Effects of breastfeeding on postpartum weight change in Japanese women: The Japan Environment and Children's Study (JECS).

AIM: The aim of this study was to examine the relationship between breastfeeding and postpartum maternal weight change. METHOD: This study used data from the Japan Environment and Children's Study (JECS), an ongoing nationwide birth cohort study. Participants were categorized into two groups: full breastfeeding (FB) and non-full breastfeeding (NFB) groups. Postpartum weight changes between the FB (n = 26,340) and NFB (n = 38,129) groups were compared. RESULTS: At 6 months postpartum, mean weight retention was significantly lower in the FB group than in the NFB group (0.2 vs 0.8 kg, respectively, p<0.001). Weight retention differed by pre-pregnancy body mass index (BMI), with postpartum weights of overweight (pre-pregnancy BMI 25.0-29.9) and obese (pre-pregnancy BMI ≥30.0) participants being lower than pre-pregnancy weight; this trend was more pronounced in the FB group than in the NFB group (overweight: -2.2 vs -0.7 kg, respectively; obese: -4.8 vs -3.4 kg, respectively). Factors affecting weight retention at 6 months postpartum were weight gain during pregnancy (ß = 0.43; p<0.001), pre-pregnancy BMI (ß = -0.147; p<0.001) and feeding method. FB resulted in lower weight retention than NFB (ß = -0.107; p<0.001). CONCLUSION: Breastfeeding reduced maternal weight retention, which was greater in mothers who were obese before pregnancy. For obese women, active breastfeeding may improve their health.

Characteristics of ovarian endometrioma during pregnancy.

AIM: During pregnancy, the ovarian endometrioma generally decreases in size and occasionally ruptures. We evaluated (1) whether and how ovarian-endometrioma size changes from the first trimester to the postdelivery period, and (2) the type of endometrioma more likely to rupture during pregnancy. METHODS: During an 18-year period (2000-2018), ultrasound in the first trimester revealed ovarian endometrioma in 149 pregnant women at our tertiary institute. Among these, we subjected 138 endometriomas in 145 patients to expectant management (wait-and-watch approach during pregnancy). We compared the cyst sizes in the first trimester and the postdelivery period, and defined a >1 cm diameter size-change as a significant increase/decrease. We analyzed four patients with rupture and characterized the predictors of rupture. RESULTS: A comparison of cyst sizes in the first trimester and the postdelivery period revealed that the size of 94 (68%), 37 (27%), and 7 ovaries (5.0%), respectively, decreased, remained unchanged, and increased; in 56 ovaries (40%), apparent cysts were no longer present. Of the 145 patients, four (2.8%) required emergency surgery for cyst rupture. Adhesion to the surroundings, an increase in cyst size, large size (diameter of ≥6 cm), and compression due to the enlarged uterus in late pregnancy were factors clinically related to rupture. CONCLUSIONS: Approximately two-thirds of ovarian endometriomas decreased in size during pregnancy (40% disappeared), 27% remained unchanged, and only 5% increased in size. However, 2.8% of pregnant women with endometrial cysts experienced rupture. We characterized risk factors for rupture; however, clinical application requires further evaluation.

Perinatal outcomes of recurrent placental abruption.

INTRODUCTION: The purpose of this study was to classify patients with placental abruption (PA) into those with a history of PA (recurrence group) and those without a history (first-occurrence group), and compare the two groups to investigate whether perinatal outcomes differ between first-time PA and recurrent PA. MATERIALS AND METHODS: Subjects include 6475 patients diagnosed with PA from the Pregnancy Birth Registry System of the Japan Society of Obstetrics and Gynecology. Patients were classified into recurrence group and first-occurrence group. Perinatal outcomes were compared between 141 patients in the recurrence group and 705 patients in the first-occurrence group with 1:5 propensity score matching, adjusting for maternal age, history of smoking, pregnancy-induced hypertension, and premature rupture of membranes as covariates. RESULTS: There were no cases of maternal mortality in either groups, and the perinatal mortality rate did not exhibit a significant difference. Gestational age at delivery was significantly earlier in the recurrence group than in the first-occurrence group (35.3 vs 37.9 weeks, p < .001). The rate of preterm delivery at less than both 32 and 37 weeks of gestation was significantly higher in the recurrence group. The rate of UmApH < 7.1 and 5 min Apgar score < 7 were significantly higher in the recurrence group (21 vs 13%, p = .020, 20% vs 10%, p = .003, respectively). CONCLUSIONS: The results suggest that recurrent PA occurs at an earlier gestational age and follows a more severe course than the first occurrence of PA.

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).

Expectant Management Leading to Successful Vaginal Delivery following Intrauterine Fetal Death in a Woman with an Incarcerated Uterus.

Expectant management leads to successful vaginal delivery following intrauterine fetal death in a woman with an incarcerated uterus. Management of intrauterine fetal death in the second or third trimester of pregnancy in women with an incarcerated uterus is challenging. We report a case of successful vaginal delivery following intrauterine fetal death by expectant management in a woman with an incarcerated uterus. In cases of intrauterine fetal death in women with an incarcerated uterus, vaginal delivery may be possible if the incarceration is successfully reduced. If the reduction is impossible, expectant management can reduce uterine retroversion, thereby leading to spontaneous reduction of the incarcerated uterus. Thereafter, vaginal delivery may be possible.

Spontaneous reduction of an incarcerated gravid uterus in the third trimester.

An incarcerated gravid uterus is an uncommon complication of pregnancy. On rare occasions, an incarcerated gravid uterus resolves spontaneously even in the third trimester of pregnancy. Severe abdominal pain might be caused by spontaneous reduction and should be considered as a possible cause.

A classification of congenital uterine anomalies predicting pregnancy outcomes.

OBJECTIVE: To evaluate pregnancy outcomes in women with uterine anomalies by applying a method for diagnosing and classifying congenital uterine malformations. DESIGN: Retrospective study. SETTING: Tertiary care center. POPULATION: Ninety-four women with uterine anomalies who delivered after 22 gestational weeks. METHODS: Excluding the 14 women with a history of surgery and seven with one endometrial cavity, 73 women with two endometrial cavities were subdivided into those with two external uterine orifices (2-OS subgroup) and those with one external uterine orifice (1-OS subgroup). MAIN OUTCOME MEASURES: Pregnancy outcomes, such as preterm birth, abnormal fetal presentation, cesarean delivery and placental abruption. RESULTS: The 2-OS subgroup comprised women with a didelphic or complete septate uterus who had a significantly higher rate of cesarean delivery (91% vs. 18%, p < 0.001) than the control group (normal uterine morphology; n = 5763). The 1-OS subgroup comprised women with a bicornuate or incomplete septate uterus who had significantly higher rates of preterm birth (27% vs. 5%, p < 0.001) and placental abruption (14% vs. 0.7%, p < 0.001) than the control group. CONCLUSIONS: Classification of uterine anomalies by the number of uterine endometrial cavities and external uterine orifices is an easy and reliable means of predicting pregnancy outcomes.