Retained products of conception (RPOC) following delivery without placenta previa: Which patients with RPOC show postpartum hemorrhage?

INTRODUCTION: To clarify the perinatal outcome of retained products of conception (RPOC) after 22 weeks or more. METHODS: The retrospective cohort study reviewed medical records of patients with RPOC without placenta previa at 186 Japanese perinatal centers. RESULTS: Of the 323 patients with RPOC, pregnancies after assisted reproductive technology (ART) accounted for 43%. Transfusion at delivery was required in 33% of the patients. Logistic regression analyses revealed that transfusion was significantly required in the following situations: ART pregnancy (aOR: 6.0, 95%CI: 2.3-16, P < 0.001), and RPOC length ≥4 cm (aOR: 5.3, 95%CI: 2.1-13, P < 0.001). Transarterial embolization (TAE) and/or hysterectomy for subsequent RPOC-related bleeding was performed in 60 patients with RPOC. Logistic regression analysis revealed that additional interventions were significantly required in the following situations: multiparity (aOR: 6.1, 95%CI: 2.1-17.2, P < 0.001), and hypervascular RPOC (aOR: 12.8, 95%CI: 3.2-51.1, P < 0.001). TAE and/or hysterectomy was also frequently employed in ART pregnancy, although this was not significant (aOR: 2.8, 95%CI: 0.9-8.2, P = 0.063). DISCUSSION: Patients with RPOC were significantly more likely to require transfusion at delivery in the presence of large RPOC and ART. They were also more likely to require hemostatic procedures for subsequent bleeding in the presence of hypervascular RPOC and ART.

Nationwide survey (Japan) on spontaneous hemoperitoneum in pregnancy.

AIM: The purpose of this study was to evaluate the current state and clinical characteristics of spontaneous hemoperitoneum in pregnancy (SHiP) in Japan by performing a comprehensive survey. METHODS: We reviewed data on pregnant women who developed SHiP during 2013-2017 (for 5 years), and were admitted to any of the perinatal centers in Japan. The survey assessed maternal background and maternal and neonatal prognosis. We divided the cases into two groups, favorable and poor prognosis groups, and made comparisons between the two groups. RESULTS: Of the 407 facilities in Japan, 267 (66%) facilities responded to our survey. Overall, 31 cases of SHiP were registered. Maternal death occurred in one case (3%) due to liver bleeding with an unknown cause. Of 23 cases with a SHiP onset during pregnancy, 12 (53%) had been misdiagnosed as placental abruption. The prognosis for the fetuses included miscarriage or stillbirth in three cases (10%) and asphyxia in 12 cases (42%). There was no significant correlation between the amount of intra-abdominal blood loss and neonatal prognosis based on umbilical artery pH. Incidences of preterm birth <32 gestational weeks (adjusted odds ratio, 35.75; 95% confidence interval, 3.46-368.82) were higher in the poor prognosis group than that in the favorable group. Endometriosis and artificial reproductive techniques were both associated with 19% of all cases of SHiP. CONCLUSION: SHiP was associated with maternal death and poor fetal prognosis. Prematurity and persistent uterine contractions which might be misdiagnosed as placental abruption seem to contribute to poor fetal prognosis.

Reliability and validity of the Children's Depression Inventory-Japanese version.

BACKGROUND: Depression has major negative consequences for individuals and society, and psychological assessment tools for early disease detection are needed. The aim of this study was to investigate the reliability and validity of an updated Japanese version of the Children's Depression Inventory (CDI-J) and set a cut-off score for the detection of depression. METHODS: The participants consisted of 465 children and adolescents aged 7-17 years. The control (CON) groups consisted of students recruited from elementary and junior-high school (CONEJ) and children recruited from among hospital staff members (CONRE), while the outpatient clinical (OPC) groups consisted of pediatric psychosomatic outpatients (OPCPD) and adolescent psychiatric outpatients (OPCPS). The CON and OPC CDI-J scores underwent factor analysis using varimax rotation, followed by measurement invariance analysis. The Youth Self-Report (YSR) was administered to assess concurrent validity. The Mini-International Neuropsychiatric Interview was administered to the OPC group to diagnose current depressive symptoms. Receiver operating characteristics (ROC) analysis was conducted to evaluate case-finding performance and to set cut-off points for the detection of depression. RESULTS: The CDI-J was reliable in terms of internal consistency (Cronbach α = 0.86; mean inter-item correlation, 0.16). Re-test reliability was substantial (mean interval 18 days: γ = 0.59, P < 0.05). The four-factor solution exhibited adequate internal consistency (range, 0.52-0.73) and correspondence (Pearson correlation of 0.65 with the YSR) for both the CON and OPC groups. On ROC analysis the optimal cut-off score was 23/24. CONCLUSION: The CDI-J can be used as a reliable and well-validated instrument alongside standard diagnostic procedures.

The deposition densities of radiocesium and the air dose rates in undisturbed fields around the Fukushima Dai-ichi nuclear power plant; their temporal changes for five years after the accident.

The deposition densities of radiocesium and the air dose rates were repeatedly measured in a large number of undisturbed fields within the 80 km zone that surrounds the Fukushima Dai-ichi Nuclear Power Plant site between 2011 and 2016, and features of their temporal changes were clarified. The average air dose rate excluding background radiation in this zone decreased to about 20% of the initial value during the period from June 2011 to August 2016, which was essentially a result of the radioactive decay of 134Cs with a half-life of 2.06 y. The air dose rate reduction was faster than that expected from the decay of radiocesium by a factor of about two, with most of this reduction being attributed to the penetration of radiocesium into the soil. The average deposition densities of 134Cs and 137Cs in fields that were not decontaminated were found to have decreased nearly according to their expected radioactive decay, which indicated that the movement of radiocesium in the horizontal direction was relatively small. The effect of decontamination was apparently observed in the measurements of air dose rates and deposition densities. Nominally, the average air dose rates in the measurement locations were reduced by about 20% by decontamination and other human activities, of which accurate quantitative analysis is and continue to be a challenge. In this paper, new original data obtained during 2013-2016 were added to the previously reported data collected up to 2012, and it is discussed throughout.

Preeclampsia mediates the association between shorter height and increased risk of preterm delivery.

Background: Maternal short stature has been observed to increase the risk of preterm birth; however, the aetiology behind this phenomenon is unknown. We investigated whether preeclampsia, an obstetric complication that often leads to preterm delivery and is reported to have an inverse association with women's height, mediates this association. Methods: We studied 218 412 women with no underlying diseases before pregnancy, who delivered singletons from 2005 to 2011 and were included in the Japan Society of Obstetrics and Gynecology perinatal database, which is a national multi-centre-based delivery database among tertiary hospitals. We assessed the risk of preterm delivery in relation to height using multivariate analysis, and how the association was mediated by risk of preeclampsia using mediation analysis. Results: Each 5-cm decrement in height was associated with significantly higher risk of preterm delivery [relative risk 1.20; 95% confidence interval (CI): 1.13, 1.27] and shorter gestational age (-0.30; 95% CI: -0.44, -0.16 weeks). Mediation analysis showed that the effect of shorter height on increased risk of preterm delivery, due to an indirect effect mediated through increased risk of preeclampsia, was substantial for shorter gestational age (48%), as well as risk of preterm delivery (28%). When examining the three subtypes of preterm delivery separately, mediated effect was largest for provider-initiated preterm delivery without premature rupture of membranes (PROM) (34%), compared with spontaneous preterm delivery without PROM (17%) or preterm delivery with PROM (0%). Conclusions: Preeclampsia partially mediates the association between maternal short stature and preterm delivery.

Association between very advanced maternal age and adverse pregnancy outcomes: a cross sectional Japanese study.

BACKGROUND: While several studies have demonstrated the increased risk of pregnancy complications for women of advanced age, few studies have focused on women with very advanced age (≥ 45), despite the increasing rate of pregnancy among such women. Furthermore, how such risks of increase in age differ by maternal characteristics are also poorly understood. Thus, we aimed to clarify pregnant outcomes among women with very advanced age and how the effect of age differs by method of conception and parity. METHODS: We used the national multicenter Japan Society of Obstetrics and Gynecology perinatal database, including 365,417 women aged 30 years or older who delivered a singleton between 2005 and 2011. We divided women into four groups based on age (years): 30-34, 35-39, 40-44, and ≥45, and compared risk of adverse birth outcomes between the groups using Poisson regression. Effect modification by parity and use of assisted reproductive technology (ART) was also evaluated. RESULTS: Compared with women aged 30-34 years, women aged 45 or older had higher risk of emergency cesarean delivery [adjusted risk ratio (aRR): 1.77, 95% confidence interval (95% CI): 1.58-1.99], preeclampsia (aRR: 1.86, 95% CI: 1.43-2.42), severe preeclampsia (aRR: 2.03, 95% CI: 1.31-3.13), placenta previa (aRR: 2.17, 95% CI: 1.60-2.95), and preterm birth (aRR: 1.20, 95% CI: 1.04-1.39). The effect of older age on risk of emergency cesarean section, preeclampsia, and preterm birth were significantly greater among those who conceived naturally compared to those who conceived by ART. The effect on emergency cesarean section was stronger among primiparous women, whereas the risk of preeclampsia associated with older age was significantly greater among multiparous women. CONCLUSIONS: Very advanced maternal age (≥ 45) was related to greater risk for adverse birth outcomes compared to younger women, especially for maternal complications including cesarean section, preeclampsia, severe preeclampsia, and placenta previa. The magnitude of the influence of age also differed by conception method and by parity.

Association of Shorter Height with Increased Risk of Ischaemic Placental Disease.

BACKGROUND: Although adult height is inversely related with the risk of chronic disease, the association between maternal height and ischaemic placental disease remains unclear. METHODS: We used the national, multicentre Japan Society of Obstetrics and Gynecology perinatal database to assess the risk of preeclampsia, placental abruption, and small for gestational age (SGA) births (birthweight < 10th percentile), which together constitute the syndrome 'ischaemic placental disease', in relation to self-reported height in 218 412 women with no underlying diseases before pregnancy, who delivered singletons in 2005-11. Height was categorised into quartiles as well as considered in linear terms, and its effect on each outcome was estimated using multivariable log binomial regression adjusted for the maternal characteristics. RESULTS: The risk of preeclampsia, placental abruption, and SGA birth was inversely related to maternal height. In the adjusted model, mothers in the lowest quartile for height (<155 cm) were at higher risk of preeclampsia (relative risk (RR) 1.35, 95% confidence interval (CI) 1.25, 1.45), placental abruption (RR 1.20, 95% CI 1.07, 1.34), and SGA (RR 1.96, 95% CI 1.90, 2.03) compared with mothers in the highest quartile (>162 cm). When the association between height and outcomes was considered in linear terms, each 5 cm decrement in height was associated with an increased risk of preeclampsia (RR 1.11, 95% CI 1.09, 1.14), placental abruption (RR 1.04, 95% CI 1.01, 1.09), and SGA birth (RR 1.30, 95% CI 1.28, 1.31). CONCLUSION: Shorter height was associated with an increased risk of preeclampsia, placental abruption, and SGA birth.

Standard curves of placental weight and fetal/placental weight ratio in Japanese population: difference according to the delivery mode, fetal sex, or maternal parity.

OBJECTIVES: Placental weight (PW) and fetal/placental weight ratio (F/P) have been considered to be useful parameters for understanding the pathophysiology of fetal growth. However, there have been no standard data on PW and F/P in Asian populations. This study was conducted to establish nomograms of PW and F/P in the Japanese population and to clarify characteristics of PW and F/P in this population. STUDY DESIGN: Included in the study were 79,590 Japanese cases: 58,871 vaginal and 20,719 cesarean deliveries at obstetrical facilities (2001-2002) and registered to the Japan Society of Obstetrics and Gynecology Database. Multiple pregnancies, stillbirths, and fetal anomalies were excluded. Nomograms of PW and F/P were created by spline methods in groups categorized by fetal sex (male or female) and maternal parity (primipara or multipara). RESULTS: Standard curves of PW and F/P were established, which indicated that PW and F/P were lower in cesarean deliveries than vaginal deliveries, especially during preterm period. PW differed depending on fetal sex and maternal parity. F/P differed according to fetal sex. CONCLUSION: We for the first time established standard curves of PW and F/P in the Japanese population with statistically sufficient data, which showed that PW and F/P were lower in cesarean deliveries. PW and F/P were also affected by fetal sex. These data might be useful to understand the pathophysiology between the fetus and placenta in utero.

The air dose rate around the Fukushima Dai-ichi Nuclear Power Plant: its spatial characteristics and temporal changes until December 2012.

Distribution maps of air dose rates around the Fukushima Dai-ichi Nuclear Power Plant were constructed using the results of measurement obtained from approximately 6500 locations (at most) per measurement period. The measurements were conducted 1 m above the ground using survey meters in flat and spatially open locations. Spatial distribution and temporal change of the air dose rate in the area were revealed by examining the resultant distribution maps. The observed reduction rate of the air dose rate over the 18 months between June 2011 and December 2012 was greater than that calculated from radioactive decay of radiocesium by 10% in relative percentage except decontaminated sites. This 10% difference in the reduction of the air dose rate can be explained by the mobility of radiocesium in the depth direction. In the region where the air dose rate was lower than 0.25 µSv h(-1) on June 2011, the reduction of the air dose rate was observed to be smaller than that of the other dose rate regions, and it was in fact smaller than the reduction rate caused by radioactive decay alone. In contrast, the reduction rate was larger in regions with higher air dose rates. In flat and spatially open locations, no significant difference in the reduction tendency of air dose rates was observed among different land use classifications (rice fields, farmland, forests, and building sites).

Spatial distributions of radionuclides deposited onto ground soil around the Fukushima Dai-ichi Nuclear Power Plant and their temporal change until December 2012.

Spatial distributions and temporal changes of radioactive fallout released by the Fukushima Dai-ichi Nuclear Power Plant accident have been investigated by two campaigns with three measurement schedules. The inventories (activities per unit area) of the radionuclides deposited onto ground soil were measured using portable gamma-ray spectrometers at nearly 1000 locations (at most) per measurement campaign. Distribution maps of the inventories of (134)Cs, (137)Cs, and (110m)Ag as of March, September, and December 2012 were constructed. No apparent temporal change of the radionuclide inventories was observed from March to December 2012. Weathering effects (e.g., horizontal mobility) were not noticeable during this period. Spatial dependence in the ratios of (134)Cs/(137)Cs and (110m)Ag/(137)Cs were observed in the Tohoku and Kanto regions. The detailed maps of (134)Cs and (137)Cs as of September 2012 and December 2012 were constructed using the relationship between the air dose rate and the inventory.

Comparison of 1470 nm Laser and Radial 2ring Fiber with 980 nm Laser and Bare-Tip Fiber in Endovenous Laser Ablation of Saphenous Varicose Veins: A Multicenter, Prospective, Randomized, Non-Blind Study.

OBJECTIVE: The aim of this study is to compare the clinical efficacy and safety of two laser wavelengths and fiber types in endovenous laser ablation (EVLA) of saphenous varicose veins of the lower limb. DESIGN: Multi-center prospective randomized non-blind clinical trial. PATIENTS AND METHODS: From January 2007 to December 2011, 113 patients (113 limbs) with primary varicose veins were randomized into two groups. They were treated with radial 2ring fiber and 1470 nm laser in Group I (57 limbs) and bare-tip fiber and 980 nm laser in Group E (56 limbs) in order to ablate the saphenous vein. Vein occlusion rates at 12 weeks and pain in treated region were recorded as primary endpoint. Visual analogue scale (VAS) for assessment of pain, rates of bruising, complications and equipment failure were recorded as secondary endpoint of safety. RESULTS: Occlusion rates at 12 weeks were 100% in both groups. Rates of pain (0% vs. 25.0%) and bruising (7.0% vs. 57.1%) were significantly lower in Group I (p <0.0001). VAS of pain was significantly lower on postoperative day 1, day 5 and 2nd week in Group I. CONCLUSION: Treatment of saphenous varicose veins by EVLA using a 1470 nm laser and a radial 2ring fiber resulted in comparable occlusion rates at 12 weeks and less postoperative pain and bruising than EVLA with a 980 nm laser and a bare-tip fiber. (This article is a translation of Jpn J Vasc Surg 2014; 23: 964-971.).

Seasonal variation in the prevalence of pregnancy-induced hypertension in Japanese women.

AIM: Whether prevalence rate of pregnancy-induced hypertension (PIH), including gestational hypertension and pre-eclampsia, is lower for summer delivery than for winter delivery remains to be studied in Japanese women. METHODS: The prevalence rate of PIH was retrospectively determined according to month of year at delivery and at conception in 301510 Japanese women who gave birth to singleton infants on or after gestational week 22 between 2005 and 2009. RESULTS: The overall prevalence of PIH was 4.6% (13848/301510). The prevalence rate of PIH, ranging 3.6-4.6% for women with deliveries in July-August was consistently lowest during the 5-year study period. The mean ± standard deviation prevalence rate of 4.2 ± 0.3% for delivery in July-August was significantly lower than those for any other month (January-February, 4.7 ± 0.4%; March-April, 4.9 ± 0.4%; May-June, 4.6 ± 0.2%; September-October, 4.6 ± 0.1%; and November-December, 4.6 ± 0.2%). The prevalence rate of PIH was highest (4.9%) for women with conception in March and April and lowest (2.9%) for those with conception in November and December. CONCLUSION: The prevalence rate of PIH was higher for delivery in winter and early spring and lowest for summer delivery among Japanese women.

Gestational weight gain according to number of fetuses in Japanese women.

AIM: It is unknown whether weekly maternal weight gain differs between Japanese women with singleton, twin, and triplet pregnancies. METHODS: Gestational weight gain defined as net weight gain during pregnancy was analyzed in 135,036 pregnant Japanese women, including 128,838 with singletons, 5573 with twins, and 132 with triplets, who gave birth at ≥22 weeks of gestation between 2007 and 2009. Weekly weight gain was defined as follows: gestational weight gain÷[gestational week (GW) at Delivery-2]. RESULTS: Length of gestation (weeks, mean±SD) decreased significantly (38.2±2.6, 35.3±3.0, and 32.7±2.8) with increasing number of fetuses, while overall gestational weight gain (kg) was significantly smaller in women with singletons than in those with either twins or triplets (9.6±4.4 vs. 10.9±4.8 or 10.9±5.2, respectively). Thus, weekly maternal weight gain (kg/week) increased significantly with increasing number of fetuses (0.26±0.12, 0.33±0.13, and 0.35±0.16). Among women with delivery at or after GW 34, difference in gestational weight gain (kg) was prominent between the three groups (9.8±4.4, 11.4±4.7, and 13.0±5.1 for singleton, twin, and triplet pregnancies, respectively, P<0.001 between any two groups). CONCLUSIONS: Weekly maternal weight gain increases with increasing number of fetuses. Our figures may be useful for advising Japanese women with multifetal pregnancies regarding gestational weight gain.

Prospective risk of abruptio placentae.

AIM: The aim of this study was to better characterize the nature of abruptio placentae (AP) with regard to the timing of onset. MATERIAL AND METHODS: Prevalence and prospective risk of AP according to gestational week (GW) were determined among 293,899 women who gave birth to singleton infants at and after GW 30. The prospective risk of AP at gestational week N was defined as the number of all women who experienced an AP at ≥GW N divided by the number of all women who gave birth at ≥GW N. RESULTS: AP developed in 2649 (0.90%) women. The prevalence of AP (6.7% among women who gave birth at GW 30-33) sharply decreased with advancing GW at delivery to 0.9% for GW 37 and 0.1% for ≥GW 42. The highest prospective risk of AP, 9 per 1000 women at GW 30, decreased linearly with advancing gestation to 1 per 1000 women at ≥GW 42. AP accounted for 4.7% (1591/33,725) of all preterm births at GW <37, while prevalence of AP was 0.41% (1058/260,174) among term births. Preterm AP accounted for 60.1% (1591/2649) of all AP. CONCLUSION: Our figures indicate that AP is more common in preterm births than in term birth and may be helpful for better understanding the epidemiology of this condition.

Do uterotonic drugs increase risk of abruptio placentae and eclampsia?

PURPOSE: To determine whether the use of uterotonics, including oxytocin and prostaglandins, increases the risk of abruptio placentae and eclampsia. MATERIALS AND METHODS: A retrospective analysis was conducted among 260,174 Japanese women at term. Demographic characteristics were studied as possible candidates for risk factors of abruptio placentae and eclampsia using multivariate logistic regression analyses. RESULTS: A total of 1,058 (0.41 %) and 147 (0.06 %) women developed abruptio placentae and eclampsia, respectively. Abruptio placentae and eclampsia occurred in 177 (0.29 %) and 42 (0.07 %) of the 61,857 women treated with uterotonics, respectively. Multivariate regression analyses indicated that uterotonics did not increase risk of developing either abruptio placentae or eclampsia. Primiparity [odds ratio (95 % confidence interval) 1.41 (1.24-1.60)], age ≥35 years [1.17 (1.03-1.33)], and presence of hypertension [2.42 (1.93-3.03)] were significant independent risk factors for abruptio placentae, while advancing gestation [0.67 (0.63-0.71)] decreased risk of abruptio placentae. Primiparity [odds ratio (95 % confidence interval) 4.06 (2.49-6.63)], age <20 years [2.44 (1.07-5.58)], presence of hypertension [28.7 (20.5-40.1)], and advancing gestation [1.28 (1.11-1.47)] were significant independent risk factors for eclampsia. CONCLUSION: The use of uterotonics did not increase the risk of abruptio placentae and eclampsia.

Clinical features and short-term outcomes of triplet pregnancies in Japan.

OBJECTIVE: To review clinical features and short-term outcomes of triplet pregnancies among Japanese women. METHODS: A retrospective analysis was carried out among 320 Japanese women with triplet pregnancies (8 monochorionic, 75 dichorionic, and 150 trichorionic triplets; 87 with unknown placental chorionicity) who delivered at 22 gestational weeks or more between January 2005 and December 2008. RESULTS: Delivery was by cesarean for 315 (98%) women. Gestational age at delivery was 32.3±2.8 weeks (mean±SD) and 33.2 weeks (median), and 97%, 61%, and 14% of women delivered at less than 37, less than 34, and less than 30 gestational weeks, respectively. For live-born infants, mean birth weight was 1762±437 g, 1608±396 g, and 1406±380 g for the heaviest, middle, and lightest triplet, respectively. Eighteen (5.6%) women experienced perinatal mortality (3 triplets for 1 woman, 2 triplets for 4 women, and 1 triplet for 13 women). Perinatal mortality was 25 deaths per 1000 deliveries, and decreased with increasing number of chorionic membranes (125, 44, and 20 per 1000 mono-, di-, and trichorionic triplet deliveries, respectively). CONCLUSION: Short-term outcomes were good among triplet pregnancies in Japan. The data may be useful for counseling Japanese women with triplet pregnancies.

Fetal macrosomia in Japanese women.

AIM: It is unknown how to reduce the number of macrosomic neonates among women without hyperglycemia. The aim of this study was to determine clinically useful risk factors for macrosomic neonates among women without hyperglycemia. MATERIAL AND METHODS: A retrospective observational study was conducted in 117 680 Japanese women without hyperglycemia who gave birth to singleton infants at 37 weeks of gestation or later. Maternal age, parity, fetal sex, pregnancy length, and maternal body composition were studied as possible candidates for risk factors of macrosomic neonates using multivariate logistic regression analyses. Outcome measures were clinically available independent risk factors for macrosomic neonates weighing 4000 g or more. RESULTS: A total of 1037 (0.9%) women gave birth to macrosomic neonates. A male fetus (odds ratio [95% confidence interval]: 1.99 [1.75-2.27]), multiparity (1.75 [1.53-1.99]), pregnancy length of 41 weeks or more (4.28 [3.73-4.91]) and six characteristics at or above the 90th percentile values consisting of body height (≥1.65 m: 1.70 [1.45-1.99]), pre-pregnancy body weight (≥65 kg: 1.47 [1.12-1.93]), pre-pregnancy body mass index (BMI) (≥25 kg/m²: 1.49 [1.16-1.91]), weight gain during pregnancy (≥15 kg: 2.32 [1.78-3.03]), BMI gain during pregnancy (≥6.0 kg/m²: 1.52 [1.16-2.00]), and body weight at delivery (≥75 kg: 2.57 [2.08-3.17]) were identified as independent risk factors for macrosomia. CONCLUSION: Intervention, such as a counseling on dietary habits leading to a lesser net weight gain may be considered among women suspected of having fetal overgrowth.

Long-term effects of a universal prevention program for depression in children: a 3-year follow-up study.

BACKGROUND: The present study evaluates the long-term effects of a universal prevention approach for depression in children. It looks into the 2- and 3-year follow-ups of previously reported postintervention and 1-year outcomes. METHOD: One hundred and eighty-nine 3rd grade (8-9 years old) children participated in a five-session, school-based, universal prevention program designed to encourage social skills and peer support. The study was conducted from 2006 to 2009 in two public schools in Miyazaki, the south main island of Japan. RESULTS: Depressive symptoms decreased significantly from the pre to the postintervention periods, and this effect was maintained. Furthermore, children in the prevention group showed significantly lower depression than the normative sample. CONCLUSIONS: This study reveals the beneficial long-term effects of a universal approach.

Prospective risk of intrauterine fetal death in monoamniotic twin pregnancies.

This study was conducted to review the overall short-term outcome of monoamniotic twins in Japan and to determine the prospective risk of fetal death so as to adequately counsel parents with monoamniotic twins. Study subjects were 101 women with monoamniotic twins who were registered with the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System and who had given birth at ≥22 weeks of gestation during 2002-2009. The gestational week at delivery (mean±SD) was 31.8±3.7. Fourteen women experienced intrauterine fetal death (IUFD). Short-term outcomes of co-twins born to the 14 women included 8 IUFDs, one early neonatal death within 7 days of life (END), and 5 survivors. Four other women experienced 5 ENDs. Thus, 13.9% (28/202) of infants died perinatally (22 IUFDs and 6 ENDs), 13.9% (14/101) of women experienced IUFD, and 82.2% (83/101) of women experienced neither IUFD nor END. Structural anomalies and twin-to-twin transfusion syndrome explained 17.9% (five infants) and 10.7% (three infants) of the 28 perinatal deaths, respectively. The prospective risk of IUFD was 13.9% (14/101) for women who reached gestational week 22(-0/7), gradually decreasing thereafter but remaining at between 4.5% and 8.0% between gestational week 30(-0/7) and 36(-0/7).

Prevalence of hyperglycemia during pregnancy according to maternal age and pre-pregnancy body mass index in Japan, 2007-2009.

OBJECTIVE: To assess the prevalence of hyperglycemia according to maternal age and pre-pregnancy body mass index (BMI) among Japanese women before introduction of the current diagnostic criteria. METHODS: In a retrospective study, data were analyzed from women with singleton pregnancies who were registered with the JSOG Successive Pregnancy Birth Registry System and who gave birth at 22 weeks of gestation or more between January 2007 and December 2009. RESULTS: Among 138530 women, 3667 (2.6%) were diagnosed with hyperglycemia including gestational diabetes and diabetes mellitus. The prevalence of hyperglycemia increased with advancing maternal age and increasing BMI. Among women aged ≤ 24, 25-34, 35-39, and ≥40 years, the prevalence was 0.4%, 0.8%, 1.5%, and 4.0%, respectively, in lean women (BMI<18.5); 1.0%, 1.6%, 2.3%, and 3.1%, respectively, in normal weight women (BMI 18.5-24.9); and 5.7%, 9.2%, 12.9%, and 15.2%, respectively, in obese women (BMI ≥25.0). Of the 1181 newborns with a birth weight of 4000 g or more, 1046 (88.6%) were born to women not diagnosed with hyperglycemia. CONCLUSION: The results may reflect the baseline prevalence of hyperglycemia and macrosomic neonates (birth weight ≥4000 g) during the era of the old diagnostic criteria in Japan.