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Background Low birth weight (LBW) and fetal growth restriction are associated with the development of cardio-metabolic diseases later in life. A recent Mendelian randomization study concluded that the susceptibility of LBW infants to develop hypertension during adulthood is due to the inheritance of hypertension genes from the mother and not to an unfavorable intrauterine environment. Therein, a negative linear association has been assumed between genetically estimated maternal blood pressure (BP) and birth weight, while the observed relationship between maternal BP and birth weight is substantially different from that assumption. As many hypertension genes are likely involved in vasculature development and function, we hypothesized that BP-increasing genetic variants could affect birth weight by reducing the growth of the placenta, a highly vascular organ, without overtly elevating the maternal BP. Methods Using a birth cohort in the Japanese population possessing time-series fetal growth velocity data as a target and a GWAS summary statistics of BioBank Japan as a base data, we performed polygenic score (PGS) analyses for systolic BP (SBP), diastolic BP, mean arterial pressure, and pulse pressure. A causal mediation analysis was performed to assess the meditation effect of placental weight on birth weight reduced by maternal BP-increasing PGS. Maternal genetic risk score constituted of only “vasculature-related” BP single nucleotide polymorphisms (SNPs) was constructed to examine the involvement of vascular genes in the mediation effect of placental weight. We identified gestational week in which maternal SBP-increasing PGS significantly decreased fetal growth velocity. Results We observed that maternal SBP-increasing PGS was negatively associated with offspring birth weight. A causal mediation analysis revealed that a large proportion of the total maternal PGS effect on birth weight was mediated by placental weight. The placental mediation effect was remarkable when genetic risk score was constituted of “vasculature-related” BP SNPs. The inverse association between maternal SBP PGS and fetal growth velocity only became apparent in late gestation. Conclusions Our study suggests that maternal hypertension genes are strongly associated with placental growth and that fetal growth inhibition is induced through the intrauterine environment established by the placenta.

Parents of infants with autistic behaviors frequently face difficulties in childrearing owing to their infants’ behavioral traits. This study aimed to clarify the characteristics of parent-infant interaction, parental depressive symptoms, and parenting stress in the context of infants’ autistic behaviors. We employed a cross-sectional, case-control observational design with a case group of 52 parents and a control group of 56 parents. We measured parent- infant interaction using the Japanese version of the Nursing Child Assessment Teaching Scale, and parental depressive symptoms and parenting stress with the Japanese version of the Center for Epidemiologic Studies Depression Scale and the Japanese Parenting Stress Index Short Form, respectively. There was no significant difference between the two groups regarding parent-infant interaction. Mothers in the case group had significantly higher depressive symptoms than those in the control group (p < .05). Both fathers (p < .05) and mothers (p < .01) in the case group scored significantly higher than the control group on parenting stress. Thus, parents of infants with autistic behaviors have greater mental health problems right from infancy. We suggest that nurses should provide families with appropriate support to promote adaptive parent-infant interaction and prevent the aggravation of parental mental health problems irrespective of Autism Spectrum Disorder diagnoses.

The maternal diet can potentially influence the life-course health of the child. A poor-quality maternal diet creates nutrient deficiencies and affects immune–metabolic regulation during pregnancy. The nutrient-based overall dietary quality can be assessed using the Nutrient-Rich Food Index 9.3 (NRF9.3), which measures adherence to the national reference daily values of nutrient intake. Pro- and anti-inflammatory nutrient intake can be assessed using the energy-adjusted dietary inflammatory index (E-DII), a comprehensive index of diet-derived inflammatory capacity. Using these indices, we assessed the overall dietary quality and inflammatory potential of pregnant women during mid-gestation in an urban area of Japan (n = 108) and found that there was a strong inverse correlation between the NRF9.3 and E-DII scores. Comparison of the scores among the tertiles of NRF9.3 or E-DII indicated that dietary fiber, vitamin C, vitamin A, and magnesium mainly contributed to the variability of both indices. Intake of vegetables and fruits was positively associated with high NRF9.3 scores and negatively associated with high E-DII scores, after adjustment for maternal age, pre-pregnancy body mass index, and educational level. Consistent with the previous studies that used dietary pattern analysis, this study also demonstrated that vegetables and fruits were the food groups chiefly associated with high dietary quality and low inflammatory potential among pregnant Japanese women.

Low birth weight is associated with the development of cardio-metabolic diseases later in life1-4. A recent Mendelian Randomization Study concluded that the susceptibility of low-birth-weight infants to develop hypertension during adulthood is due to the inheritance of hypertension genes from the mother, and not to an unfavorable intrauterine environment5. Therein, it has been assumed that low birth weight is caused by maternal hypertension5,6, although there is no evidence to support such a linear relationship. In the present study, we have noted that most of blood pressure SNPs are related to vascular regulation7-9 and found that the relationship between maternal blood pressure-increasing polygenic score and reduction of offspring birth weight is mediated by a reduced growth of the placenta but not by the mother's high blood pressure. This suggests that the risk of hypertension of low-birth-weight infants may result from a poor placental environment.

Placenta-derived extracellular vesicles and their cargoes, especially microRNAs (EV-miRNAs), may contribute to fetal and placental development. During pregnancy, the levels of several maternal blood EV-miRNAs, including miRNAs of placental origin, vary among individuals and change throughout gestation. However, the effects of these miRNAs on fetal growth and trimester-specificity have not been fully elucidated. The purpose of this study is to test the hypothesis that the serum levels of two extracellular vesicles (EV)-miRNAs (miR-127-3p and miR-26b-5p), which may be involved in fetoplacental regulation, would be significantly associated with fetal growth in a trimester-specific manner. This is a single-center birth cohort of maternal serum samples obtained at both the second and third trimesters. To minimize the influence of confounding factors, the analysis was limited to singleton vaginal deliveries, resulting in 27 participants being included in this study. EV RNAs were isolated using a membrane affinity method, and the relative expression levels of miR-127-3p and miR-26b-5p were measured using the RT-qPCR method with miR-484 as control. The associations between the two EV-miRNAs and fetal and placental growth were evaluated using a linear regression model and compared between the two trimesters. EV-miR-127-3p levels tended to correlate inversely with the z-scores of birth weight for gestational age (BWGA) and placental weight for gestational age (PWGA) in the second trimester, but not in the third trimester. EV-miR-26b-5p levels were positively associated with birth weight in the second trimester, but this association was weakened in the third trimester. Our results suggest a trimester-specific association of circulating miRNA levels with fetal and placental growth. The precise roles of EV-miR-127-3p and EV-miR-26b-5p in fetal and placental development warrant further investigation.

This study was conducted with infants diagnosed with bilateral retinoblastoma (RB) and their mothers. It explored characteristics of the mother-infant interaction, the infants' developmental characteristics and related risk factors.Cross-sectional statistical analysis was performed with 18 dyads of one-year-old infants with bilateral RB and their mothers.Using the Japanese Nursing Child Assessment Teaching Scale (JNCATS) results showed that infants with RB had significantly lower scores compared to normative Japanese scores on all of the infants' subscales and "Child's contingency" (p 0.01). Five infants with visual impairment at high risk of developmental problems had a pass rate of 0% on six JNCATS items. There were positive correlations between Developmental quotients (DQ) and JNCATS score of "Responsiveness to caregiver" (ρ = 0.50, p 0.05) and DQ and "Child's contingency" (ρ = 0.47, p 0.05).Infants with visual impairment were characterized by high likelihood of developmental delays and problematic behaviors; they tended not to turn their face or eyes toward their mothers, smile in response to their mothers' talking to them or the latter's changing body language or facial expressions, or react in a contingent manner in their interactions. These infant behaviors noted by their mothers shared similarities with developmental characteristics of children with visual impairments. These findings indicated a need to provide support promoting mother-infant interactions consistent with the developmental characteristics of RB infants with visual impairment.

Mid-to-late gestation is a unique period in which women experience dynamic changes in lipid metabolism. Although the recent intensive epigenome-wide association studies (EWAS) using peripheral leukocytes have revealed that lipid-related traits alter DNA methylation, the influence of pregnancy-induced metabolic changes on the methylation levels of these differentially methylated sites is not well known. In this study, we performed a prospective cohort study of pregnant women (n = 52) using the MassARRAY EpiTYPER assay and analyzed the methylation levels of variably methylated sites, including CPT1A intron 1 and SREBF1 intron 1 CpGs, which were previously verified to be robustly associated with adiposity traits. Although methylation of SREBF1 was associated with body mass index (BMI) and low-density lipoprotein cholesterol at mid-gestation, this association was attenuated at late gestation, which was consistent with the metabolic switch from an anabolic to a catabolic state. However, the BMI association with CPT1A intron 1 methylation appeared to strengthen at late gestation, this association was mediated by pre-pregnancy BMI-dependent change in the leukocyte proportion during mid-to-late gestation. Thus, the methylation of adiposity-related differentially methylated regions was sensitive to metabolic and immunological changes during mid-to-late gestation.

Aim.This study aimed to investigate how public health nurses identify, intervene in, and implement the guidelines on child maltreatment in Finland and Japan and to compare the data between the two countries.Method.This study employed a cross-sectional design. Public health nurses’ knowledge and skills with respect to child maltreatment prevention were assessed using a questionnaire consisting of three categories: identification, intervention, and implementation of guidelines. Public health nurses working in the area of maternal and child health care in Finland (n=193) and Japan (n=440) were the participants.Results. A significantly higher percentage of Japanese public health nurses identified child maltreatment compared to Finnish public health nurses, while Finnish nurses intervened in child maltreatment better than their Japanese counterparts. In both countries, public health nurses who had read and used the guidelines dealt with child maltreatment better than those who did not.Conclusion.The results suggest that effective training on child maltreatment and the use of guidelines are important to increase public health nurses’ knowledge and skills for identifying and intervening in child maltreatment.

This study investigated the effects of the Japanese Early Promotion Program (JEPP), which is based on the Infant Mental Health (IMH) program. The JEPP aims to promote mother-infant interactions by enhancing the mother's ability to respond appropriately her child. Mothers in the JEPP group (n = 15) received support from IMH nurses in a pediatric clinic until their infants reached 12 months of age. The nurses provided positive feedback that emphasized strength of parenting, and assisted the mothers in understanding the construct of their infants. Mother-infant interactions and mother's mental health status were assessed at intake (1-3 months), and at 6, 9, and 12 months of infants' age. The JEPP group data were compared with cross-sectional data of the control group (n = 120). Although JEPP dyads were not found to be significantly different from the control group in general dyadic synchrony, both before and after intervention, JEPP mothers significantly improved their ability to understand their infant's cues and to respond promptly. In the JEPP group, unresponsiveness to infants was reduced in mothers, while infants showed reduced passiveness and enhanced responsiveness to the mother. Furthermore, the intervention reduced the mothers' parenting stress and negative emotions, thereby enhancing their self-esteem.

This study aimed to clarify the relationships among developmental characteristics of retinoblastoma (RB) infants, mother-infant interaction, and mental health of mothers. Prospective studies were conducted twice with 13 dyads of mothers and infants who were between one (Time 1) and two years old (Time 2). Cross-sectional and longitudinal analyses were performed. The mean Developmental Quotients (DQ) significantly decreased between Time 1 and Time 2 (p.05). Four (30.8%) infants showed DQ p85 at Time 1. They showed a DQ below the borderline at Time 2 and their developmental changes were different from RB infants in the normal DQ range. Infant Behavior Checklist-R (IBC-R) scores negatively correlated with DQ (p.05). The mothers' Japanese Nursing Child Assessment Teaching Scale (JNCATS) scores were significantly higher than the normative mean. The IBC-R scores negatively correlated with mothers' JNCATS scores at Time 1 (ρ = -.66, p.05) and positively correlated with the child domain scores on the Parenting Stress Index at Time 2 (ρ = .62, p.05). Some RB infants showed a developmental delay. Mother-child interactions were negatively affected and mothers recognized their infants' problem. The support needs to be provided in early infancy.

This study aimed to clarify the characteristics of the Japanese version of the Infant-Toddler Social and Emotional Assessment (J-ITSEA), a parentreport questionnaire concerning social-emotional/behavioral problems and delays in competence in 1- to 3-year-old children. The differences in score between genders, ages, and between the J-ITSEA and the original Infant-Toddler Social and Emotional Assessment were examined. The data of 617 participants recruited from Saitama prefecture through stratified two-stage sampling were analyzed. The Cronbach's alpha ranged from 0.76 to 0.93. Gender differences emerged for some problems and all competence scales, with boys rated higher in the Externalizing problem domain and Activity/Impulsivity subscale and girls rated higher in the Internalizing problem domain, Inhibition to Novelty subscale, and all Competence scales. The Competence domain score increased across age groups. Compared with a normative sample in the US, participants in this study rated higher in Aggression/Defiance and Separation Distress, and rated lower in Peer Aggression and most of the Competence scales. The results indicate that the J-ITSEA scores should be interpreted in comparison with standard scores assigned for gender and 6-month age groups, and that specific criteria for the cut-off points for the J-ITSEA are required instead of those in the original questionnaire.

The aim of this study was to investigate the effectiveness of the Japanese Infant Mental Health Program (JIMHP) for preterm mother–infant dyads until the infants reached 12 months of corrected age. Mothers in the JIMHP group (n = 26) received one hospital visit in addition to standard care in the Growing Care Unit (GCU) and five home visits based on the principles of infant mental health (IMH) after discharge from the hospital, until the infant reached 12 months of corrected age. In contrast, mothers in the control program group (n = 40) received standard care in the GCU and three conventional home visits during the same period. The dyads were then compared across groups, revealing that the JIMHP dyads showed less maternal depressive symptoms, better maternal interaction, increased social support by medical workers and healthcare professionals, a high persistence rate for attending the program, and a more positive perception toward the program (p < .05). However, there were no significant differences in the impact of parenting stress or in child development. These results are discussed in terms of their significance and the practical/clinical availability of IMH principles and the JIMHP as a new support model for preterm infants in Japan.

The aim of this study was to compare father-infant interaction with mother-infant interaction, and explore differences and similarities between parents. Related factors for quality of father-infant interaction were also examined. Sixteen pairs of parents with infants aged 0 to 36 months were observed for play interaction between parents and their children. Results suggested no significant differences between parents, but children's interactions were significantly more contingent with fathers than mothers (p =.045). Significant correlations between parents were found in socialemotional growth fostering encouragement for children during interaction (ρ =.73, p =.001). Paternal depressive symptoms were significantly correlated to paternal sensitivity to child's cues (ρ =-.59, p =.017).

The study was an exploratory pilot study in which subjects consisted of adolescent mothers and their infants in Japan. Background: Japanese adolescents giving birth to their babies are increasing although only at a rate of 1.4%. They chose to give birth more often instead of abortion than in past years. In Japanese society, it is not easy for an adolescent to be recognized as a mother because their knowledge is not sufficient for parenting and they are not ready to be a mother. They usually need support to be a mother. Purpose: The study examined relationships among adolescent mother-infant interaction, maternal self-esteem, and parenting stress, which affect child development, in order to make recommendations for helping Japanese adolescent mothers in parenting. Methods: The subjects were 10 adolescent mothers and their infants aged 3–12 months (adolescent group) and 10 mothers whose mean age was 28.9 years, the same age range when Japanese women gave birth to their first baby (comparison group). This study examined differences in mother-infant interaction, self-esteem, and parenting stress between the adolescent and comparison groups. Results: Maternal self-esteem had a significant negative correlation with mother-infant interaction and parenting stress. Nursing Child Assessment Feeding Scale scores-especially the “Sensitivity to Cues” subscale-among the adolescent group were significantly lower than those of the comparison group. High parenting stress was influenced by difficulty in understanding about infant and a restraint coming from the parenting role. Conclusion: Delicately reading of child cues and promptly an appropriately responds to them make more attuned mother-infant relationships. The study suggested that adolescent mother-infant relationship has positive correlation of maternal self-esteem and parenting stress, informing recommendations for nurses to replace their negative selfimage of these youth with a positive one, which may ultimately lessen parenting stress.

This study examined the effects of early intervention on mothers and their preterm infants. Intervention aimed to facilitate mother-infant interaction by enhancing the mother's ability to modulate her infant's state and to read infant cues. Specifically, the intervention consisted of a nurse researcher visiting the Neonatal Intensive Care Unit (NICU) before each infant was discharged, and conducting post-discharge home visits until the infant reached a corrected age of 60 weeks. For research design purposes, mother-infant dyads were placed into either (1) an Intensive Intervention Group (ⅡG) or (2) a Mild Intervention Group (MIG). The outcomes of the groups were then compared. The effects of early intervention were rated by examining mother-infant interaction and the durations of infant sleep and crying. Despite individual differences, there were more improved interaction scores at Time 1 in ⅡG members that had recorded lower interaction scores earlier than those of MIG. A lower frequency of night crying was also recorded from the ⅡG. The results implied that interventions teaching state-modulation methods and cue reading to the mothers should be started while their infants are in the NICU.

Background: Mother–infant interactions have been acknowledged as one of the most important elements in measuring outcomes of parent support and infant mental health interventions. The present study was conducted to measure early intervention outcomes using the Nursing Child Assessment Teaching Scale (NCATS), and to identify factors that affected Japanese mother–infant interactions. Methods: Healthy Japanese mother–infant dyads who had lower scores on the NCATS, indicating potential problems, were assigned to an intervention group, and compared with a control group who had higher scores on NCATS. Health-care professionals visited the intervention group dyads in their homes, and gave them positive feedback on their interactions, consultations on parenting, and health advice. The control group dyads had home visitation once every 6 months for assessment only. Results: The home visitations started at 3 months of age and continued until 18 months. NCATS scores in both groups were significantly different at baseline but differences faded by the end, which suggests that the intervention promoted improved interactions in the intervention group. Two of five factors were identified as influencing mother–infant interactions: maternal age; and personal networks, and together they significantly explained 27–30% of NCATS variance. Conclusion: The results appear to support the validity of measuring Japanese mother–infant interactions with NCATS. This study is the first to measure the outcomes of early intervention on Japanese dyads’ interactions using NCATS. Additional replication studies should be conducted elsewhere in Japan, and clinical practices for promoting mother–infant interactions should begin to assess their effectiveness with NCATS as an outcome measure.