The COVID-19 pandemic affects pregnancy complications and delivery outcomes in Japan: a large-scale nationwide population-based longitudinal study.

The impact of the coronavirus disease 2019 (COVID-19) pandemic on pregnancy outcomes in Japan at the national level is unclear. This study aimed to assess the impact of the pandemic on pregnancy complications and delivery outcomes in Japan using nationwide population-based longitudinal data. Secondary data from the Japan Society of Obstetrics and Gynecology from 2016 to 2020 were analyzed. Obstetric information, pregnancy complications, and delivery information of pregnant women over 22 weeks of gestation were compared before and during the pandemic. The trends of hypertensive disorder of pregnancy, fetal growth restriction, and APGAR < 7 increased, whereas those of preterm birth and low birth weight decreased during the COVID-19 pandemic. Pregnancy complications and delivery outcomes have worsened during the COVID-19 pandemic in Japan. Social changes caused by unprecedented situations may have massively influenced pregnancy in several ways. Our findings suggest that even in mild lockdowns like those in Japan, the introduction of social fear during the pandemic might negatively impact pregnancy outcomes.

Comparison of Three Diagnostic Definitions of Metabolic Syndrome and Estimation of Its Prevalence in Mongolia.

We sought to estimate the prevalence of metabolic syndrome (MS) in the urban population of Mongolia and suggest a preferred definition. This cross-sectional study comprised 2076 representative samples, which were randomly selected to provide blood samples. MS was defined by the National Cholesterol Education Program's Adults Treatment Panel III (NCEP ATP III), the International Diabetes Federation (IDF), and the Joint Interim Statement (JIS). The Cohen's kappa coefficient (κ) was analyzed to determine the agreement between the individual MS components using the three definitions. The prevalence of MS in the 2076 samples was 19.4% by NCEP ATP III, 23.6% by IDF, and 25.4% by JIS criteria. For men, moderate agreement was found between the NCEP ATP III and waist circumference (WC) (κ = 0.42), and between the JIS and fasting blood glucose (FBG) (κ = 0.44) and triglycerides (TG) (κ = 0.46). For women, moderate agreement was found between the NCEP ATP III and high-density lipoprotein cholesterol (HDL-C) (κ = 0.43), and between the JIS and HDL-C (κ = 0.43). MS is highly prevalent in the Mongolian urban population. The JIS definition is recommended as the provisional definition.

Atrial Fibrillation With and Without Cardiovascular Risk Factors and Stroke Mortality.

AIM: The association between atrial fibrillation (AF) and risk of stroke mortality among men and women without traditional cerebrocardiovascular risk factors (TCVRFs) is unclear. This study aimed to determine whether AF was a risk factor for stroke and total cardiovascular disease mortality among individuals without TCVRFs. METHODS: A total of 90,629 Japanese subjects from the Ibaraki Prefectural Health Study aged 40-79 years, with and without TCVRFs, were studied from 1993 to 2013. Hazard ratios (HRs) were calculated using the Cox proportional hazard regression model stratified by sex and the presence of TCVRFs. Covariates were age, systolic blood pressure, anti-hypertensive medication use, and serum total cholesterol levels. A standard 12-lead electrocardiogram at rest was used to screen AF. Cause-specific mortality was classified according to the International Classification of Disease code. RESULTS: Compared with participants without AF, multivariable-adjusted hazard ratios (with 95% confidence intervals) for stroke mortality among participants without TCVRFs were 4.3 (1.1-17.8) and 15.0 (5.5-40.8) for men and women with AF, respectively. HRs for total cardiovascular disease mortality were 6.2 (2.8-14.2) for men and 10.7 (4.8-24.1) for women. For participants with TCVRFs, multivariable-adjusted HRs for stroke mortality were 3.1 (2.2-4.6) and 4.3 (2.6-7.3), whereas HRs for total cardiovascular disease mortality were 2.9 (2.2-3.8) and 3.5 (2.4-5.1) for men and women, respectively. CONCLUSIONS: AF was found to be an independent risk factor for stroke and total cardiovascular mortality even in individuals without other TCVRFs.

Changes in vitamin D status considering hemodilution factors in Japanese pregnant women according to trimester: A longitudinal survey.

OBJECTIVES: There have been no longitudinal surveys on the changes in 25-hydroxyvitamin D [25(OH)D] while considering hemodilution factors among pregnant Japanese women. Therefore, we examined 25(OH)D levels as well as red blood cell count (RBC), hemoglobin (Hb), and Hematocrit (Hct) at the three trimesters among pregnant Japanese women to determine the distribution of serum 25(OH)D levels and the influence of hemodilution. DESIGN: This was a longitudinal study. SETTING: The study was conducted at Ibaraki Seinan Medical Center Hospital in Japan. PARTICIPANTS: The participants comprised 50 women in the first trimester with singleton pregnancies and without any complications. OUTCOME MEASURES: Participants were recruited from June to August 2018, and followed up till their postpartum period. Blood samples were collected at the first, second, and third trimesters, i.e., at 4-15, 16-27, and 28-39 weeks, respectively. 25(OH)D levels, RBC, Hb, and Hct were analyzed across the three trimesters. RESULTS: Comparing the first, second, and third trimesters, 25(OH)D, RBC, and Hb were significantly declined in the second and third trimesters (p < 0.001). According to Spearman's correlation coefficient with 25(OH)D and RCB, Hb, Hct, significant correlations were found between 25(OH)D and Hb (p < 0.001), as well as Hct (p < 0.001) in the third trimester. CONCLUSIONS: The present study had two major findings. First, it showed that the vitamin D status of most pregnant Japanese women were considered as vitamin D deficient. Second, the maternal serum 25(OH)D levels, RBC, Hb, and Hct of the pregnant women declined in the second and third trimesters. Thus we propose to have routine screening of vitamin D status of pregnant women, especially in the second trimester.

High Hematocrit Levels Are Associated with Risk of Cardiovascular Mortality among Middle-Aged Japanese Women: The Ibaraki Prefectural Health Study (IPHS).

In Japan, heart disease and cerebrovascular disease were the second and fourth leading cause of death, respectively in 2014. Hematocrit, the ratio of the red blood cells to the total volume of blood is known to play a role in cardiovascular diseases. However, the relationship between elevated hematocrit and the risk of cardiovascular disease based on sex has not been examined in Asian countries. We analyzed data from the Ibaraki Prefectural Health Study, a community-based large cohort study, which included 87,533 individuals, aged 40 to 79 years living in 38 municipalities of the Ibaraki Prefecture, who had completed an annual health checkup in 1993, and were followed until 2013. The hematocrit levels of the subjects were categorized into 5 quintiles (Q1-Q5), and hazard ratios for cause-specific mortality were calculated using the Cox proportional hazards regression models. Age and other cardiovascular risk factors were the covariates in the study. During the follow-up for a mean of 17.9 years, 1,207 deaths (615 men and 592 women) due to acute myocardial infarction (AMI) were reported in this population. The p values for the trend in the Q3-Q5 groups were 0.661 for men and 0.020 for women. Additionally, these values were significant in younger (40 to 59 years) women but not in older (60 to 79 years) women. This study is the first one to demonstrate an association between high hematocrit level and risk of AMI mortality in younger Japanese women, but not in men and older women.

Distribution of serum 25-hydroxyvitamin D levels of reproductive age Japanese women.

Objectives　The distribution of serum 25-hydroxyvitamin D [25(OH)D] levels among reproductive age Japanese perinatal (prepartum, intrapartum, postpartum) and non-perinatal women remains unknown. In addition to this, vitamin D deficiency cut-off values, which consider the effects of these levels during the perinatal period and infant development, have not been determined. Thus, we systematically reviewed the distribution of serum 25(OH)D levels among reproductive age Japanese women, in order to provide basic data to determine vitamin D deficiency cut-off values.Methods　A systematic literature review was conducted on research published between 1963 and 2015, using PubMed web and Japan Medical Abstracts Society web. The key words "Japan," "Vitamin D," "women," and "pregnant women," were used. After filtering for age, sex, race, indication of numerical number, and duplications, 18 papers were extracted and categorized into reproductive age non-perinatal women (13 papers/22 groups), and reproductive age perinatal women (6 papers/8 groups). The mean serum 25(OH)D levels were grouped by age, test period, and measuring methods.Results　Mean serum 25(OH)D levels among reproductive age non-perinatal women were lower than 20 ng/ml in 10 out of 22 groups (45.4%), and lower than 30 ng/ml in 21 groups (95.5%). The mean serum 25(OH)D level among reproductive age perinatal women was lower than those among reproductive age non-perinatal women. Among reproductive age perinatal women, except for one group that included women in the first trimester of pregnancy (5-10 weeks), the mean serum 25(OH)D levels of the other groups were lower than 20 ng/ml.Conclusion　Serum 25(OH)D levels among reproductive age Japanese women, especially perinatal women, appear to be low. Studies of serum 25(OH)D levels among reproductive age Japanese women are limited; hence, further investigation is required.