Differences in health literacy related to gestational weight gain and children's birth weight according to maternal nativity status in the Japan Environment and Children's Study (JECS): a longitudinal cohort study.

OBJECTIVES: We examined literacy related to healthy gestational weight gain (GWG) in immigrant and native Japanese mothers and determined whether it is associated with children's birth weight. DESIGN: Longitudinal cohort study. SETTING: As the baseline survey in the Japan Environment and Children's Study (JECS), mothers completed self-administered questionnaires distributed by hand during pregnancy. The self-administered questionnaires used in this study were distributed by mail 6 months after delivery. Children's birth weight, actual GWG and any complications during delivery were recorded by obstetricians collaborating with JECS. PARTICIPANTS: Of 97 452 mothers who consented to participate in the JECS during pregnancy between January 2011 and March 2014, 67 953 were included in this study after exclusions for multiple births, multiple instances of consent by the same pregnant woman, miscarriages/stillbirths or withdrawal from the study within 3 years after participating. In total, 324 immigrant mothers and 963 native Japanese mothers were selected by propensity score matching for analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Data were collected on maternal literacy related to healthy GWG at the baseline survey, and data on actual GWG and children's birth weight were collected by obstetricians. The associations of knowledge about healthy GWG and mothers' actual GWG with maternal nativity status were examined using a χ2 or Student's t-test. RESULTS: More native Japanese mothers than immigrant mothers knew the appropriate GWG and reason the for needing to know this. Actual GWG was significantly higher among the immigrant mothers, but was within the recommended range. The low birthweight (LBW) incidence was significantly higher among the native mothers. CONCLUSIONS: Immigrant mothers to Japan had less knowledge about appropriate GWG, but their actual GWG was appropriate and they delivered fewer LBW infants than native Japanese mothers. These findings may indicate the presence of other protective factors for pregnancy or delivery among immigrant mothers.

Content analysis of health-related subjects in the K12 school curricula of Japan, Indonesia, Philippines, Guam, Micronesia, Marshall Islands, Palau, and Fiji.

BACKGROUND: As a component of health promoting school, a school curriculum for health education was considered a fundamental. This survey aimed to identify the components of health-related topics and in which subjects were they taught. METHODS: Four topics were chosen: (i) hygiene, (ii) mental health, (iii) nutrition-oral Health, and (iv) environmental education related to global warming in Education for Sustainable Development (ESD). Before gathering the curricula from partner countries, school health specialists were gathered to discuss the appropriate components of a curriculum that required evaluation. The survey sheet was distributed to and answered by our partner in each country. RESULTS: About hygiene, individual practices or items that improve health-related were widely covered. However, items that imparted health-related education from an environmental perspective were not widely covered. About mental health, two types of country groups were identified. The first group included countries that taught mental health topics mainly as part of morals or religion; the second group included countries that imparted mental health topics mainly as part of health. The first group focused mainly on communication skills or coping methods. The second group focused not only on communication and coping skill but also on basic knowledge of mental health. About nutrition-oral education, three types of country groups were identified. One group imparted nutrition-oral education mainly in terms of health or nutrition. Another group imparted this topic mainly in terms of morals, home economics, and social science. The third group was the intermediate group. About ESD, a solid structure for this topic was not identified in any country. Many items were taught as part of science, while some were taught as part of social studies. Climate change was the most commonly taught item across all countries. The items related to environment were relatively limited compared to those related to natural disasters. CONCLUSIONS: Overall, two different approaches were identified: the cultural-based approach, which promotes healthy behaviors as moral codes or community-friendly behaviors and the science-based approach, which promotes children's health through scientific perspectives. Policymakers should initially  consider the findings of this study while making decisions on which approach should be taken.

Predictors of non-response to successive waves of surveys in the Japan Environment and Children's Study during the 3-year postpartum period: a longitudinal cohort study.

OBJECTIVES: We examined changes in factors related to non-response to successive waves of the nationwide birth cohort study, the Japan Environment and Children's Study (JECS), during the first 3 years after childbirth. DESIGN: Longitudinal cohort study. SETTING: As the baseline survey, mothers completed self-administered questionnaires distributed by hand during pregnancy or 1 month after delivery. The self-administered questionnaires that we used in this study were then distributed by mail every 6 months until the children were 3 years old, for a total of six times. PARTICIPANTS: Of 103 060 mothers who consented to participate in the JECS during pregnancy, 88 489 mothers were included in the study after excluding those with multiple births, miscarriages or stillbirths and those who withdrew from the study within 3 years after providing informed consent. PRIMARY AND SECONDARY OUTCOME MEASURES: Data were collected at the baseline survey on participants' socioeconomic status, medical history, health status, health-related behaviours and their children's health conditions and living situations. The strength of the impact of related factors and the prediction of response status were examined and compared using binominal logistic regression analysis. RESULTS: For all six follow-up questionnaire surveys, higher maternal age was strongly associated with providing a response. Factors that were strongly associated with mothers not providing a response were smoking after childbirth and having more children. The concordance rate of response status based on the presented model was about 70%, suggesting that the response status for the first 3 years after birth can be predicted from the information collected in the baseline survey. CONCLUSION: By identifying predictors of non-response from information obtained in baseline surveys, researchers may be able to reduce non-response to successive survey waves by issuing reminders, reviewing data collection methods and providing appropriate financial and/or non-financial incentives.

Status of school health programs in Asia: National policy and implementation.

BACKGROUND: The WHO's Health Promoting Schools (HPS) framework is based on an understanding of the reciprocal relationship between health and education, and the need to take a holistic approach to health promotion in schools. We aim to clarify the degree to which the HPS framework is reflected in the national policies of eight target countries and the issues surrounding its successful implementation. METHODS: Date were collected through two expert workshops with participants from eight Asian countries: Cambodia, China, Japan, Korea, Lao PDR, Nepal, the Philippines, and Thailand. In the first workshop, data collected on national policy were mapped against the HPS framework. From this, key issues were identified, and follow-up data collection was conducted in each country for a second workshop. RESULTS: We identified a policy shift toward the HPS framework in six out of the eight countries. Neither Japan nor Korea had changed their national policy frameworks to reflect an HPS approach; however, in the latter, model programs had been introduced at a local level. We identified various barriers to successful implementation, especially in relation to mental health and wellbeing. CONCLUSION: Given the recent shift toward the HPS approach in six out of the eight countries in this study, there is a need to conduct research to assess the impact of this framework on the health and wellbeing of students and school staff. At the same time, we call for more dialog in the context of Japan to explore the possible benefits of introducing the HPS framework into schools.

Provision of educational events and subsequent questionnaire response rates in a large-scale birth cohort study from Japan.

OBJECTIVES: We examined whether providing educational events for participants in a birth cohort study would increase the response rates of study questionnaires. DESIGN: Birth cohort study. SETTING: Questionnaires were distributed and returned by post twice in 1 year. We developed and implemented two educational sessions; a Baby Food lecture for mothers with children around 8 months old (analysis 1) and a Eurythmic session for mothers with children around 1 year and 8 months old (analysis 2). Mothers with children over the target ages were not invited (not-invited group). The invited participants were divided into three groups: those who did not apply to attend (not-applied group), those who applied but did not attend (applied group), and those who applied and attended (attended group). PARTICIPANTS: The participants were 5379 mother-child pairs registered with the Toyama Regional Center of the Japan Environment and Children's Study (JECS). OUTCOME MEASURE: The outcome measure was return of the JECS questionnaire for 1 year old sent out after the Baby Food lecture and the JECS questionnaire for 2 years old sent out after the Eurythmic session. The questionnaires were returned to us by post. RESULTS: The response rate for the attended group of the Baby Food lecture was 99.7%, and the odds ratio (OR) was significantly higher for this group than for the not-invited group (crude OR 24.54; 95% confidence interval (CI) 3.42 to 176.13; analysis 1). After the exclusion of participants who had previously attended the Baby Food lecture, the response rate for the attended group of the Eurythmic session was 97.8%, and the OR was significantly higher for this group than for the not-invited group (adjusted OR 5.66; 95% CI 1.93 to 16.54; analysis 2). CONCLUSION: Providing educational events that are appropriate to the age and needs of the participants may increase questionnaire response rates in birth cohort studies. TRIAL REGISTRATION NUMBER: UMIN 000030786.

Association between maternal smoking history and congenital anomalies in children: Results from the Japan Environment and Children's Study.

We investigated the relationship between maternal smoking history and congenital anomalies in children. Drawing on data from the Japan Environment and Children's Study collected between January 2011 and March 2014, the smoking habits of pregnant women were categorized as "never smoked," "quit before pregnancy, "quit after pregnancy," and "full smoking." Of the 91 626 participants examined, a total of 2199 (2.4%) infants were born with any congenital anomalies. Logistic regression analysis was used to determine the odds ratio for congenital anomalies in each group based on maternal smoking history. No significant difference was seen between the full-smoking and never smoked groups in the odds ratios for congenital anomalies of the nervous system; the eyes, ears, face, and neck; the cardiovascular system; or the musculoskeletal system. However, in the full-smoking group, the odds ratios for trisomy (adjusted odds ratio, 2.14; 95% confidence interval, 1.15-3.97) and any congenital anomalies (adjusted odds ratio, 1.35; 95% confidence interval, 1.09-1.67) were significantly higher compared with the never smoked group. Our results indicate that continuing to smoke during pregnancy is associated with increased risk of trisomy and any congenital anomalies in the general Japanese population.

Health screening system to ensure children's health and development in Japan.

BACKGROUND: The establishment of health screening systems for children is important, however, such systems are not always well-established in developing countries. This study aimed to improve child health screening systems in developing countries by analyzing the factors that contribute to enabling continuous and proper screenings at various governmental levels in Japan. METHODS: We reviewed the history of child health and development screening systems in Japan and examined factors that enabled their regular and nationwide implementation. RESULTS: We identified the six enabling factors: (i) the existence of relevant laws and regulations in health and education systems for health checkups, (ii) mandated and detailed conditions for health checkups within both school and community health, (iii) the provision of guidelines and manuals for health checkups, (iv) a sufficient number of professionals to carry out the health checkups, (v) clear criteria for evaluating and interpreting the checkup results, and (vi) understanding among teachers, children, and guardians of the importance of health checkups. CONCLUSION: We proposed the following six requirements to the governments in developing countries for establishing their own health screening programs: (i) a clear description of the need for regular and continuous health checkups in the relevant laws, regulations, and policies, (ii) mandate as essential activity and detailed requirements of the screening activities, (iii) provision of relevant manuals for health workers and teachers, (iv) provision of enough well-trained professionals and a training system, (v) studying growth and development curves for children, and (vi) promoting understanding among stakeholders about the importance of health checkups.

Association of blood cadmium levels in pregnant women with infant birth size and small for gestational age infants: The Japan Environment and Children's study.

BACKGROUND: There is growing evidence of an association between cadmium (Cd) and unfavorable birth outcomes. The effect of Cd exposure on anthropometric measures at birth or small for gestational age (SGA) infants in a large, nationwide Japanese cohort remains to be clarified. OBJECTIVES: To analyze the association between maternal blood Cd levels at different sampling times and sex-dependent infant birth size, weight, body length, chest, and head circumferences, in addition to SGA. METHODS: Data of 17,584 pregnant women in the Japan Environment and Children's Study were analyzed for anthropometric measurements. For SGA determination, 13,969 cases of vaginal delivery were analyzed after excluding infants born by cesarean section. Maternal blood Cd levels were categorized into quartiles (Q1-Q4), and the Q1 was used as a reference. Multiple linear regression analysis was performed for anthropometric measurements, and multiple logistic regression analysis was used to investigate the association of maternal blood Cd levels with the risk of SGA. RESULTS: Birth weight tended to decrease according to the increase in quartiles of blood Cd levels (15.63 g decrease [95% confidence level (CI): -33.26, 2.01] for Q4). The overall analysis revealed no decreases in body length and head and chest circumference, but subgroup analysis revealed that chest circumference tended to decrease according to the increase in quartiles in the female sex/third-trimester stratification (0.16 cm decrease [95% CI: -0.32, 0.00] for Q4). SGA risk was also higher and paralleled the increase in blood Cd levels associated with the female sex/third-trimester group (Odds Ratio 1.90 [95% CI: 1.23, 2.94] for Q4). CONCLUSION: Our results provide further evidence of sex-specific health risks associated with Cd exposure in early life in a large Japanese pregnancy cohort.

Relationship between tartrate-resistant acid phosphatase 5b and stress fractures in female athletes.

BACKGROUND: Approximately 10% of female athletes have a history of stress fractures, which most commonly occur between the ages of 16 and 17 years old. PURPOSE: We investigated whether tartrate-resistant acid phosphatase 5b (TRACP-5b), which is a bone resorption marker, can serve as a valid predictor of stress fractures in female athletes in their teens and 20s. METHODS: Three hundred and sixteen elite female athletes were recruited between 2013 and 2015. Serum TRACP-5b and various hormones were examined in blood samples. The serum TRACP-5b level was compared between athletes with and without stress fractures within 3 months after the initial collection of their blood samples. RESULTS: The 316 athletes were divided into two age groups: 13-19 years old and 20-29 years old. Thirty-six athletes (11.4%) experienced new stress fractures within 3 months after the initial collection of their blood samples. The median serum TRACP-5b level was significantly higher in teenage athletes with new stress fractures than in teenage athletes without new stress fractures. In univariate logistic regression analysis, the Z-score of serum TRACP-5b was a significant predictive factor of stress fractures in teenage athletes only (odds ratio: 1.87; 95% CI: 1.31-2.66; P < 0.0012). CONCLUSION: For teenage female athletes, TRACP-5b is a predictor of the risk of stress fractures, and measuring TRACP-5b levels may be useful to prevent stress fractures.

Low Bone Mineral Density in Elite Female Athletes With a History of Secondary Amenorrhea in Their Teens.

OBJECTIVE: To determine whether secondary amenorrhea during teenage years influences bone mineral density (BMD) in female athletes in their 20s. DESIGN: Original research. SETTING: Japan Institute of Sports Sciences. PARTICIPANTS: Two hundred ten elite female athletes older than 20 years were included in the study. MAIN OUTCOME MEASURES: Information on the participants' past (ie, during their teenage years) and current menstrual cycle, training time, history of stress fractures, and blood tests for hormones received was obtained. Bone mineral density of the lumbar spine was evaluated by dual-energy x-ray absorptiometry; low BMD was defined as a Z-score ≤-1. We investigated the correlation factors for low BMD in athletes in their 20s by univariable and multivariable logistic regression analysis. RESULTS: A total of 39 (18.6%) female athletes had low BMD. Secondary amenorrhea in their teens [odds ratio (OR), 7.11, 95% confidence interval (CI), 2.38-21.24; P < 0.001] and present body mass index (BMI) (OR, 0.56, 95% CI, 0.42-0.73; P < 0.001) were independent correlation factors for low BMD in the multivariable logistic regression analysis. The average Z-score for those with secondary amenorrhea in their teens and 20s, secondary amenorrhea in their 20s only, and regular menstruation was -1.56 ± 1.00, -0.45 ± 1.21, and 0.82 ± 1.11 g/cm, respectively. CONCLUSIONS: Secondary amenorrhea for at least 1 year during teenage years in female athletes and BMI at present was strongly associated with low BMD in their 20s.

Factors of non-responsive or lost-to-follow-up Japanese mothers during the first year post partum following the Japan Environment and Children's Study: a longitudinal cohort study.

OBJECTIVES: We examined the factors related to lost-to-follow-up of a birth cohort study during the first year after delivery. DESIGN: Longitudinal cohort study. SETTING: Questionnaires were provided by mail. Mothers answered the questionnaires about the children twice: at 6 months and 1 year. PARTICIPANTS: Of 103 062 pregnancies who consented to participate in the Japan Environment and Children's Study (JECS), 93 417 mothers were included in the study after excluding those with multiple births, miscarriages or stillbirths and those who withdrew from the study within 1 year after providing informed consent. PRIMARY AND SECONDARY OUTCOME MEASURES: Participants' socioeconomic status, medical history, health status, health-related behaviours, their children's health conditions and living situations were collected by self-administered questionnaires during pregnancy or 1 month after delivery as the baseline survey. In addition, two self-administered questionnaires were distributed 6 months and 1 year after delivery. Using the response status of the two questionnaires after delivery, participants' follow-up status was divided into four groups. The related factors were examined using logistic regression analysis. RESULTS: Factors positively correlated with lost-to-follow-up to the questionnaires were postpartum physical conditions, psychological distress during pregnancy, the child's health status at birth, the child's primary caregiver and the number of siblings of the child. Partners' active participation in JECS was associated with a lower lost-to-follow-up rate to the two questionnaires, whereas inactive participation was positively associated with a higher lost-to-follow-up rate. CONCLUSION: The response rate to the questionnaires seems to be related to the interest and understanding of participants' partners. In addition, the response rates are related to participants' physical conditions and living conditions. To decrease lost-to-follow-up rates in consecutive questionnaire surveys within a cohort study, it may be important for investigators to recognise that participants and their motivation in research can be influenced by perceptions they may have regarding the objectives of the research.

Serum soluble interleukin-2 receptor levels for screening for malignant lymphomas and differential diagnosis from other conditions.

The serum soluble interleukin 2 receptor (sIL2R) level is elevated in patients with most types of lymphoid neoplasms, and is also elevated in patients with solid tumors or reactive conditions, such as severe inflammation. To evaluate the diagnostic significance of sIL2R levels for the screening and differential diagnosis of lymphomas, data from 248 consecutive adult patients with suspected lymphoma were retrospectively analyzed in order to determine its diagnostic characteristics and the clinical parameters that affect diagnosis. In 133 patients with aggressive or indolent lymphomas or related neoplasms, the sIL2R level was higher (median: 920 U/ml, standard deviation: 7,312 U/ml) compared with that of 115 patients with other diagnoses (median: 520 U/ml, standard deviation: 727 U/ml), including solid tumors, infection, inflammation, and others. When the cutoff value of sIL2R was 1,104 U/ml, the specificity was 80%, at which point lymphoma was suspected. When the threshold levels were increased from 1,500 to 2,000 U/ml, the specificity increased from 87 to 93%, with the positive likelihood ratio increasing from 2.99 to 4.97, strongly suggesting the diagnosis of lymphoma. The receiver operating characteristic curve for prediction of lymphoma by sIL2R revealed that the area under the curve was 0.695. The curve was nearest to the left corner of the plot when the threshold was 1,946 U/ml; at this point, the sensitivity, specificity and positive likelihood ratio were 35%, 93% and 5.06, respectively. Multivariate analysis demonstrated that an age >46 years and lactate dehydrogenase level >173 U/l appeared to increase the risk of malignant lymphoma diagnosis. Although sIL2R appears to be a less specific marker for the screening of lymphomas, its detection at higher levels strongly suggests the diagnosis of lymphomas. Therefore, sIL2R may be more useful compared with any other parameter for lymphoma diagnosis, provided other false-positive conditions are taken into consideration.

Analysis of non-respondent pregnant women who were registered in the Japan Environment and Children's Study: a longitudinal cohort study.

OBJECTIVES: Non-response to questionnaires in a longitudinal study reduces the effective sample size and introduces bias. We identified the characteristics of non-respondent pregnant women, and compared them with respondents in the Japan Environment and Children's Study (JECS) during the gestational period. DESIGN: This was a questionnaire-based, longitudinal cohort study. SETTING: Questionnaires were provided by research coordinators to mothers at prenatal examinations (at obstetrics clinics) or by mail. Mothers were measured twice: during the first trimester and during the second/third trimester. PARTICIPANTS: Data were collected from the 10 129 participating mothers of the 10 288 children surveyed in the 2011 baseline JECS. We excluded responses from mothers who had a miscarriage or stillbirth; therefore, we analysed data from 9649 participants. PRIMARY AND SECONDARY OUTCOME MEASURES: Data concerning demographics, medical history, health characteristics, health-related behaviour and environmental exposure were collected via self-administered questionnaires. The response status of participants' partners and contact with their obstetrician were also examined. Multivariate logistic regression analysis was used to examine factors related to non-response. RESULTS: Response was associated with living with one's mother-in-law (ORs: 0.47, 95% CIs: 0.24 to 0.85), positive participation of participants' partner (OR: 0.25, 95% CI: 0.17 to 0.35) and multiple visits to the obstetrician (OR: 0.02, 95% CI: 0.02 to 0.03). Participants who had a medical history of allergic rhinitis, had body pain or drank alcohol had higher odds of responding (ORs: 0.68, 0.96 and 0.36, 95% CIs: 0.48 to 0.95 and 0.95 to 0.98 and 0.16 to 0.72, respectively); those exposed to secondary smoke had lower odds of responding (OR: 1.59, 95% CI: 1.12 to 2.23). CONCLUSIONS: The non-response rate decreased when participants reported health-related behaviour or characteristics. Obtaining the understanding of people around each participant might help increase response rates.

Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties.

BACKGROUND: The female athlete triad (Triad), defined by the American College of Sports Medicine as low energy availability (LEA) with or without disordered eating, menstrual dysfunction, and low bone mineral density (BMD), is associated with stress fractures and athletes aged 16-17 years are most susceptible. PURPOSE: To examine whether the Triad increases the risk of stress fractures, athletes were assigned to a "teenage" group and a "20s" group. METHODS: This prospective study enrolled 390 elite female athletes and was conducted from 2012 to 2016 at Japan Institute of Sports Sciences. Blood concentrations of various hormones were examined, and BMD was measured at the lumbar spine and throughout the whole body using dual-energy X-ray absorptiometry. LEA was defined as body weight ≤85% of the ideal body weight for teenage athletes, or BMI ≤17.5 for athletes in their 20s. Low BMD was defined as a BMD Z-score of <-1.0 in the lumbar spine and the whole body. RESULTS: Among 390 athletes enrolled, 36 developed new stress fractures within 3 months of registration. The risk for stress fractures due to the Triad in teenage athletes was higher than for athletes in their 20s. In teenage female athletes, secondary amenorrhea, low BMD for the whole body, and a low ratio of actual body weight to ideal body weight increased the risk for stress fractures by 12.9 times, 4.5 times, and 1.1 times, respectively. CONCLUSION: To prevent stress fractures in female athletes with the Triad, age of athletes should be taken into consideration.

Effects of physical activity during pregnancy on preterm delivery and mode of delivery: The Japan Environment and Children's Study, birth cohort study.

BACKGROUND: The aim of this study was to examine how physical activity (PA) before and during pregnancy influences pregnancy outcomes, particularly preterm delivery and mode of delivery. METHODS: This study was based on the Japan Environment and Children's Study. A total of 92,796 pregnant women who gave birth to live singleton babies were included. Information on mean PA per week during pregnancy was extracted from the responses to questionnaires completed by women during the second and third trimesters of pregnancy. Information on PA before pregnancy was obtained from questionnaires answered based on recall at participation. The level of PA was stratified into the following quartiles for categorical analysis: Very low, Low, Medium, and High. Pregnancy outcomes, gestational age at delivery (whether preterm delivery or not), and mode of delivery (spontaneous, instrumental, or caesarean delivery) were compared between the different groups adjusted for multiple covariates. RESULTS: With respect to PA during pregnancy, the risk of preterm delivery and instrumental delivery increased significantly in the Very low group compared to that in the Medium group (odds ratios [OR] 1.16, 95% confidence interval [CI], 1.05-1.29; OR 1.12, 95% CI, 1.03-1.22, respectively). Moreover, the risks of caesarean delivery in the Low group and instrumental delivery in the High group were significantly higher than the risks in the Medium group (OR 1.07, 95% CI, 1.00-1.15; OR 1.12, 95% CI, 1.02-1.22, respectively). In contrast, with respect to PA before pregnancy, there were no statistically significant differences when the other groups were compared to the Medium group. CONCLUSIONS: Pre-pregnancy PA has no negative effects on preterm birth and caesarean delivery. In contrast, both may be affected by PA during pregnancy because a low level of PA appears to slightly increase the risk of preterm delivery and operative delivery (caesarean and instrumental).

A Yolk Sac Larger Than 5 mm Suggests an Abnormal Fetal Karyotype, Whereas an Absent Embryo Indicates a Normal Fetal Karyotype.

OBJECTIVES: It is very hard to estimate an abnormal or normal fetal karyotype in miscarriage before surgery. We investigated whether the abnormal fetal karyotype in early miscarriage could be estimated by comprehensive ultrasonographic findings by a multivariate analysis. METHODS: One hundred fifty-one patients with early miscarriage (<12 weeks' gestation) were selected in our hospital. The clinical characteristics were compared between pregnant women carrying a fetus with an abnormal karyotype and those with a normal one, and the size and configuration of the gestational sac, yolk sac, and embryo at diagnosis of early miscarriage were also evaluated. RESULTS: The rate of abnormal fetal karyotypes was 66.2 % (100 of 151). A maternal age older than 35 years (odds ratio, 3.2; 95% confidence interval, 1.4-7.4; P = .005), yolk sac larger than 5 mm (odds ratio, 6.2; 95% confidence interval, 2.2-22.7, P < .001), and absent embryo (odds ratio, 0.40; 95% confidence interval, 0.16-0.95; P = .038) were independent markers for predicting an abnormal fetal karyotype by multiple logistic regression analysis. CONCLUSIONS: At the point of early miscarriage diagnosis, a yolk sac larger than 5 mm suggests an abnormal fetal karyotype, whereas an absent embryo indicates a normal fetal karyotype.

Dietary intake of fish and n-3 polyunsaturated fatty acids and risks of perinatal depression: The Japan Environment and Children's Study (JECS).

The results of several epidemiological studies and clinical trials investigating the effects of n-3 polyunsaturated fatty acids (PUFAs) on antenatal and postnatal depression remain controversial. We investigated the possible association of dietary intake of fish and n-3 PUFAs with the risks of maternal and paternal psychological distress during pregnancy and of maternal postpartum depression in Japan. From a dataset comprising 104,102 maternal registrations and 52,426 paternal registrations in The Japan Environment and Children's Study, this study analyzed complete data on questionnaires for 75,139, 79,346, and 77,661 women during early pregnancy, mid-late pregnancy, and after pregnancy, respectively, and for 41,506 male partners. Multivariable logistic regression showed reduced risk of psychological distress in the second and third quintiles for fish intake in early pregnancy and in the second to fifth quintile in mid-late pregnancy. No reductions were observed for n-3 PUFA intake in early pregnancy but in the second to fourth quintile in mid-late pregnancy. For postpartum depression, reductions were observed in the second to fourth quintile for fish intake but only in the first quintile for n-3 PUFA intake. As for paternal psychological distress, only the fourth quintile for fish intake showed a significant reduced risk but none were shown for n-3 PUFA intake. In conclusion, fish intake was associated with some reduced risk of psychological distress during pregnancy, even for male partners. The associations were weaker for n-3 PUFA intake than for fish intake.

Sludge reflects intra-amniotic inflammation with or without microorganisms.

PROBLEM: To investigate whether amniotic fluid (AF) "sludge" in patients with preterm labor (PTL) with intact membranes is related to intra-amniotic infection or inflammation. METHOD OF STUDY: 105 PTL patients before 29 weeks' gestation were enrolled. AF "sludge" was evaluated by transvaginal sonography. Microorganisms were identified in AF by our newly established PCR method using a eukaryote-made thermostable DNA polymerase. RESULTS: AF "sludge" was present in 18.1% (19/105) of patients. The results obtained in the AF "sludge" group vs the no "sludge" group were as follows: (i) a similar positive rate of microorganisms in AF by PCR, 31.6% (6/19) vs 38.4% (33/86); (ii) a higher level of AF interleukin-8, 15.2 (0.2-381.5) ng/mL vs 5.8 (0.1-413.7) ng/mL; P = .005); and (3) a higher frequency of histological chorioamnionitis, 52.6% (10/19) vs 23.3% (20/86); P = .010. CONCLUSION: The presence of AF "sludge" is related to intra-amniotic inflammation with or without microorganisms.

In which preterm labor-patients is intravenous maintenance tocolysis effective?

AIM: We evaluated whether maintenance tocolysis (intravenous ritodrine hydrochloride and/or magnesium sulfate) was effective in cases of spontaneous preterm labor with intact membranes. METHODS: One hundred and thirty preterm labor patients who reached 36 weeks of gestation by maintenance tocolysis were selected. Immediate delivery (ID) after ceasing maintenance tocolysis was defined as an 'effective case'. The correlated factors between ID and no immediate delivery (NID) were statistically analyzed. RESULTS: Thirty-six patients delivered < two days after ceasing maintenance tocolysis (27.7%) and were defined as effective cases. Multiple logistic regression analysis revealed that amniotic fluid interleukin-8 at admission (≥ 2.3 ng/mL; odds ratio [OR] 5.6, 95% confidence interval [CI] 2.1-17.6; P < 0.001), pre-pregnancy body mass index (≤ 21.4; OR 5.3, 95% CI 2.0-16.2; P < 0.001) and cerclage (OR 3.6, 95% CI 1.1-11.8; P = 0.028) were independent factors correlated with ID (< 2 days). CONCLUSION: Maintenance tocolysis may be effective in limited cases with mild intra-amniotic inflammation, in lean women and in cerclage cases. Maintenance tocolysis should be ceased in cases without these clinical factors when clinical symptoms disappear.

Antibiotic Therapy Increases the Risk of Preterm Birth in Preterm Labor without Intra-Amniotic Microbes, but may Prolong the Gestation Period in Preterm Labor with Microbes, Evaluated by Rapid and High-Sensitive PCR System.

OBJECTIVES: To examine the efficacy of the use of antibiotics in preterm labor (PTL) with intact membranes, after evaluating intra-amniotic microbes by our rapid and bacteria-free polymerase chain reaction (PCR) system. MATERIALS AND METHODS: One hundred and four PTL patients before 32 weeks of gestation were recruited. Until 2012, antibiotics were empirically prescribed based on the clinical severity of PTL. Intra-amniotic microbes in stored samples were evaluated later by our newly established PCR system, and the efficacy of the use of antibiotics in PTL was evaluated. RESULTS: In the amniotic fluid (AF) microbe-negative patients (n = 67), antibiotic therapy significantly shortened the gestation period (P < 0.0001), whereas in the microbe-positive patients (n = 37), appropriate antibiotic therapy (proper antibiotic selection against identified AF microbes) was significantly associated with an increase in gestation period (P < 0.0001). CONCLUSION: Appropriate antibiotic therapy in PTL with intact membranes prolonged the gestation period.