Maternal birth weight is an indicator of preterm delivery: the Japan environment and children's study.

This study aimed to investigate the association between maternal birth weight (MBW) with preterm delivery (PTD) in the Japanese population. To this end, a total of 78,972 Japanese pregnant women were included in a prospective birth cohort study. Multiple logistic regression and multinominal logistic regression models were applied to investigate the associations of MBW with PTD (delivery from 22 to < 37 weeks of gestation), early PTD (delivery from 22 to < 34 weeks), and late PTD (delivery from 34 to < 37 weeks). The results showed that MBW was inversely associated with PTD, early PTD, and late PTD (p-for-trend < 0.0001, 0.0014, and < 0.0001, respectively). The adjusted odds ratios per each 500 g of MBW decrease were 1.167 (95% confidence interval [CI]: 1.118-1.218) for PTD, 1.174 (95% CI: 1.070-1.287) for early PTD and 1.151 (95% CI: 1.098-1.206) for late PTD. The effect size of the association of MBW with early PTD was similar to that with late PTD. This study demonstrated for the first time an association of a low MBW with PTD, early PTD, and late PTD in a Japanese nationwide cohort.

Maternal birth weight as an indicator of early-onset and late-onset hypertensive disorders of pregnancy: The Japan Environment and Children's study.

OBJECTIVES: This study aimed to investigate the association between maternal birth weight (MBW) and hypertensive disorders of pregnancy (HDP) according to the gestational age when HDP develops. STUDY DESIGN: A total of 77,345 subjects were included in this prospective birth cohort study. The association between MBW and HDP was investigated by a multinomial logistic regression model. MAIN OUTCOME MEASURES: Early-onset HDP (EO-HDP), preterm late-onset HDP (preterm LO-HDP), and term late-onset HDP (term LO-HDP). RESULTS: Lower MBW was associated with higher odds of preterm and term LO-HDP (p-values for trend < 0.0001 and = 0.0005, respectively). A linear association between MBW and EO-HDP was observed (p-values for trend = 0.0496). The shape of the association between MBW and preterm LO-HDP was a combination of the associations between MBW with EO-HDP or LO-HDP. The effect size of the association between MBW < 2,500 g and EO-HDP was lower than that of MBW < 2,500 g with preterm or term LO-HDP. The adjusted odds ratios for EO-HDP, preterm LO-HDP, and term LO-HDP in subjects with MBW < 2,500 g were 1.052 (95 % confidence interval [CI]: 0.665-1.664), 1.745 (95 % CI: 1.220-2.496), and 1.496 (95 % CI: 1.154-1.939), respectively. CONCLUSIONS: MBW was associated with HDP, regardless of gestational age when HDP developed. Furthermore, the association of MBW < 2,500 g with preterm or term LO-HDP was stronger than that with EO-HDP.

Comprehensive evaluation of machine learning algorithms for predicting sleep-wake conditions and differentiating between the wake conditions before and after sleep during pregnancy based on heart rate variability.

Introduction: Perinatal women tend to have difficulties with sleep along with autonomic characteristics. This study aimed to identify a machine learning algorithm capable of achieving high accuracy in predicting sleep-wake conditions and differentiating between the wake conditions before and after sleep during pregnancy based on heart rate variability (HRV). Methods: Nine HRV indicators (features) and sleep-wake conditions of 154 pregnant women were measured for 1 week, from the 23rd to the 32nd weeks of pregnancy. Ten machine learning and three deep learning methods were applied to predict three types of sleep-wake conditions (wake, shallow sleep, and deep sleep). In addition, the prediction of four conditions, in which the wake conditions before and after sleep were differentiated-shallow sleep, deep sleep, and the two types of wake conditions-was also tested. Results and Discussion: In the test for predicting three types of sleep-wake conditions, most of the algorithms, except for Naïve Bayes, showed higher areas under the curve (AUCs; 0.82-0.88) and accuracy (0.78-0.81). The test using four types of sleep-wake conditions with differentiation between the wake conditions before and after sleep also resulted in successful prediction by the gated recurrent unit with the highest AUC (0.86) and accuracy (0.79). Among the nine features, seven made major contributions to predicting sleep-wake conditions. Among the seven features, "the number of interval differences of successive RR intervals greater than 50 ms (NN50)" and "the proportion dividing NN50 by the total number of RR intervals (pNN50)" were useful to predict sleep-wake conditions unique to pregnancy. These findings suggest alterations in the vagal tone system specific to pregnancy.

Secondhand smoke exposure is associated with the risk of hypertensive disorders of pregnancy: the Japan Environment and Children's Study.

Hypertensive disorders of pregnancy (HDP) are associated with poor maternal and neonatal prognoses. Although several studies have indicated an effect of secondhand smoke (SHS) exposure on HDP, such evidence is lacking in Japan. Therefore, we analyzed data from the Japan Environment and Children's Study, a large-scale epidemiological investigation, to elucidate a possible link between SHS exposure and HDP risk. Data were obtained from the all-birth fixed datasets and included information on 104,062 fetuses and their parents. SHS exposure was assessed in terms of the frequency (rarely, 1-3, or 4-7 days/week) and the daily duration of exposure (<1, 1-2, or ≥2 h(s)/day). Modified Poisson regression model analyses were performed with adjustment for known risk factors for HDP. Additionally, the population attributable fractions (PAFs) of SHS exposure and maternal smoking to HDP prevalence were estimated. The relative risks of developing HDP among individuals with SHS exposures of 4-7 days/week and ≥2 h/day were 1.18 and 1.27 (95% confidence interval: 1.02-1.36 and 0.96-1.67), respectively, compared to the reference groups (rare exposure and <1 h/day). The PAFs for the risk of HDP due to SHS exposure and perinatal smoking were 3.8% and 1.8%, respectively. Japanese women with greater exposure to SHS have a higher risk of HDP after adjustment for possible confounding factors; thus, relevant measures are required to reduce SHS exposure to alleviate HDP risk. The association between second-hand smoking exposure and hypertensive disorders of pregnancy risk was analyzed using the JECS data. The relative risks in 4-7 days/week and ≥2 h/day of SHS exposures were 1.18 and 1.27, respectively. The PAFs due to SHS exposure and maternal smoking were 3.80% and 1.81%, respectively.

The impact of maternal and paternal birth weights on infant birth weights: the Japan environment and children's study.

This study aimed to evaluate the association between parental and infant birth weights in Japan. In total, 37,504 pregnant Japanese women and their partners were included in this birth cohort study. A multinomial logistic regression model was used to evaluate the associations of parental birth weights with small-for-gestational-age (SGA) or large-for-gestational-age (LGA) infants. Associations between parental birth weight and low birth weight (LBW) infants or macrosomia were also examined, and linear associations between parental birth weight and SGA or LGA were found. The adjusted odds ratios (aORs) for SGA infants per 500 g decrease in maternal and paternal birth weights were 1.50 (95% confidence interval [CI],1.43-1.58) and 1.31 (95% CI, 1.25-1.38), respectively. The aORs for LGA infants per 500 g increase in maternal and paternal birth weights were 1.53 (95% CI, 1.47-1.60) and 1.41 (95% CI, 1.35-1.47), respectively. The association between parental birth weight and LBW infants or macrosomia was also linear. The aORs for LBW infants per 500 g decrease in maternal and paternal birth weights were 1.47 (95% CI, 1.40-1.55) and 1.25 (95% CI, 1.19-1.31), respectively. The aORs for macrosomia per 500 g increase in maternal and paternal birth weights were 1.59 (95% CI, 1.41-1.79) and 1.40 (95% CI, 1.23-1.60), respectively. Parental birth weight was found to be associated with infant birth weight even after adjusting for various parental factors. Furthermore, maternal birth weight was more strongly associated with infant birth weight than with paternal birth weight.

A potential preventive method for scar stenosis after esophageal endoscopic mucosal resection using human amniotic epithelial cells in a porcine model.

Objectives: The current methods employed for esophageal endoscopic mucosal resection (EMR) involve the risk of adverse postprocedural complications. Therefore, this study aimed to develop a new method to prevent stenosis following a resection procedure using human amniotic epithelial cells in a porcine model. Methods: With the consent of a woman who underwent a cesarean section, amniotic epithelial cells were isolated from the amniotic membrane of the delivered placenta. Six swine were used for this study. Under general anesthesia, four EMRs using cap-fitted microscope ulcers were performed on each porcine esophagus. Of the four ulcers, the two on the oral side were treated by injecting human amniotic epithelial (AE group) cells, and the remaining two on the anal side were left untreated (control group). One week after the procedure, the swine were sacrificed, and the ulcers were evaluated. The epithelialization rate was calculated by dividing the length of the epithelialized portion of each section by the length of the ulcer, which was determined using an optical microscope. Moreover, the mucosal thickening in each section was measured in terms of diameter. Results: The epithelialization rate was significantly higher in the AE group than in the control group. Mucosal thickening was not significantly different between the groups. Conclusions: Transplanting amniotic epithelial cells into the ulcer promoted ulcer epithelialization. Amniotic epithelial cell transplantation is a potential method for the management of ulcer scar stenosis following esophageal endoscopic submucosal dissection.

Risk scores for predicting small for gestational age infants in Japan: The TMM birthree cohort study.

This study aimed to construct a prediction model for small-for-gestational-age (SGA) infants in Japan by creating a risk score during pregnancy. A total of 17,073 subjects were included in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study, a prospective cohort study. A multiple logistic regression model was used to construct risk scores during early and mid-gestational periods (11-17 and 18-21 weeks of gestation, respectively). The risk score during early gestation comprised the maternal age, height, body mass index (BMI) during early gestation, parity, assisted reproductive technology (ART) with frozen-thawed embryo transfer (FET), smoking status, blood pressure (BP) during early gestation, and maternal birth weight. The risk score during mid-gestation also consisted of the maternal age, height, BMI during mid-gestation, weight gain, parity, ART with FET, smoking status, BP level during mid-gestation, maternal birth weight, and estimated fetal weight during mid-gestation. The C-statistics of the risk scores during early- and mid-gestation were 0.658 (95% confidence interval [CI]: 0.642-0.675) and 0.725 (95% CI: 0.710-0.740), respectively. In conclusion, the predictive ability of the risk scores during mid-gestation for SGA infants was acceptable and better than that of the risk score during early gestation.

Distribution of Amniotic Epithelial Cells After Intraportal Infusion in a Rat Model.

BACKGROUND: Human amniotic epithelial cells (hAECs) are increasingly gaining attention as novel sources for cell transplantation. In clinical practice, intraportal infusion is considered one of the leading approaches for transplantation; however, this has not yet been validated for in vivo transplantation of hAECs. Thus, this study aims to investigate the distribution of hAECs post intraportal infusion and compare this distribution with other cell administration routes. METHODS: Wistar/ST rats were divided into 4 groups (n = 3 for each) based on cell administration route: group 1, intraportal; group 2, the spleen; group 3, tail veins; and group 4, penile veins. Subsequently, hAECs (1 × 107) stained with XenoLight DiR were infused into each recipient. Cell distribution was evaluated using an in vivo imaging system. RESULTS: DiR signals were detected in the rat livers of groups 1 and 2 with those in group 2 being much weaker than those in group 1. Necrosis of small intestine was observed in 2 cases in group 2. DiR signals were detected in the lungs in groups 3 and 4 because of systemic circulation; however, all the animals died within 20 minutes of infusions. CONCLUSIONS: Intraportal infusion is potentially applicable for safe and efficient transplantation of hAECs into the liver, whereas hAECs administration via the spleen carries a risk of thrombosis in a narrow portal vein system. Our results also indicate that hAECs administration via the systemic circulation could cause pulmonary embolism in clinical settings.

Evaluation of the Safety of Taking Lamotrigine During Lactation Period.

Introduction: Evaluation of the safety of taking lamotrigine (LTG) during lactation in breastfed infants varies according to the information sources. As it is possible that prescribers may avoid prescribing LTG despite of it being one of the essential drugs, more information needs to be accumulated to facilitate its use. Materials and Methods: We retrospectively compared the safety of LTG during the lactation period in 20 pairs of mothers and infants with 20 pairs as the control group. Results: The mean dose of LTG in 20 mothers was 161.1 mg/day (range: 50-400 mg/day). None of the infants showed a neonatal withdrawal syndrome score of 2 or more up to 1 month after delivery. Although drowsiness (n = 3), skin rash (n = 11), jaundice (n = 8), heart murmur (n = 1), poor suckling (n = 1), and retractive breathing (n = 1) were observed in infants, none of these adverse events were serious and the infants recovered. Nineteen of 20 pairs could continue lactation until 1 month after delivery. One pair discontinued breastfeeding because of pain in the mother's nipples. All pairs could continue maternal medication. We then compared the results with those of the control group. There were no significant differences in the presence of adverse events between the LTG and control groups. Conclusion: These data suggest that taking low to moderate doses of LTG during the lactation period might be relatively safe, at least for a period of 1 month after delivery.

Heart Rate Information-Based Machine Learning Prediction of Emotions Among Pregnant Women.

In this study, the extent to which different emotions of pregnant women can be predicted based on heart rate-relevant information as indicators of autonomic nervous system functioning was explored using various machine learning algorithms. Nine heart rate-relevant autonomic system indicators, including the coefficient of variation R-R interval (CVRR), standard deviation of all NN intervals (SDNN), and square root of the mean squared differences of successive NN intervals (RMSSD), were measured using a heart rate monitor (MyBeat) and four different emotions including "happy," as a positive emotion and "anxiety," "sad," "frustrated," as negative emotions were self-recorded on a smartphone application, during 1 week starting from 23rd to 32nd weeks of pregnancy from 85 pregnant women. The k-nearest neighbor (k-NN), support vector machine (SVM), logistic regression (LR), random forest (RF), naïve bayes (NB), decision tree (DT), gradient boosting trees (GBT), stochastic gradient descent (SGD), extreme gradient boosting (XGBoost), and artificial neural network (ANN) machine learning methods were applied to predict the four different emotions based on the heart rate-relevant information. To predict four different emotions, RF also showed a modest area under the receiver operating characteristic curve (AUC-ROC) of 0.70. CVRR, RMSSD, SDNN, high frequency (HF), and low frequency (LF) mostly contributed to the predictions. GBT displayed the second highest AUC (0.69). Comprehensive analyses revealed the benefits of the prediction accuracy of the RF and GBT methods and were beneficial to establish models to predict emotions based on autonomic nervous system indicators. The results implicated SDNN, RMSSD, CVRR, LF, and HF as important parameters for the predictions.

Interannual Changes in the Prevalence of Intimate Partner Violence Against Pregnant Women in Miyagi Prefecture After the Great East Japan Earthquake: The Japan Environment and Children's Study.

This study aimed to clarify the interannual changes in intimate partner violence against pregnant women after the March 11, 2011 Great East Japan Earthquake in target areas of Miyagi Prefecture that were damaged by the earthquake and tsunami. Because of this disaster, in Miyagi Prefecture, approximately 12,000 people died or went missing, and approximately 238,000 buildings were destroyed. According to the U.S. Geological Survey, the Great East Japan Earthquake is the fourth largest earthquake in the world and the largest in Japan since 1900. The present study was part of the Japan Environment and Children's Study. Data from June 2011 to May 2014 of 79,222 pregnant women were analyzed, calculating the prevalence of physical and mental intimate partner violence in the inland, north coastal, and south coastal areas of Miyagi. These prevalence rates were compared with nationwide rates of intimate partner violence in 2011 using univariate and logistic regression analyses. After the disaster, the incidence of mental intimate partner violence increased in the south coastal area and then improved later (19.4%, 13.1%, and 13.3% for south coastal area, and 13.8%, 13.8%, and 13.1% for nationwide in 2011, 2012, and 2013, respectively). However, in the north coastal area, the incidence of physical intimate partner violence increased after the disaster and then improved later (2.7%, 1.5%, and 1.3% for north coastal area, and 1.4%, 1.3%, and 1.1% for nationwide in 2011, 2012, and 2013, respectively). In the inland area, however, the prevalence of both mental and physical intimate partner violence was consistently higher than nationwide rates after the disaster.

Associations between glycosylated hemoglobin level at less than 24 weeks of gestation and adverse pregnancy outcomes in Japan: The Japan Environment and Children's Study (JECS).

AIMS: To investigate the associations between glycosylated hemoglobin (HbA1c) levels at less than 24 weeks of gestation and adverse pregnancy outcomes in Japan. METHODS: This was a prospective nationwide birth cohort study of 77,526 subjects with an HbA1c level of <6.5% (<48 mmol/mol) at less than 24 weeks of gestation. Associations of HbA1c level with adverse pregnancy outcomes were evaluated using multivariate analyses. RESULTS: The adjusted odds ratios per 1% (11 mmol/mol) increase in HbA1c level were 1.77 (95% confidence interval [CI]: 1.48-2.12) for hypertensive disorders of pregnancy; 1.78 (95% CI: 1.12-2.83) for placental abruption; 1.30 (95% CI: 1.12-1.50) for preterm birth; 2.11 (95% CI: 1.41-3.16) for very preterm birth; 1.49 (95% CI: 1.33-1.68) for low birth weight infants; 1.95 (95% CI: 1.42-2.70) for macrosomia; 1.23 (95% CI: 1.09-1.39) for small for gestational age; 1.15 (95% CI: 1.04-1.28) for large for gestational age; and 1.29 (95% CI: 1.20-1.39) for the composite adverse pregnancy outcome. CONCLUSIONS: The higher the HbA1c level, the higher the risk of adverse pregnancy outcomes in Japan. Further studies will be needed to determine prenatal management based on the HbA1c level in pregnant women with HbA1c <6.5% (<48 mmol/mol) at less than 24 weeks of gestation.

Mother-to-infant bonding failure and intimate partner violence during pregnancy as risk factors for father-to-infant bonding failure at 1 month postpartum: an adjunct study of the Japan Environment and Children's Study.

Objective: To survey the frequency and risk factors for father-to-infant lack of affection (LA) and anger/rejection (AR) bonding failure at 1 month postpartum.Material and methods: The study participants enrolled in the prospective birth cohort study of an adjunct study of the Japan Environment & Children's Study. Bonding failure, psychological distress during pregnancy and postnatal depression symptoms were evaluated using the Japanese version of the Mother-Infant Bonding Scale (MIBS-J), the Kessler 6-item (K6) psychological distress scale and the Edinburgh Postnatal Depression Scale (EPDS-J). This study extracted relative factors based on approximately 10% occupancy of the total high scores in MIBS-J subscales as a cut-off for bonding failure. The cut-off scores on the paternal EPDS-J were eight, on maternal EPDS-J was 9, and on the K6 psychological distress scale score was 13.Results: A total of 1008 couples who had single delivery were assessed at 1 month postpartum, respectively. The prevalence of paternal MIBS-J_LA scores ≥4 was 8.3%, MIBS-J_AR scores ≥3 was 7.9%, and EPDS-J scores ≥8 was 11.2%, respectively. In the multiple logistics analysis, paternal MIBS-J_LA scores ≥4 were significantly associated with maternal MIBS-J_LA score ≥3 (adjusted odds ratio (AOR) 2.814; 95% confidence interval (CI): 1.377-5.747), mental intimate partner violence (IPV) against the mother during pregnancy (AOR 2.176; 95% CI: 1.185-3.997), maternal K6 psychological distress scale score ≥13 (AOR 2.980; 95% CI: 1.317-6.745), paternal EPDS-J score ≥8 (AOR 3.227; 95% CI: 1.767-5.892), and a history of mental health disorder (AOR 4.125; 95% CI: 1.423-11.963). Paternal MIBS-J_AR scores ≥3 were significantly associated with maternal MIBS-J_AR scores ≥3 (AOR 5.082; 95% CI: 2.453-10.529), a history of physical IPV against the mother during pregnancy (AOR 5.230; 95% CI: 1.016-26.920), paternal K6 psychological distress scale score ≥13 (AOR 4.145; 95% CI: 1.311-13.107), and paternal EPDS-J scores ≥8 (AOR 4.479; 95% CI: 2.503-8.013). In Pearson's product moment correlation coefficient analyses between paternal and maternal MIBS-J score, MIBS-J_LA score was r = 0.2112, p < .0001, and MIBS-J_AR score was r = 0.3281, p < .0001.Conclusion: Father-to-infant lack of affection bonding failure was associated with mother-to-infant lack of affection bonding failure, mental IPV against mother during pregnancy, maternal psychological distress during pregnancy, paternal postpartum depression symptoms, and history of paternal mental health disorders. Father-to-infant anger/rejection bonding failure was associated with mother-to-infant anger/rejection bonding failure, physical IPV against mother during pregnancy, paternal psychological distress during pregnancy, and paternal postpartum depression symptoms. Since bonding failure is a risk factor for infant maltreatment, further investigations are recommended to fully assess these associations to resolve parent perinatal mental health issues for preventing father-to-infant bonding failure.

The prevalence and risk factors for postpartum depression symptoms of fathers at one and 6 months postpartum: an adjunct study of the Japan Environment & Children's Study.

Objective: To survey prevalence and risk factors for paternal postpartum depression symptoms at one and 6 months postpartum in Japan.Material and methods: The study participants enrolled in the prospective birth cohort study of an adjunct study of the Japan Environment and Children's Study. Postpartum depression symptoms were evaluated using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS-J). The cut-off scores on the paternal EPDS-J were eight and on maternal EPDS-J was nine, respectively. The multivariate logistic regression included an adjustment for paternal age, maternal age, the number of children in the family, family structure, paternal employment, paternal academic history, household income, paternal smoking status, paternal history of mental health disorders, the Kessler 6-item psychological distress scale (K6) score during pregnancy, infertility treatment, paternal mental intimate partner violence (IPV) during pregnancy, paternal physical IPV during pregnancy, the sex of the newborn, congenital anomalies of the newborn, infant disease under medical treatment, returning to the maternal parent's house to give birth or take care of infant, the father's history of disease or injury that required medical treatment, paternity leave, and the EPDS-J for mothers.Results: A total of 1023 and 1330 fathers and their spouse who had a single delivery were assessed at one and 6 months postpartum, respectively. The prevalence of paternal EPDS-J scores ≥8 was 11.2 and 12.0% at one and 6 months postpartum, respectively. In the multiple logistics analysis, paternal EPDS-J scores ≥8 at 1 month postpartum was significantly associated with history of mental health disorders (adjusted odds ratio (AOR) 2.825; 95% confidence interval (CI): 1.047-7.623), K6 score ≥13 during pregnancy (AOR 4.116; 95% CI: 1.598-10.599), household income <4000 × 103 yen (AOR 1.799; 95% CI: 1.072-3.021), and infant disease under medical treatment (AOR 1.720; 95% CI: 1.015-2.915). Paternal EPDS-J scores ≥8 at 6 months postpartum was significantly associated with K6 scores ≥13 during pregnancy (AOR 4.621; 95% CI: 2.113-10.107), unemployment (AOR 3.751; 95% CI: 1.739-8.091) and maternal EPDS-J scores ≥9 (AOR 2.460; 95% CI: 1.514-3.996).Conclusion: The prevalence of paternal postpartum depression symptoms were 11.2 and 12.0% at one and 6 months postpartum. Paternal postpartum depression symptoms at 1 month postpartum were associated with the history of mental health disorders, psychological distress during pregnancy, low income, and infant disease under medical treatment. Paternal postpartum depression symptoms at 6 months postpartum were associated with psychological distress during pregnancy, unemployment, and maternal postpartum depression. It is important to consider the paternal postpartum depression symptoms, and further enlightenment regarding these issues is recommended in Japan.

Higher prevalence of hypertensive disorders of pregnancy in women who smoke: the Japan environment and children's study.

Smoking during pregnancy is a risk factor for various adverse birth outcomes but lowers the risk of preeclampsia. Cardiovascular adaptations might underlie these associations. We examined the association of maternal smoking with the risk of hypertensive disorders of pregnancy (HDP) in a low-risk population-based cohort of 76,303 pregnant women. This study was a part of the Japan Environment and Children's Study. Smoking status was assessed using questionnaires completed by participants. Information about HDP was assessed using questionnaires completed by doctors. Compared with that for women who did not smoke, women who continued smoking >10 cigarettes per day during pregnancy had a significantly higher risk of developing HDP (odds ratio: 1.58, 95% confidence interval: 1.11-2.25). In multivariate analyses with adjustment for possible confounding factors, the association still remained (odds ratio: 1.51, 95% confidence interval: 1.04-2.19). When we regarded the number of cigarettes as a continuous variable, there was a linear association between the number of cigarettes and risk of HDP, with an odds ratio of 1.02 per cigarette per day (95% confidence interval: 1.00-1.04). Smoking a greater number of cigarettes was associated with a higher risk of HDP after adjustment for possible confounding factors. Cigarette smoking cessation may avoid the complications of HDP. Our findings suggest that, in addition to the risk of small-for-gestational-age children, an increased risk of HDP should be considered in the management of pregnant women who smoke cigarettes.

Preconception folic acid supplementation use and the occurrence of neural tube defects in Japan: A nationwide birth cohort study of the Japan Environment and Children's Study.

We evaluated the relationship between preconception folic acid supplementation and the occurrence of neural tube defects (NTDs) in offspring, using data from the Japan Environment and Children's Study (a nationwide prospective birth cohort study) database. Of 92 269 participants with single pregnancies, 74 cases (offspring or fetuses) had NTDs, including 32 cases of spina bifida, 24 cases of anencephaly, and 19 cases of encephalocele. A total of 7634 participants (8.27%) used preconception folic acid supplementation, and of these, 621 (0.67%) also took in dietary folic acid at ≥480 µg/day. Multivariate logistic regression analyses demonstrated no association between preconception folic acid supplementation and NTDs in offspring or fetuses (odds ratio [OR] 0.622; 95% confidence interval [CI]: 0.226-1.713). Moreover, the participants who combined preconception folic acid supplement use with dietary folic acid intake ≥480 µg/day demonstrated no incidence of NTDs in offspring or fetuses. Our analysis is limited by the absence of the data on the daily amount of supplementary folic acid intake, requiring careful attention to the interpretation. Additional surveys are required in Japan to resolve those limitations for further comprehensive assessment.

Development of algorithms to determine the onset of pregnancy and delivery date using health care administrative data in a university hospital in Japan.

PURPOSE: To develop and assess algorithms to determine the onset of pregnancy and delivery date using health administrative data from a university hospital in Japan. METHODS: All women who were hospitalized in the maternity ward and had at least one pregnancy that ended with a delivery during the period of January 2014 and December 2015 were included in this study. The true delivery date was obtained from the electronic medical records and was used as a gold standard. The onset of pregnancy was calculated by subtracting the gestational age at birth from the delivery date based on the electronic medical records and was also used as a gold standard. The administrative data-based algorithms to identify (1) the onset of pregnancy estimated from the gestational age recorded as part of a diagnosis during a specific visit and (2) the delivery date estimated using the delivery-related diagnosis, procedure, or prescription were compared with the gold-standard data. RESULTS: Of the 1705 women included in this study, the onset of pregnancy was determined in 1704 subjects with 1582 (92.8%) within ± 7 days from the gold-standard date of pregnancy onset. The delivery date was determined in 1654 subjects, and 1594 (96.4%) were within ± 7 days before the true delivery date using the algorithm of "selected" diagnosis and a surgical procedure followed by some other delivery-related data. CONCLUSIONS: The algorithms developed in this study are expected to accelerate future studies for real-world exposure and quantify drug safety during pregnancy using Japanese health care administrative databases.

Regional Birth Outcomes after the 2011 Great East Japan Earthquake and Tsunami in Miyagi Prefecture.

OBJECTIVES: This study was aimed to analyze post-disaster birth outcomes in coastal and inland regions of Miyagi Prefecture, Japan. METHODS: Primary data sets were compiled from birth records of obstetric facilities and 12,808 patients were analyzed for baseline birth outcomes by region. Regional risk analysis of the low-birth-weight rate and premature birth rate were conducted using multi-level logistic regression analysis. RESULTS: From overall baseline birth outcomes, a preterm birth rate was 4.6% and low-birth-weight rate was 8.8%. Regional analysis revealed that a preterm birth rate was 3.2% (coastal) and 5.0% (inland), respectively, and the rate of low birth weight was 6.5% in the coastal and 8.5% in the inland region. In the risk analysis of low-birth-weight rate and preterm birth rate, the risk in the coastal region could not be considered any higher than in the inland region (adjusted odds ratio 0.91 [0.73-1.14] and 0.85 [0.46-1.59], respectively). CONCLUSIONS: The incidence of preterm birth and low birth weight were not adversely affected by the disaster. Early transfer and intensive medical intervention may have led to those findings. Further survey will be necessary to determine the long-term effects in both mothers and children. Sugawara J , Iwama N , Hoshiai T , Tokunaga H , Nishigori H , Metoki H , Okamura K , Yaegashi N . Regional birth outcomes after the 2011 Great East Japan Earthquake and tsunami in Miyagi Prefecture. Prehosp Disaster Med. 2018;33(2):215-219.

Selective serotonin reuptake inhibitors and risk of major congenital anomalies for pregnancies in Japan: A nationwide birth cohort study of the Japan Environment and Children's Study.

We analyzed data from the Japan Environment and Children's Study (JECS), on the association between selective serotonin reuptake inhibitors (SSRI) use during pregnancy and the risk of developing of major congenital anomalies in Japan. JECS is an ongoing nationwide birth cohort study. The study includes 95 994 single pregnant women and their offspring. Among them, 172 used any SSRI up to the 12th gestational week. Crude analyses show a significantly increased incidence of upper limb, abdominal, and urogenital abnormalities. In particular, the incidence of microcephaly, hydrencephalus, esophageal atresia, small intestinal atresia, and achondroplasia was significantly higher with than without exposure to these substances. On multivariate analyses, urogenital abnormality was significant (odds ratio 3.227; 95% confidence interval: 1.460-7.134). This Japanese nationwide birth cohort survey clarified that the use of any SSRI until the 12th gestational week was associated with urogenital abnormality in children. The survey for association with minor classification abnormality needs further examination in Japan.

Impact of the Great East Japan Earthquake on Regional Obstetrical Care in Miyagi Prefecture.

OBJECTIVES: The authors report the results of surveys on the emergency transport or evacuation status of obstetric patients conducted in Miyagi prefecture, one of the major disaster areas of the Great East Japan Earthquake and tsunami. METHODS: The surveys examined the damages to maternity institutions, evacuation status and transport of pregnant women, and prehospital childbirths and were conducted in 50 maternity institutions and 12 fire departments in Miyagi. RESULTS: Two coastal institutions were destroyed completely, and four institutions were destroyed partially by the tsunami, forcing them to stop medical services. In the two-month period after the disaster, 217 pregnant women received hospital transport or gave birth after evacuation. Satisfactory perinatal outcomes were maintained. Emergency obstetric transport increased to approximately 1.4 fold the number before the disaster. Twenty-three women had prehospital childbirths, indicating a marked increase to approximately three times the number of the previous year. CONCLUSION: In the acute phase of the tsunami disaster, maternity institutions were damaged severely and perinatal transport was not possible; as a result, pregnant women inevitably gave birth in unplanned institutions, and the number of prehospital births was increased extremely. To obtain satisfactory obstetric outcomes, it is necessary to construct a future disaster management system and to re-recognize pregnant women as people with special needs in disaster situations. Sugawara J , Hoshiai T , Sato K , Tokunaga H , Nishigori H , Arai T , Okamura K , Yaegashi N . Impact of the Great East Japan Earthquake on regional obstetrical care in Miyagi Prefecture. Prehosp Disaster Med. 2016;31(3):255- 258.