Factors Associated with Anemia and Iron Deficiency during Pregnancy: A Prospective Observational Study in Japan.

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.

Association of Eicosapentaenoic and Docosahexaenoic Acid Intake with Low Birth Weight in the Second Trimester: The Japan Pregnancy Eating and Activity Cohort Study.

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.

Dietary Intake and Its Association with Birth Outcomes in Women with Nausea and Vomiting during the Second Trimester of Pregnancy: A Prospective Cohort Study in Japan.

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.

Sleep quality and temperament in association with autism spectrum disorder among infants in Japan.

BACKGROUND: Sleep problems and irritable temperaments are common among infants with autism spectrum disorder (ASD). The prospective association between such sleep problems and irritable temperaments and ASDs needs to be determined for elucidating the mechanism and exploring the future intervention study. Thus, in this study, we investigated whether sleep quality and temperament in 1-month-old infants are associated with the onset of ASD in 3-year-old children. We also assessed its sex-stratified associations. METHODS: We conducted a longitudinal study using data from 69,751 mothers and infants from a large-cohort study, the Japan Environment and Children's Study. We examined the prospective association between infant sleep quality and temperament at 1 month of age and ASD diagnosis by 3 years of age. RESULTS: Here we show infants with longer daytime sleep have a higher risk of later ASD than those with shorter daytime sleep (risk ratio [RR]: 1.33, 95% confidence interval [CI]: 1.01-1.75). Infants who experienced intense crying have a higher risk of ASD than those who did not (RR: 1.31, 95% CI: 1.00-1.72). There is a difference in sex in the association between a bad mood and later ASD. In particular, female infants experiencing bad moods have a higher risk of ASD than others (RR: 3.59, 95% CI: 1.91-6.75). CONCLUSIONS: The study findings provide important information for future intervention to reduce the risk of future ASD.

Sleep problems and irritable temperaments are common among infants with autism. This study looked at the sleep and temperament of nearly 70,000 1-month-old infants in Japan and whether they were subsequently diagnosed with autism spectrum disorder during the first three years of life. Children who had slept for longer during the day and were more prone to frequent, prolonged, or intense crying were more likely to have been diagnosed with Autism Spectrum Disorder by age 3. The findings of this study might be useful for those monitoring the development of autism spectrum disorder or developing support for those with autism spectrum disorders.

Association of sleep quality with temperament among one-month-old infants in The Japan Environment and Children's Study.

This study aimed to examine the association between infant sleep quality and temperament in one-month-old infants using a large cohort study data. We used data from the Japan Environment and Children's Study, a cohort study which follows around 100,000 women from pregnancy until their children's development. The mothers were asked about their infants' sleep and temperament using a structured questionnaire. Frequent crying (adjusted odds ratio [AOR]: 1.05, 95% confidence interval [CI]: 1.00-1.10) and intense crying (AOR: 1.19, 95% CI: 1.13-1.25) were positively associated with longer sleep periods during the day than at night. Female infants with longer daytime sleep periods than that at nighttime were more likely to cry frequently (AOR: 1.11, 95% CI: 1.04-1.20). Parous women with infants who had frequent night awakening believed their infants cried more intensely (AOR: 1.17, 95% CI: 1.03-1.31). The study demonstrated a specific association between sleep quality and temperament in one-month-old infants. Based on the results of this study, further sleep intervention studies are required to improve infant temperament.

Interoception is associated with anxiety and depression in pregnant women: A pilot study.

Pregnancy and postpartum are periods in which women develop psychosocially. However, becoming a mother is stressful, and mood disorders related to anxiety and depression often develop. In recent years, research on interoception-sensations related to the body's internal physiological state-has attracted attention. Interoception has multifaceted characteristics. It involves directly perceiving information in the body while also inferring and evaluating it. In this study, we examined interoception, anxiety, and depression in Japanese pregnant women. Empirical examinations and questionnaire surveys were used to measure interoception in 32 pregnant women not at high risk of pregnancy. A Japanese adaption of the Multidimensional Assessment of Interoceptive Awareness was used to measure interoceptive sensibility, and a heartbeat counting task performance was used to measure interoceptive accuracy. Anxiety and depression were measured using the Japanese versions of the State-Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale, respectively. A correlation analysis was performed between interoception, anxiety and depression and between differences between sensibility and accuracy of interoception, anxiety and depression. We revealed that interoceptive sensibility and differences between sensibility and accuracy of interoception were associated with anxiety. Based on results of this pilot study, it is necessary to investigate using longitudinal studies whether interoception might be an effective predictor tool for early detection of anxiety during pregnancy and postpartum.

Influence of mothers' nighttime responses on the sleep-wake rhythm of 1-month-old infants.

The purpose of this study was to analyze the influence of the mothers' nighttime responses on the sleep-wake rhythm of their 1-month-old infants. This study used an anonymous self-administered survey questionnaire with 1133 mothers of 1-month-old infants. The questionnaire investigated basic information about the parents, growth environment of infants, mothers' sleep patterns during pregnancy, and infants' sleep patterns at the age of one month. Logistic regression analysis was used to analyze the influence of nighttime responses on the risk of infants sleeping longer during the day than at night. Regarding nighttime response behavior, it was found that immediately picking up 1-month-old infants results in longer sleep during the day than at night (OR 1.616 [1.017 - 2.566], p = 0.042), compared to delaying picking up the infant. It was suggested that the stimulation due to picking up an infant may affect sleep-wake rhythm formation.

A longitudinal study of bonding failure related to aspects of posttraumatic stress symptoms after childbirth among Japanese mothers.

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.

Use of the Stafford Interview for assessing perinatal bonding disorders.

Perinatal bonding disorders have been advocated by Brockington and he developed the semistructured Stafford Interview which contains a specific section to assess these disorders. To our knowledge, this is the first report on a fully described clinical case by using the interview. A 29-year-old primiparous mother gave birth to a healthy girl, but visited our clinic because of depression at one month postnatally and received pharmacotherapy. Despite improvement of her depression, at around 7 months postnatally, she felt distressed by childcare. The Stafford Interview was conducted and it manifested evidences of anger and rejection to her infant: she screamed at her infant because of anger towards her infant, and had desire to escape from the baby care and then temporally transferred the care to her mother (grandmother of the baby). The evidence of maternal feelings by using the Stafford Interview is practically useful for treating mothers with bonding disorders.

The Japanese version of the Postpartum Bonding Questionnaire: Examination of the reliability, validity, and scale structure.

OBJECTIVE: The purpose of this study was to develop the Japanese version of the Postpartum Bonding Questionnaire (PBQ) to gather data on Japanese mothers for comparison with other cultures and to examine the scale structure of the PBQ among Japanese mothers. METHODS: We administered the PBQ to a cross-section of 244 mothers 4 weeks after delivery and again 2 weeks later to 199 mothers as a retest to examine reliability. We used exploratory factor analysis to evaluate the factor structure of the PBQ. Correlations with the Mother-to-Infant Bonding Scale (MIBS), the Maternal Attachment Inventory (MAI), Edinburgh Postnatal Depression Scale (EPDS), and sociodemographic variables were calculated for validation. RESULTS: The 14-item version of the PBQ extracted by exploratory analysis consisted of four factors: 'impaired bonding', 'rejection and anger', 'anxiety about care', and 'lack of affection'. We found significant correlations of the total scores of the PBQ and the 14-item version of the PBQ positively with the MIBS and negatively with the MAI. Moderate significant correlations with total scores were also found with the EPDS. Total scores for primiparous and depressed mothers were higher than those for multiparous mothers and mothers without depression. CONCLUSION: The results of this study demonstrated the reliability and validity of the PBQ and the 14-item version of the PBQ in Japanese mothers 4 weeks after delivery.

Information-seeking experiences and decision-making roles of Japanese women with breast cancer.

PURPOSE: To investigate the information-seeking experiences and decision-making roles of Japanese women with breast cancer, to examine the relationship between information-seeking experiences and decision-making roles, and to explore the factors that influenced taking a more active role than the preferred role during the treatment decision-making process. METHODS: In a cross-sectional study, women with breast cancer were retrospectively administered the Control Preferences Scale and the Information-Seeking Experience Scale. The Chi-Square test was used to compare differences among individual variables in decision-making roles and information-seeking experiences. Logistic regression analysis was used to explore the factors that influenced taking a more active role than the preferred role. RESULTS: One hundred and four patients with breast cancer participated in the investigation. Eighty-five patients (78%) perceived themselves as having knowledge of breast cancer and most patients (92%) sought information on breast cancer. The preferred roles in decision-making that they reported having before treatment were 18% active, 69% collaborative and 13% passive. The actual roles they perceived having experienced were 27% active, 43% collaborative and 30% passive. Although there was concordance of preferred and actual role for only 59% of the women, most patients reported that they were satisfied with their decision-making. Many women with breast cancer reported negative experiences with information seeking, including wanting more information (49%), expending a lot of effort to obtain the information needed (53%), not having enough time to obtain needed information (55%), frustration during the search for information (44%), concerns about the quality of the information (45%) and difficulty understanding the information received (49%). This study revealed that having a more active actual role than the initial preferred role was associated with emotional expression to the physician, having undergone mastectomy, and the desire for more information. CONCLUSION: Most women with breast cancer sought information on breast cancer and expressed a preference for a collaborative relationship with physicians in treatment decision-making. Patients who expressed emotion to their physician, wanted more information, and underwent mastectomy were most likely to change their actual decision-making role toward a more active choice.

[Analysis of parent-child sleeping and living habits related to later bedtimes in children].

PURPOSE: To find the relationship between parents' sleeping and living behaviors and their children's sleeping habits, and to investigate factors specifically related to children staying up late in recent Japan. METHODS: During regular health check-ups of children at three local health centers in the city A, we recruited the parents of one-and-half-year-old and three-year-old children to participate in the Child Sleep Cohort Project (ChiSCoP). Parents of 184 children who consented to participation were mailed three questionnaires by placement method. These are "sleeping diary for 10 days," "sleeping and lifetime rhythm survey," and "emotional behavior assessment scale (CBCL : Child Behavior Checklist 2rd/3rd edition)," of which valid data on 178 children were collected over two years and analyzed. ANALYSIS: Participants' demographic data, perceived and actual sleeping and living habits, and bedtime patterns were compared among the groups classified by bedtime of children. Bedtimes were classified as early (before 21 : 00), normal (21 : 00 to 21 : 59), and late (after 22 : 00). Using one-way analysis of variance with two (early vs. late) and three bedtime categories, significant differences were found among the three bedtime categories about childcare environmental factors (meal, daytime activity, TV, nap, and bath). So we performed logistic regression analysis with "late bedtime" as the dependent variable and scores of environmental factors (upper or lower than median values) as independent variables in a stepwise manner to eliminate collinear variables and to obtain adjusted odds ratios. RESULTS: 1) Among the 178 children, 96 and 82 were recruited during the physical check-up for one-and-half-year-old and three-years-old, respectively. There were 49, 72, and 57 children in the early, normal, and late bedtime groups, respectively, and no significant difference in attribute factors was found. 2) In children of the early bedtime group, proportions of those with "efforts to establish good life rhythm" (P < 0.0001), "efforts to cultivate sleeping habits" (P < 0.0001), and "keeping a regular bedtime" (P < 0.05) were significantly higher, as well as for children who had more than 105 minutes of "daytime nap" compared to children who had less (P < 0.05). 3) Children's bedtimes were significantly correlated with "mother's wake-up time on weekdays" (r = 0.33) and "mother's bedtime on weekdays" (r = 0.33). Children's wake-up times were also correlated with "mother's wake-up time on weekdays and weekends" (r = 0.49) and "mother's bedtime on weekdays" (r = 0.34), which indicates that children's wake-up times had relationship with mother's sleeping and life habits. 4) Later "wake-up time on weekends" (odds ratio = 4.9) and "regular bedtime hour" (odds ratio = 3.53) were found to be the determinant of late bedtimes of children. CONCLUSIONS: To encourage earlier bedtimes in children, it is important to take he mother's sleeping and living habits into account and to maintain a regular wake-up and bedtime schedule across weekdays and weekends.

[Analysis of late bedtime and influencing factors for it with respect to infants' development age and sleep behavior of parents and children].

PURPOSE: To understand influencing factors for late bedtime of infants having nocturnal life, with respect to each development age and sleep behavior of parents and children. We researched on sleep-awake behaviors and ten-day sleep logs of 277 subjects, who registered for a three-year cohort survey. The cohort is recruited at the time of routine examinations for 4 month, 1.5 years, and 3 years, held at three Health and Welfare centers in Fukuoka city in September and October, 2007. We conducted two-way analysis of variance and post-hoc test of Turkey's multiple comparative tests. The independent variables are three age groups (infants, 1.5 years, and 3 years) and three bedtime categories (late: after 22 o'clock, normal: between 21 and 22 o'clock, and early: before 21 o'clock), and the dependent variables are background date, sleep parameter of parents and children, and factors of sleep behavior and so on. The qualitative data including physical conditions, growth status, frequencies of each life activity are analyzed by tabulation, and fulfillment in child raring is analyzed by stepwise multiple linear regression analysis with 15 objective variables, to bring out factors to induce nocturnal life. RESULTS: Children's bedtime had significant effect for bedtime variables. The bedtime difference was about 40 minutes between the early bedtime group and the late bedtime group. The early bedtime group had the earliest wake-up time among the all age groups, followed by the normal, and then the late bedtime group. Efforts to keep regular sleep and wake-up times were made greatly in the early bedtime group, and the normal and then the late bedtime group followed after. The mothers in the late bedtime group considened an ideal bedtime was around 21h although they were not able to realize it. The lengths of TV viewing and daytime nap had also significant effects for children's bedtimes. As a result of multiple comparisons, there were significant differences between the early and the late bedtime groups and between the normal and the late bedtime groups. For the bedtime of children, only mothers' total sleep hours on weekdays had a significant negative correlation, while all the other parameters were significantly and positively correlated. DISCUSSION: The study showed influencing factors for bedtime of children were mothers' routine duties in daily life, especially wake-up time, total sleep hours, daytime napping hours of children, and the length of TV viewing. This suggests that further effort on education for sleep environment management is needed.