarkers by frequency of supplement use were determined using multiple comparison analyses, and Spearman's correlation coefficient was used to determine biomarkers and DHA and EPA intakes by food group. Of the 116 participants, 11 (9⋅5 %) in the second trimester and 18 (15⋅5 %) in the third trimester regularly used supplements (≥5 times per week). Regular users had higher serum DHA and EPA levels than never users in the second and third trimesters. Dietary DHA and EPA intake from fish and shellfish was positively correlated with serum DHA and EPA in the second and third trimesters. Supplement use ≥5 times per week and fish and shellfish intake were associated with high serum DHA and EPA levels.

Background: The rate of predominant breastfeeding was 51.3% at 1 month postpartum, even though 93.4% of Japanese mothers expressed a desire to predominantly breastfeed during pregnancy. A wide range of historical, socioeconomic, cultural, and individual factors, as well as mental health, affect breastfeeding practices. However, the relationship between breastfeeding and mental health—depressive symptoms—has been controversial. Purpose: The aim of this study was to identify factors relationship including mental health and the feeding methods adopted by mothers at 1 month postpartum in Japan. Methods: A cross-sectional study was conducted at 2 Tokyo area hospitals between July and October 2014. We recruited a total of 560 eligible women. The participants included 392 women without severe illnesses or low birth weight babies at 1 month postpartum. The feeding methods were “mainly breastfeeding” (exclusively or mostly breastfeeding) and “mixed feeding and formula only”. Depressive symptoms as a mental health were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Multiple logistic regression analysis clarified the factors associated with mainly breastfeeding. Results: The mean (SD) age for the categories of mainly breastfeeding and mixed feeding and formula only was 33.0 (5.1) and 33.9 (5.5) years, respectively (p = 0.085). Women who were mainly breastfeeding at 1 month postpartum were more likely to be multiparous (adjusted odds ratio [AOR]: 1.80, CI:1.11 - 2.94), had EPDS score < 9 (AOR:1.87, CI:1.09 – 3.20), and had been desirous of breastfeeding from their pregnancy (AOR: 7.73, CI: 4.68 – 12.74). Conclusion: Our results suggested that healthcare providers should focus on the relationship between feeding methods and new mothers’ mental health. Further research must identify effective care strategies for women who desire to breastfeed exclusively.

Nausea and vomiting in pregnancy (NVP) is a common symptom. Although the influence of NVP during the first trimester on dietary intake and birth outcomes has been revealed, no study has focused on NVP during the second trimester. This study aimed to reveal whether NVP severity during the second trimester is associated with dietary intake, gestational weight gain (GWG), birth weight, and delivery week. Participants completed a questionnaire at 18–27 gestational weeks. NVP severity was assessed using the modified Pregnancy-Unique Quantification of Emesis and Nausea scale in the questionnaire. Dietary habits were assessed using a brief-type diet history questionnaire. In total, 825 responses were analyzed: 202 (24.5%), 135 (16.4%), and 8 (1.0%) women reported mild, moderate, and severe NVP, respectively; 480 (58.2%) women did not have NVP during the second trimester. No significant association was observed between energy and nutrient intake and no/mild and moderate/severe NVP. Women with moderate/severe NVP had lower total GWG than those with no/mild NVP (p = 0.007). There was no significant difference in low birth weight and preterm birth rates (p = 0.246 and p = 0.604). This is the first study to investigate whether NVP severity during the second trimester is associated with dietary intake and birth outcomes.

Glucose is a vital fuel for fetal growth, and carbohydrates are the primary source of glucose in the diet. The effects of carbohydrate intake during pregnancy on neonatal birth weight have not been fully investigated or systematically reviewed. Therefore, this systematic review aimed to collate the available evidence to determine whether carbohydrate intake during pregnancy impacts newborn birth weight. A literature search was performed from inception to March 2022 in Embase, Medline, and PsycInfo. Articles published in English were independently screened for the title and abstracts, and then for full texts. Out of 17 studies included, a significant relationship between the intake of maternal carbohydrate or its subcomponents and neonatal birth weight was reported in six studies. Of them, one study reported that higher carbohydrate intake in early pregnancy was associated with lower birth weight. The two other studies reported a positive correlation between maternal carbohydrate intake and neonatal birth weight regarding first- and second-trimester intake. Maternal carbohydrate intake may have an impact on birth weight, as suggested by the included studies in this systematic review. However, the overall review indicates contradictory findings concerning the relationship between carbohydrate intake and neonatal birth weight. Studies assessing the type of carbohydrate and the amount consumed with improved methodological quality are recommended.

Objective: The objective of this study is to determine the factors associated with time spent performing housework/childcare by fathers of children under 12 years of age (preschool and elementary school children) in Japan. Methods: An online survey of employees and employers was conducted in 2017. Of the 7,796 total responses to the survey, those of 621 fathers of children aged 0–12 years were analyzed. Participants were divided into two groups: fathers of children aged 0–6 years, and fathers of children aged 7–12 years. Multiple logistic regression analysis was performed on the items for which there was a significant intergroup difference, setting time spent performing housework as the dependent variable and the survey items as the independent variables. Results: For fathers of children aged 0–6 years, working 40 hours or less per week and commuting for one hour or less were associated with more time spent performing housework/childcare. For fathers of children aged 7–12 years, working less than 40 hours a week, working from home more than once a week, and having spouses with full-time jobs were associated with more time spent performing housework/childcare. Conclusion: This study revealed the factors associated with the time spent by fathers of children under 12 in performing housework/childcare. As several of these factors cannot be altered by the fathers’ efforts alone, companies and society in general must endeavor to improve work styles to better suit the habits and preferences of fathers. This will promote work–life balance and create better family relationships.

Background:. Pregnant women with allergies face difficulties, as they tend to avoid medication for symptom control during pregnancy. Moreover, some women experience exacerbations during this period. These difficulties can affect their mental health. Objective:. This study aimed to investigate the factors influencing allergy exacerbations during pregnancy and examine the effects of allergy symptoms on the mental health of pregnant women. Methods:. A cross-sectional study was conducted through web-based research in March 2020, amid the COVID-19 pandemic. Pregnant women were collected from 3 groups (target: 150 participants in each group): atopic dermatitis (AD), allergic rhinitis, and without allergies. We evaluated mental health using Kessler Psychological Distress Scale (K6) and health-related quality of life using the Short Form-8 questionnaire. Results:. Overall, 202 (49.1%) of 411 pregnant women had depressive symptoms, and 45 (10.9%) had severe depressive symptoms. Women with allergies had significantly worse mental health than those without allergies. Among 119 AD patients, 36 (30.3%) experienced exacerbations during pregnancy. Of them, 11 (30.6%) did not consult a practitioner and endured the exacerbation. A significant association was observed between severe prepregnancy symptoms, job situation, coping with symptoms of AD during pregnancy, and AD exacerbation. Among 210 rhinitis patients, 17.1% experienced rhinitis exacerbation during pregnancy. The presence of rhinitis symptoms in winter and the second trimester was significantly associated with exacerbation. Conclusion:. This study revealed higher rates of depressive symptoms among pregnant women with allergies. The psychological well-being of pregnant women with AD or allergic rhinitis should be considered.

Abstract Background Posttraumatic stress symptoms (PTSS) after childbirth may affect mother-infant bonding. This study examined the relationship between aspects of PTSS after childbirth and bonding failure for mothers at 1 month and 4 months after delivery. Methods This longitudinal study surveyed 130 mothers at 1 month (T1) and 4 months (T2) after delivery. We performed multiple regression analysis with the Postpartum Bonding Questionnaire (PBQ) as the dependent variable and the Impact of Event Scale-Revised (IES-R), Edinburgh Postnatal Depression Scale (EPDS), Relationship Questionnaire (RQ), Family Adaptation, Partnership, Growth, Affection, and Resolve score (F.APGAR), and demographic data as independent variables. Results The rate of mothers with an IES-R score of ≥ 25 was 6.2% at T1 and 3.8% at T2. The IES-R and the EPDS were relevant factors for the PBQ at T1. The IES-R was not a relevant factor, but the EPDS was a relevant factor for the PBQ at T2. The IES-R at T1 was not a predictor for the PBQ at T2. The PBQ at T1 was the largest predictor for the PBQ at T2, when compared with the EPDS, F.APGAR, and dismissive attachment pattern (RQ) at T1. Conclusions PTSS after childbirth had a strong influence on bonding failure at T1. However, the important factor affecting bonding failure was not PTSS after childbirth, but depression at T2. If PTSS after childbirth are accompanied by depression at T2, bonding failure may be affected. Bonding failure affected by PTSS after childbirth at T1 could affect bonding failure at T2. Health professionals should assess the degree of PTSS after childbirth and start to care for mothers at T1.

Parents had better to assess their infant’s skin daily to prevent the development of any skin problems. However, there are no standard methods for assessing infant skin at home. This study aimed to validate the assessment of infant face skin conditions by parents as compared to using skin barrier function clinical tests. In addition, we evaluated the degree of agreement between parents and physicians/midwives when assessing an infant’s skin. A cross-sectional study involving 184 infants aged 3 months was conducted. To evaluate the parents’ infant skin assessment, we used the Neonatal Skin Condition Score (NSCS). On the same day, we evaluated the skin barrier function on the infant’s forehead and cheek, including transepidermal water loss (TEWL), stratum corneum hydration, skin pH, and sebum secretion. Skin barrier function values were correlated with infant skin condition assessed by parents, especially in cases of TEWL of the cheek, for which a moderate positive correlation was found between parental assessment score (ρ = 0.448). In addition, infant with skin problems based on parental assessment had a significantly higher TEWL, lower SCH, and higher skin pH. However, there was weak agreement between parental and physician/midwife assessment. Thus, there was a relationship between parental assessment and skin barrier function; thus, parents can use at-home assessment to assist with infant skin care. In the future, research focused on developing methods of examining infant skin conditions should consider incorporate parental daily skin assessment.

In Mongolia, cardiovascular disease is the leading cause of death, and prevalence of hypertension is very high. The aim of this study was to investigate the association between hypertension and sociodemographic factors and health-related behaviors among men in Darkhan-Uul Province, Mongolia. This cross-sectional study was conducted between November 2015 and January 2016. Men whose wives were pregnant with ≤20 weeks gestation and had attended antenatal health checkups at public health facilities were recruited in this study. The data were collected as part of a survey of pregnant women and their partners. Data were collected using selfadministered questionnaires, anthropometry, and spot urine samples. A total of 224 men participated in the survey, and data from 209 participants were included in the analysis. Multiple logistic regression analysis showed that men with higher BMI had higher odds of hypertension than those with lower BMI (adjusted odds ratio [AOR]: 1.14, 95% CI: 1.03–1.26). Those with urinary cotinine >100 ng/ml (smokers) had a lower risk of hypertension (AOR: 0.24, 95% CI: 0.09–0.67) compared to participants with urinary cotinine/ml (nonsmokers). This is the first study to investigate the association between hypertension and sociodemographic factors and health-related behaviors among men in Mongolia. Based on the findings of this study, clinicians responsible for public health in Mongolia should provide health education regarding the importance of weight control in preventing hypertension.

Intense fear of childbirth by expectant women is called tokophobia. Because there are no qualitative studies targeting women with an intense fear of childbirth in Japan, it is unknown whether there is any link between the type of fear of objects/situations among tokophobic women and their psychological/demographic background. Furthermore, there is no available summary of the lived experience of Japanese women with tokophobia. This study aims to identify the intensity patterns of various types of fear among the participants and summarize the lived experience of having intense fear of childbirth. A qualitative descriptive study was conducted using a semi-structured interview. Pregnant women with an intense fear of childbirth participated in individual interviews facilitated by a psychiatrist and a midwife. Audio recordings of the interviews were transcribed and analyzed using a content analysis approach. The number of participants was ten. The types of feared objects varied individually and these were categorized as being related to either prospective or retrospective fear. The participants’ experiences were grouped into three categories: difficulty in daily life, preoccupied negative expectation towards childbirth, and psychological adaptation to the upcoming childbirth. The results imply that women with tokophobia continuously suffer from fear in their daily life; hence, a special approach is needed to detect and reduce their fear.

Abstract Background This study examined whether infants aged 0–3 months exhibited long-term effects of using a moisturizer skincare intervention and whether a short-term skin problem resulted in the subsequent development of food allergies or atopic dermatitis (AD) until the age of 2 years. Methods This study was a follow-up of a completed randomized control trial (RCT) of moisturizer skincare for infants aged 0–3 months. A self-reported questionnaire was mailed to the parents of children aged 1–2 years who had participated in the RCT. Data were analyzed using a Chi square test, by intention to treat analysis, and by multiple logistic regression. Results Of 155 infants, 22 (14.2%) and 28 (18.1%) had food allergies and AD/eczema until 2 years of age, respectively. No significant difference was seen in food allergies or AD between the group that received moisturizer skincare intervention and the control group. On the contrary, food allergies until 2 years of age were significantly associated with short-term (4–7 days) and long-term (more than 7 days) body skin problems occurring in the first 3 months of life, a family history of AD, and the time of starting complementary food. High value of face transepidermal water loss at 3 months of age was also associated with food allergies. Moreover, a short duration of severe diaper dermatitis during the first 3 months, a family history of AD, and being male were significantly associated with AD/eczema until the age of 2 years. Conclusions After adjusting for family history of AD, a short-term skin problem in the first 3 months of life was significantly associated with the development of food allergies or AD/eczema until the age of 2 years. Prevention or prompt treatment of skin problems in newborns is essential for preventing future allergic diseases. Trial registration This was a follow-up study conducted 2 years after the completed RCT of a moisturizer skincare intervention for early infants, which was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000013260)

More than half of women are reported to be overweight or obese in Mongolia, thus becoming a big health issue. Though maternal obesity is a known risk factor for cesarean section (CS), it remains unclear how much a high maternal body mass index (BMI) would influence the risk of CS among pregnant women in Mongolia. This study aimed to investigate whether a higher maternal BMI is related to CS delivery in Darkhan-Uul Province, Mongolia. Pregnant women at 20 weeks’ gestation or less who visited public health facilities for antenatal health checkups between November 2015 and January 2016 were recruited. Data were collected using self-administered questionnaires, body weight measurement, and medical records. In total, 508 pregnant women participated, and data from 336 women were analyzed. Multiple logistic regression analysis showed that higher maternal BMI at first antenatal care visit (adjusted odds ratio [AOR] = 1.102, p = .033), higher gestational weight gain (AOR = 1.111, p = .001), older maternal age (AOR = 1.076, p = .030), and gestational age at delivery (AOR = 0.765, p = .005) were associated with CS delivery. This study is the first to demonstrate that higher maternal BMI and higher gestational weight gain are associated with CS delivery in Mongolia. Moreover, older maternal age and lower gestational age at delivery were found to be associated with CS delivery. Preventing obesity among women is important not only from the viewpoint of prevention of lifestyle diseases but also from the obstetric point of view; it is important for medical personnel to communicate the importance of preventing obesity to all women in Mongolia.

This study aimed to compare knowledge about smoking, including passive smoking, and urinary cotinine (UC) levels in pregnant women and their partners in Mongolia. The study was conducted between November 2015 and January 2016 in Darkhan-Uul Province, Mongolia. Pregnant women with less than 20 weeks’ gestation were recruited, and their partners were also invited to participate. Self-administered questionnaires and urine samples were used to collect data. Knowledge about smoking including passive smoking was measured using 14 questions. Data were analyzed using a Student’s t-test, a chi-squared test, a one-way analysis of variance, and the Tukey–Kramer method for post-hoc analysis. Correlations were measured by computing Pearson’s r or Spearman’s ρ. A total of 508 pregnant women and 227 partners participated in this study; of these, 221 couples’ data were analyzed. Pregnant women’s scores on knowledge about smoking and passive smoking were significantly higher than those of their partners (9.4 ± 2.9 and 8.7 ± 3.1, respectively; p = 0.017). Pregnant women’s and their partners’ scores were slightly correlated (r = 0.163, p = 0.015). Pregnant women’s and their partners’ UC levels were significantly correlated (ρ = 0.250, p < 0.001). This study is the first to examine knowledge about smoking and passive smoking and UC levels among pregnant women and their partners in Mongolia. Because pregnant women’s and their partners’ scores and UC levels were positively correlated, health education on the harm caused by smoking and passive smoking should be provided to both pregnant women and their partners.

This study aimed to investigate the exercise habits of pregnant women in the third trimester (N = 303). We assessed participation in physical activities, including exercise or sports, using the Japanese version of the Pregnancy Physical Activity Questionnaire. A total of 183 (60.4%) pregnant Japanese women participated in some form of exercise and 87 (28.7%) exercised for 2 hours or more, per week, in the third trimester. Multiple logistic regression analyses indicated that women who set themselves a gestational weight gain target (adjusted odds ratio [AOR] = 8.10, 95% CI [2.82, 23.4], p< .001), were more likely to participate in exercise or sports. In contrast, multiparous women (AOR = 0.44, 95% CI [0.26, 0.72], p = .001), and those whose pre-pregnancy body weights suggested obesi-ty (AOR = 0.51, 95% CI [0.30 0.87], p = .013) were less likely to participate in such activities. We found a relation-ship between non-participation for 2 hours or more, per week, to being multiparous (AOR = 0.33, 95% CI [0.18, 0.94], p< .001) and the presence of anemia in the second trimester (AOR = 0.51, 95% CI [0.28, 0.94], p = .031). Working status, seasonal differences, concerns about being overweight, and individual dietary nutritional guidance were not related to participation in exercise or sports. While setting a target for gestational weight gain may motivate participation in exercise or sports, women who were multiparous and those who perceived themselves as obese be-fore pregnancy, showed a negative association with participation.

No dietary intervention that focuses on the diet quality of postpartum women has been developed in Japan, although most postpartum women experience an insufficient intake of vitamins and minerals. We aimed to examine whether dietary intervention, based on the health belief model, at both 1 and 3 months postpartum affects nutrient intake and food group consumption at 6 months postpartum. A randomized controlled trial was conducted at a university hospital in Tokyo between 2015 and 2016. Healthy women at 1 month postpartum were randomly allocated to either an intervention group (n = 100) or a control group (n = 94). Dietary intervention included dietary assessment, individual feedback, and dietary guidance. The dietary intakes between the two groups were compared using the Mann-Whitney U test. At 6 months postpartum, the energy-adjusted intakes of protein, total dietary fiber, potassium, magnesium, phosphorus, zinc, vitamin B6, and β-carotene were significantly higher in the intervention group than in the control group. The changes in energy-adjusted intakes of total dietary fiber and iron from 1 month postpartum to 6 months postpartum were significantly different between the two groups. Dietary intervention based on the health belief model improved nutrition at 6 months postpartum, although the impact was limited.

Abstract This cross-sectional study investigated the prevalence of smoking and secondhand smoking (SHS) among pregnant women in Darkhan-Uul Province, Mongolia, using urinary cotinine (UC) levels, and clarified the factors related to SHS exposure. It targeted pregnant women who underwent antenatal health check-ups from November 2015 to January 2016. Self-administered questionnaires and urine samples were used to collect data. Using UC levels as the criterion, it was found that the prevalence of smokers (>100 ng/ml) among 493 pregnant women was 11.8%, while SHS exposure (≥5 ng/ml) among nonsmokers was 44.8%. Older and highly educated women had lower odds of SHS exposure (p = 0.006 and 0.002, respectively). Furthermore, nonsmoking pregnant women from homes where smoking was permitted had higher odds of SHS exposure compared to women from homes where smoking was not permitted. These results suggest that community guidance programs, such as home smoking cessation that include families, are necessary.

Background: Adequate amounts of physical activity during pregnancy have been recognized to have good effects on fetal growth and prevention of pregnancy complications. Aims: This study aimed to examine physical activity levels in the second trimester of pregnancy according to intensity and type of activity, and to identify factors related to physical activity levels. Methods: We utilized the baseline data of the cohort study for our analysis. These data included records of healthy women in the second trimester, undergoing treatment at a university hospital in Tokyo, between 2010 and 2012. Physical activity levels were assessed using a pregnancy physical activity questionnaire. Demographic variables including age, pre-pregnancy body mass index, parity, working status, and education levels were obtained using a self-administered questionnaire. The Mann–Whitney U test or Kruskal–Wallis test was performed to investigate differences in physical activity levels according to demographic variables. Multiple linear regression analysis was conducted to identify the related factors to total physical activity levels. Results: A total of 461 women were analyzed. The mean (standard deviation) of total physical activity level was 22.2 (9.6) metabolic equivalents·hour/day. In a multiple linear regression analysis, multigravidae (β = 0.510) and working women (β = 0.334) had significantly higher total physical activity levels. Working multigravidae had more than twice as much total physical activity level as non-working primigravidae. Conclusions: Parity and working status strongly influence on physical activity levels in the second trimester among Japanese women. The results would be useful for healthcare professionals to estimate physical activity levels in consideration of demographic characteristics.

Dietary under-reporting is a common problem when using self-reported dietary assessment tools. However, there are few studies regarding under-reporting during pregnancy. This study aimed to explore the demographic and psychosocial characteristics related to dietary under-reporting in pregnant Japanese women. A cross-sectional study was conducted between 2010 and 2011 at a university hospital in Tokyo, Japan. Nutrient intake was assessed using a self-administered Diet History Questionnaire (DHQ), which had questions about the consumption frequency and portion size of selected food items. The 24-h urinary excretion levels of urea N and K were used as the dietary protein and K intake reference values, respectively. Under-reporting of protein and K was defined as the bottom 25 % of the reporting accuracy (the ratio of reported intake on the DHQ to the estimated intake based on urinary excretion). Under-reporters were defined as participants who under-reported both protein and K intake. Multiple logistic regression analysis was performed to examine the factors associated with under-reporters. Of 271 healthy women at 19–23 weeks of gestation, thirty-five participants (12·9 %) were identified as under-reporters. Under-reporters had a lower pre-pregnancy BMI (adjusted OR (AOR) = 0·81) and lower gestational weight gain (AOR = 0·82); they also reported managing their gestational weight gain with the aim to return to their pre-pregnancy weight soon after childbirth (AOR = 2·99). Healthcare professionals should consider the potential for dietary under-reporting and the possible related factors when assessing the dietary intakes of pregnant Japanese women using self-administered questionnaires.

OBJECTIVE: To examine the association between gestational weight gain and maternal body mass index (BMI) among Vietnamese women and the risk of delivering an infant too small or too large for gestational age. METHODS: A prospective health-facility-based study of 2989 pregnant Vietnamese women was conducted in the city of Nha Trang in 2007-2008. Cubic logistic regression was used to investigate the association of interest. Infants were classified into weight-for-gestational-age categories according to weight centiles for the Asian population. Gestational age was based on the date of last menstrual period and adjusted by the results of first-trimester ultrasound. FINDINGS: BMI was low (< 18.5), normal (18.5-22.9) and high (> 23.0) in 26.1%, 65.4% and 8.5% of the women, respectively. In each of these BMI categories, the percentage of women who delivered infants too small for gestational age was 18.1, 10.0 and 9.4, respectively, and the mean gestational weight gain was 12.5 kg (standard deviation, SD: ± 3.6), 12.2 kg (SD: ± 3.8) and 11.5 kg (SD: ± 4.7), respectively. Among women with low BMI, the risk of delivering an infant too small for gestational age ranged from approximately 40% if the gestational weight gain was < 5 kg to 20% if it was 5-10 kg. CONCLUSION: Having a low BMI, commonly found in Viet Nam, puts women at risk of delivering an infant too small for gestational age, especially when total maternal gestational weight gain is < 10 kg.

Background. To examine the effects of temperament and character domains on depression during pregnancy. Methods. We examined 601 pregnant women using a questionnaire that included the Edinburgh Postnatal Depression Scale (EPDS), the Temperament and Character Inventory (TCI), and demographic variables. Results. In a hierarchical regression analysis, severity of depression during pregnancy was predicted by the women’s negative response towards the current pregnancy, low self-directedness, and high harm avoidance, persistence, and self-transcendence. Conclusion. Depression during pregnancy is predicted by personality traits as well as women’s negative attitudes towards the current pregnancy.

Purpose The aim of this study was to examine the characteristics of users of postpartum care services and compare the factors associated with utilization of these services for users and non-users. The focus was on postpartum physical and mental discomfort, childcare anxiety, qualities of partners regarded as the closest supporters, and the use of instruction in childcare techniques. Methods A longitudinal study using a web-based self-administered questionnaire was conducted from May 2019 to February 2020 with study participants at 35 weeks gestation and one month postpartum. Of the 2,402 women given the research information leaflet at the time of their antenatal checkup, 667 (27.8%) responded to the first self-administered webbased survey, and 448 (18.7%) responded to the second one. The 448 respondents who answered at both time points and indicated whether they used the postpartum care services were included in the analysis. The respondents were divided into two groups: those who answered that they had used the postpartum care services and those who responded that they had not. Chi-square tests, Mann-Whitney U tests, and student t-tests were performed on the investigation variables. Results Characteristics significantly associated with users of postpartum care services included the following: annual household income of at least 9 million yen, status as an employed woman, desiring to be pregnant, receiving a negative reaction from one's partner when becoming pregnant, first breastfeeding was the day following the birth, a strained relationship with one's partner at one month postpartum, and low scores on the Short Form-8 (SF-8) Japanese version of the Physical Component Summary (PCS) at one month postpartum. Conclusion In this study, the use of postpartum care services was associated with decreased physical quality of life (QoL) after childbirth. In addition to the need for rest, the relationship with one's partner might be related, suggesting the need to consider the relationship with the partner as a factor in deciding whether to use postpartum care services. In addition, financial difficulties associated with using the current postpartum care services also existed. Therefore, physical QoL, the relationship with one's partner, and financial support should be considered so that those needing postpartum care services can access them. [ABSTRACT FROM AUTHOR]

Social support is an important factor in reducing fear of childbirth (FOC). Recently, the Internet and Social Networking Services (SNS) have become new forms of social support. However, it is unclear whether such support can reduce pregnant women's fear. This study aimed to investigate the association between FOC and social support through the Internet and SNS in pregnant women. A cross-sectional study using a web-based questionnaire including questions about FOC, social support, the Internet and SNS usage, psychological variables, and sociodemographic variables was conducted. Data from 111 participants were analyzed. A greater number of social support from people who are often seen during pregnancy, and becoming relieved by interaction with others through the Internet and SNS were negatively associated with FOC. This study showed that face-to-face social support was associated with lower FOC, while social support through the Internet and SNS was not. Further research is needed on how to use Internet and SNS to reduce FOC in pregnant women. [ABSTRACT FROM AUTHOR]

Purpose Pregnancy and childbirth are the most common risk factors leading to pelvic floor disorders including pelvic organ prolapse (POP). POP is caused by the descent of pelvic organs due to increased intra-abdominal pressure and load on the birth canal. POP presents various symptoms. Therefore, it is difficult to diagnose through interview. If the relationship between the prevalence of specific POP symptoms and risk factors including habits that increase intra- abdominal pressure can be determined, the incidence of POP in women after childbirth may be prevented. This study aimed to clarify the prevalence of POP symptoms for each postpartum period during 5 years after childbirth and to determine the risk factors of these symptoms. Methods This cross-sectional study included participants who underwent vaginal delivery at the University of Tokyo Hospital in Japan. We used the Japanese version of the Pelvic Floor Distress Inventory -- short form 20, which includes the Prolapse Distress Inventory, to assess POP. The rate of women experiencing POP symptoms was calculated every 6 months after childbirth. Participants' characteristics including lifestyle, delivery records, and other variables were obtained from the questionnaire or medical records. The participants were divided into two groups: group with and without symptoms. Logistic regression analysis was performed using variables that showed a significant difference between the two groups. The research procedures were approved by the Research Ethics Committee of the Uni- versity of Tokyo. Results Questionnaires were distributed to 3776 women, and 1056 (28.0%) were returned. The number of valid re- sponses was 681. Approximately 36% and 43% of women had POP symptoms during 5 years and 6 months after childbirth, respectively. There was no significant difference in the rate of POP symptoms in each postpartum period. Women with POP symptoms were significantly more likely to experience incontinence, hard stools before and after pregnancy, and straining habits during defecation before pregnancy than those without. Conclusion Lifestyle habits before pregnancy and defecation conditions during the postpartum period were related to POP symptoms after childbirth. The study suggested the need for care to prevent the onset and worsening of POP symptoms, including advice on daily living behaviors such as early postpartum monitoring for the presence or absence of symptoms, voiding care, and avoiding increased intra-abdominal pressure that could stress the pelvic floor. [ABSTRACT FROM AUTHOR]

Purpose Cultural differences in complementary infant foods across countries and regions are unclear. Therefore, this study aimed to clarify the differences in guidelines and recommendations for complementary infant foods worldwide, especially focusing on foods that infants eat first and the order in which they are consumed. Methods Web questionnaires were sent to midwifery associations or nurses' associations in 166 countries that are members of the International Council of Midwives (ICM) or the International Council of Nursing (ICN). Midwives or nurses were asked about recommended foods for infants to eat first and recommendations for the order in which they should be eaten. For the analysis, we categorized the recommendations for complementary foods in each country, focusing on the order in which they were consumed. Chi-square test was used to analyze the differences in eating order classification and region. Results Responses were received from a total of 46 countries. Thirty-seven out of 46 countries, or 80.4%, responded that they had guidelines on complementary foods. Six patterns were found for complementary diets, including 2 patterns starting with grains and 3 with vegetables and patterns of parents' and infant-led diets. Grains were the most common starting pattern in Asia and Africa, while vegetables were the most common in Europe and America. Conclusion We believe that international nutritional intake and disease prevention guidelines should be considered as recommendations for complementary foods suitable for each country and region. [ABSTRACT FROM AUTHOR]

Purpose Many Japanese women continue to work during pregnancy, but half of them quit work. Several symptoms and discomfort during pregnancy are known to interfere with daily life and to be a reason for taking sick leaves or retiring during pregnancy. However, little is known about the factors behind their motivation to continue working throughout pregnancy. Work engagement is a concept defined as "a positive, fulfilling, work-related state of mind characterized by vigor, dedication, and absorption of workers", and can predict positive work outcomes, such as job performance, job satisfaction and motivation. This study has two hypotheses: (1) job resources would be positively associated with work engagement, and (2) the perceived symptoms during pregnancy would be negatively associated with work engage- ment. Then, this study aimed to explore the factors associated with work engagement among Japanese pregnant women. Methods Between July and November 2019, a cross-sectional study was conducted at two general hospitals in the urban area of Tokyo. Pregnant women were recruited during antenatal health check-ups and asked to answer self-ad- ministered questionnaires after obtaining written informed consent. The eligibility criteria were having a single preg- nancy, being at ≥16 weeks of gestation, and being able to read and write Japanese. The outcome variable was work engagement using the 3-item version of the Utrecht Work Engagement Scale. Furthermore, work-related variables, such as job demands and job resources, perceived physical and mental symptoms, and demographic characteristics were obtained. To examine the relationships between the independent variables and work engagement, a bivariate analysis was conducted. Then, multivariate regression analysis was performed on the variables that were significantly associated with work engagement in the bivariate analysis. Results Of 252 participants at ≥16 weeks' gestation who agreed to participate, 226 completed the questionnaires. After excluding 86 women who were not working at the time of recruitment, the data of 140 working pregnant women were included in the analyses. Participants' age (mean ± standard deviation) was 33.1 ± 4.3 years, and the mean score of work engagement was 3.6 ± 1.3. The results of the multivariate analysis showed that the factors associated with a higher level of work engagement were higher supervisor support (β = 0.259, p = 0.008), higher job demands (β = 0.267, p = 0.006), higher sense of coherence (β = 0.276, p = 0.001), and higher age (β = 0.188, p = 0.024). As for the hypotheses, this study revealed that (1) job resources were positively associated with work engagement, and (2) the perceived symptoms during pregnancy were not associated with work engagement. Conclusion Higher supervisor support was significantly associated with a higher level of work engagement. The finding demonstrates the importance of social support in the workplace in promoting work engagement among pregnant women. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to evaluate the current state of intrapartum care practices in El Salvador and examine whether the presence or absence of care makes a difference in women's satisfaction with care, based on the recommendations listed in the "WHO recommendations: Intrapartum care for a positive childbirth experience" (hereafter, WHO guidelines). Methods Secondary analysis was performed on data from a baseline survey conducted to assess the effectiveness of the interventions of the Japan International Cooperation Agency (JICA) Technical Cooperation Project for "Humanization of Childbirth based on Scientific Evidence in the National Women's Hospital" (hereafter, project). In the project, pregnant women who were admitted to the National Women's Hospital of El Salvador for vaginal delivery were recruited to (1) a direct observation survey on care during labor, and to (2) an interview regarding satisfaction with obstetric care on postpartum women, from May to June 2021. Those who participated in both the survey and the interview were included in the secondary analysis. Of the 56 items of care specified in the WHO guidelines, 22 were examined and the relationships between the care items and the scores of the Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) scale were analyzed by conducting a Mann-Whitney U test. Results Forty-four women were included in the study. The median COMFORTS scale score was 154 out of 200. Women with heavy postpartum hemorrhage were significantly less satisfied with the COMFORTS subscale of "Care during labor" (p=0.046). Further, women who were not administered prophylactic uterotonics for postpartum hemorrhage prevention as part of the active third stage of labor were also significantly less satisfied with obstetric care (p=0.042). Among the recommended care items, those routinized in El Salvador (including the use of prophylactic uterotonics for the prevention of postpartum hemorrhage and early skin-to-skin contact) were followed. However, vaginal examination at intervals of four hours and intermittent fetal heart rate auscultation were not followed. Non-recommended care including fundal pressure (Kristeller maneuver) and nasal or oral suctioning of the newborn was also observed. Conclusion Satisfaction was lower when women experienced postpartum hemorrhage or were not administered prophylactic uterotonics during the third stage of labor; these women may have felt that they did not receive adequate care. The results indicate that women who received the adequate care recommended in WHO guidelines and experienced better birth outcomes reported higher levels of satisfaction. The study suggests the need to ensure proper intrapartum care practices and provide adequate obstetric care to women in El Salvador to ensure proper satisfaction. [ABSTRACT FROM AUTHOR]