Kazutomo Ohashi

Kolmogorov–Sinai (KS) entropy is an indicator of the chaotic behavior of entire systems from an information-theoretic viewpoint. Here, we used KS entropy values derived from the heart sounds of four fetus–mother pairs to identify the changes in fetal and maternal informational patterns during the four phases of pregnancy (early, mid, late, and postnatal). Time-series data of the heart sounds were reconstructed in a five-dimensional phase space to obtain the Lyapunov spectrum, and KS entropy was calculated. Statistical analyses were then conducted separately for the fetus and mother for the four phases of pregnancy. The fetal KS entropy significantly increased from early pregnancy to the postnatal period (0.054 ± 0.007 vs. 0.097 ± 0.007; p < 0.001), whereas the maternal KS entropy decreased in late pregnancy and then significantly increased after birth (0.098 ± 0.002 vs. 0.133 ± 0.003; p < 0.001). The increase in KS entropy with the course of fetal gestation reflects an increase in information generation and adaptive capacity during the developmental process. Thus, changes in maternal KS entropy play a dual role, temporarily enhancing physiological stability to support fetal development and helping to rebuild the mother’s own adaptive capacity in the postpartum period.

Objective: Parenting self-efficacy (PSE) is an important factor in children’s development. Mothers’ PSE tends to be the lowest 1 month postpartum. A common measure of PSE is the Parenting Sense of Competence (PSOC) scale. However, no existing scale measures the PSE of Japanese mothers with newborns. Therefore, this study developed a Japanese version of the PSOC scale for mothers 1 month postpartum (Study 1) and investigated the structure of their PSE (Study 2). Methods: In Study 1, data were collected from mothers 1 month postpartum from April to October 2017, and an exploratory factor analysis was performed on their PSOC scores. In Study 2, data were collected from mothers 1 month postpartum from January to September 2022. A confirmatory factor analysis was conducted of the Japanese PSOC scale developed in Study 1 to investigate the structure of the participants’ PSE 1 month postpartum. Results: In Study 1, a 2-factor (Efficacy and Satisfaction) 12-item Japanese PSOC scale was obtained after deleting four items because of low factor loadings. In Study 2, the model showed an acceptable fit. The Japanese PSOC (12 items) had a moderate positive correlation with Rosenberg’s Self-Esteem Scale and the Maternal Attachment Inventory and a moderate negative correlation with the Edinburgh Postpartum Depression Scale. Furthermore, mothers whose children had siblings (versus no siblings) and mothers with three children (versus two children) had significantly higher PSOC scores. Conclusions: We developed a reliable and valid Japanese version of the PSOC for mothers 1 month postpartum and revealed the structure of their PSE.

Body dissatisfaction during pregnancy can significantly impact maternal and child health. Therefore, this longitudinal study investigated changes in body dissatisfaction using two figure rating scales developed from photographic digital data of Japanese pregnant women during the sixth and tenth months of pregnancy. Study participants were recruited at their sixth month prenatal visit at a primary maternity clinic in Japan from October 2014 to March 2015. Body dissatisfaction was estimated based on the perceived and ideal body sizes of 135 pregnant women, expressed as body mass index. Data were collected using selfadministered questionnaires. The study found that body dissatisfaction in the tenth month was significantly higher than that in the sixth month. Among the participants, 75 (55.6%) and 79 (58.5%) experienced body dissatisfaction, desiring to be thinner (where perceived body size exceeded ideal body size) during the sixth and tenth months of pregnancy, respectively. Pregnant women who had body dissatisfaction and a desire to be thinner in the sixth month tended to experience an increase in body dissatisfaction by the tenth month compared to those without body dissatisfaction in the sixth month. During the sixth and tenth months, women with body dissatisfaction showed significantly larger perceived body sizes than those without body dissatisfaction. These results indicated that the use of a figure rating scale at the sixth month of pregnancy may help identify women with body dissatisfaction; moreover, perceived body size might be a key factor in preventing an increase in body dissatisfaction from the second to third trimesters.

Objective: This study aimed to examine the presence of high-risk women developing type 2 diabetes mellitus among women with a history of gestational diabetes mellitus (GDM) who had not undergone a postpartum oral glucose tolerance test (OGTT). Methods: This was a retrospective observational study. The participants were Japanese women diagnosed with GDM and were managed at two perinatal medical centers. We compared the risk factors for developing type 2 diabetes between women who had undergone a postpartum OGTT (examinees) and those who had not had it (nonexaminees). In addition, we divided the participants with a history of GDM into high- and low-risk groups and examined the presence of high-risk women developing type 2 diabetes mellitus. Results: Of the 117 participants, 77 (65.8%) underwent a postpartum OGTT and 40 (34.2%) did not. There were no significant differences in the risk factors for developing type 2 diabetes between the two groups, except for the premature birth rate. We divided the 80 participants into two groups, including 30 nonexaminees and 50 examinees, and 34 high- and 46 low-risk women. Although there was no significant difference in the percentage of high-risk women who had undergone a postpartum OGTT, 10 (33.3%) of the 30 nonexaminees were assessed as high-risk. Conclusions: Our results indicate that 10 (12.5%) of 80 women with a history of GDM did not undergo a postpartum OGTT despite being in the high-risk group and improving the rate of postpartum OGTT may contribute to the prevention and early detection of type 2 diabetes.

Although the association between gestational diabetes mellitus (GDM) and maternal postpartum depression has been reported, the association between these two factors during pregnancy has not been sufficiently examined. We compared pregnant women with and without GDM to clarify the association and examined factors related to depression in pregnant women with GDM. Questionnaires were administered longitudinally to pregnant Japanese women in the third trimester and at 2 and 4 weeks postpartum. One hundred and five and 108 pregnant women with and without GDM, respectively, were included in the study. Of the 105 women with GDM, 20 (19.0%) reported being depressed during pregnancy, which was significantly higher than that among those without GDM (9.3%). Binomial logistic regression analysis revealed that depression was significantly positively associated with diet‐related distress and negatively associated with social support among women with GDM. Diet‐related distress and social support are important factors in managing depression in pregnant women with GDM.

Traditional menstruation practices in Nepal (Chhaupadi in Nepalese) lack scientific support and undermine women’s health. This study aimed to understand the changes in the traditional menstruation practices due to migration from Nepal to Japan. This study included 104 Nepalese women of reproductive age living in an urban area of western Japan. Participants were recruited using snowball sampling, and the method of data collection was a questionnaire survey. To examine how Nepalese women adapt traditional menstruation practices to their living environment, we compared how women followed frequently 17 traditional practices when they lived in Nepal and later in Japan. We examined the relationships among behavioural changes in traditional practices, education level, and caste. The frequency of 14 of the 17 traditional practices decreased after the women moved to Japan. Among women who reduced the frequency of traditional practices after moving from Nepal to Japan, the reduction was not associated with educational level or caste of the participants. This study suggests that the attitudes towards the traditional menstruation practices change in response to living circumstances. Future studies should focus on determining living environment factors related to behavioural changes in traditional practices.

Background: Menstrual attitudes include negative and positive perceptions of menstruation and are associated with reproductive health, underscoring the importance of its evaluation in women. Given that social and cultural factors affect menstrual attitudes, developing evaluation methods specific to distinct societal cultures is necessary. Methods: We developed a scale based on the menstrual attitude questionnaire, which is the most widely used measure of menstrual attitudes, to evaluate negative menstrual attitudes among Nepalese women in consideration of Nepalese cultural backgrounds and literacy. In total, 352 Nepalese women aged 20–45 years living in urban or suburban areas in Nepal were enrolled in the study. Participants were randomly divided into two groups using the permuted block method. Using the prototype, Group 1 (n = 176) was evaluated with an exploratory factor analysis to develop a reliable scale, and Group 2 (n = 176) was evaluated with a confirmatory factor analysis to confirm the structure of negative menstrual attitudes. Further, we preliminarily examined the relationship of negative menstrual attitudes with the frequency of traditional menstrual practices and intensity of menstrual pain, which are significant reproductive health issues in Nepal, in Group 2. Results: We developed a 15-item, 3-factor scale to evaluate negative menstrual attitudes among Nepalese women using exploratory factor analysis. The first, second, and third factors were “Natural event” (α = 0.82), “Debilitating event” (α = 0.76), and “Bothersome event” (α = 0.69), respectively. Confirmatory factor analysis revealed that negative menstrual attitudes comprised a 3-factor structure. Participants who performed three traditional menstrual practices (“stay in their own house”, “go to public spaces”, and “contact with others generally”) demonstrated significantly higher scores for negative menstrual attitudes than did non-performers. Negative menstrual attitudes were positively correlated with the intensity of menstrual pain (r = 0.558). Conclusions: This study is the first to evaluate menstrual attitudes and analyse its factor structure among Nepalese women. In the future, the relationship between accurately evaluated negative menstrual attitudes and reproductive health issues should be examined more comprehensively.

Background: The use and sharing of patient-generated health data (PGHD) by clinicians or researchers is expected to enhance the remote monitoring of specific behaviors that affect patient health. In addition, PGHD use could support patients'decision-making on preventive care management, resulting in reduced medical expenses. However, sufficient evidence on the use and sharing of PGHD is lacking, and the impact of PGHD recording on patients' health behavior changes remains unclear. Objective: This study aimed to assess patients'engagement with PGHD recording and to examine the impact of PGHD recording on their health behavior changes. Methods: This supplementary analysis used the data of 47 postpartum women who had been assigned to the intervention group of our previous study for managing urinary incontinence. To assess the patients' engagement with PGHD recording during the intervention period (8 weeks), the fluctuation in the number of patients who record their PGHD (ie, PGHD recorders) was evaluated by an approximate curve. In addition, to assess adherence to the pelvic floor muscle training (PFMT), the weekly mean number of pelvic floor muscle contractions performed per day among 17 PGHD recorders was examined by latent class growth modeling (LCGM). Results: The fluctuation in the number of PGHD recorders was evaluated using the sigmoid curve formula (R2=0.91). During the first week of the intervention, the percentage of PGHD recorders was around 64% (30/47) and then decreased rapidly from the second to the third week. After the fourth week, the percentage of PGHD recorders was 36% (17/47), which remained constant until the end of the intervention. When analyzing the data of these 17 PGHD recorders, PFMT adherence was categorized into 3 classes by LCGM: high (7/17, 41%), moderate (3/17, 18%), and low (7/17, 41%). Conclusions: The number of PGHD recorders declined over time in a sigmoid curve. A small number of users recorded PGHD continuously; therefore, patients' engagement with PGHD recording was low. In addition, more than half of the PGHD recorders (moderate- and low-level classes combined: 10/17, 59%) had poor PFMT adherence. These results suggest that PGHD recording does not always promote health behavior changes.

BACKGROUND The use and sharing of patient-generated health data (PGHD) by clinicians or researchers is expected to enhance the remote monitoring of specific behaviors that affect patient health. In addition, PGHD use could support patients’ decision-making on preventive care management, resulting in reduced medical expenses. However, sufficient evidence on the use and sharing of PGHD is lacking, and the impact of PGHD recording on patients’ health behavior changes remains unclear. OBJECTIVE This study aimed to assess patients’ engagement with PGHD recording and to examine the impact of PGHD recording on their health behavior changes. METHODS This supplementary analysis used the data of 47 postpartum women who had been assigned to the intervention group of our previous study for managing urinary incontinence. To assess the patients’ engagement with PGHD recording during the intervention period (8 weeks), the fluctuation in the number of patients who record their PGHD (ie, PGHD recorders) was evaluated by an approximate curve. In addition, to assess adherence to the pelvic floor muscle training (PFMT), the weekly mean number of pelvic floor muscle contractions performed per day among 17 PGHD recorders was examined by latent class growth modeling (LCGM). RESULTS The fluctuation in the number of PGHD recorders was evaluated using the sigmoid curve formula (R2=0.91). During the first week of the intervention, the percentage of PGHD recorders was around 64% (30/47) and then decreased rapidly from the second to the third week. After the fourth week, the percentage of PGHD recorders was 36% (17/47), which remained constant until the end of the intervention. When analyzing the data of these 17 PGHD recorders, PFMT adherence was categorized into 3 classes by LCGM: high (7/17, 41%), moderate (3/17, 18%), and low (7/17, 41%). CONCLUSIONS The number of PGHD recorders declined over time in a sigmoid curve. A small number of users recorded PGHD continuously; therefore, patients’ engagement with PGHD recording was low. In addition, more than half of the PGHD recorders (moderate- and low-level classes combined: 10/17, 59%) had poor PFMT adherence. These results suggest that PGHD recording does not always promote health behavior changes.

The Japanese Midwifery Association (JMA) guidelines allow midwives to manage group B Streptococcus (GBS)-positive women during pregnancy and labour at maternity homes. However, no guidelines exist to manage neonates born to GBS-positive women in Japan. We aimed to investigate the opinions of paediatricians regarding optimal management strategies for neonates born to GBS-positive women in maternity homes. A questionnaire was sent to paediatricians at 396 Japanese perinatal medical centres. We examined opinions regarding examinations and routine clinical tests for neonates born to GBS-positive women in maternity homes. Of 235 paediatricians, only 11.2% considered that paediatric examinations were unnecessary for neonates born to GBS-positive women in maternity homes. Moreover, 20.5%, 13.2%, and 11.1% of paediatricians considered culture test of the nasal cavity, serum C-reactive protein level analysis, and blood cell count analysis, respectively, necessary for neonates born to GBS-positive pregnant women with intrapartum antibiotic prophylaxis (IAP), whereas 36.3%, 56.2%, and 40.6% of paediatricians considered these tests necessary in cases without IAP. The JMA guidelines had low penetration rates among paediatricians in Japan. To manage neonates born to GBS-positive women in maternity homes, midwives should engage with commissioned paediatricians in more detail and develop appropriate strategies to increase awareness and cooperation.