Purpose

Preterm birth complications are the leading cause of death in infants under five years of age worldwide. Midwifery interventions during pregnancy are effective in preventing preterm birth. The aim of this study was to evaluate the feasibility of a 90-minute online midwifery education program to prevent preterm birth.

Methods

We developed a midwifery education program to prevent preterm birth. The educational program was created based on the theory of planned behavior and was conducted online in an interactive format. The program included lectures on past research on midwifery care to prevent preterm birth and guidelines for midwifery care during pregnancy, discussion among midwives on midwifery care during pregnancy, and practical exercises. The study was an open-label, parallel, randomized controlled trial. Participants in the study were midwives. Sixteen midwives were randomly assigned to take part in an online education program (intervention group) or to read a pamphlet summarizing the guidelines (control group). Midwives in the control group could access the online education program after the end of the study if they wished. The feasibility evaluation assessed the acceptability, demand, adaptability, implementation, and limited-efficacy testing of the program. Surveys were conducted at three time points: before, immediately after, and two weeks after the educational program. Acceptability, demand, adaptability, and implementation of the program were evaluated based on a questionnaire administered to the intervention group immediately after the educational program. The participants' baseline was assessed before the educational program. Limited-efficacy testing of the program compared the scores of the Japanese version of the Continuing Professional Development (CPD) REACTION Questionnaire, knowledge scores on midwifery care to prevent preterm birth, and scores on the Japanese version of the Evidence-Based Practice Attitude Scale between the intervention and control groups. The primary outcome of the limited-efficacy testing of the program was the score on the Japanese version of CPD-REACTION Questionnaire two weeks after implementation.

Results

The acceptability and practicality of the educational program were scored highly. In addition, positive opinions were obtained regarding demand and adaptability. However, some participants (n=2) found the educational materials difficult to read. Although satisfaction with group work was high, some participants (n=3) said they would have liked more time to discuss with the midwives. Immediately after and two weeks after the implementation of the educational program, midwifery care knowledge to prevent preterm birth was significantly higher in the intervention group than in the control group (Immediately after of the education program; p=.03, two weeks after the implementation of the education program; p=.001). There was no difference in the Japanese version of CPD-REACTION Questionnaire after 2 weeks compared with the intervention and control groups (p=.35).

Conclusion

The online midwifery education program to prevent preterm birth is feasible in terms of acceptability, demand, adaptability, and limited efficacy testing. It is desirable to improve materials and extend the time required for group work.

Objective

This study aimed to clarify the calculation status of mastitis prevention and guidance in fee from health insurance claims data in Japan, as well as validate the calculation status of Mastitis Prevention and Guidance fee and potential issues.

Methods

This study conducted a fact-finding survey of secondary data based on health insurance claims data in Japan from October 2019 to September 2020. Patient data with a diagnosis of inflammatory disorder of the breast (ICD-10 code [N61]) were analyzed to determine the calculation status of the Mastitis Prevention and Guide Fee. The actual number of days of medical care and the status of breast abscess incision were evaluated using t-test and χ-square test.

Results

Out of 12,976 enrolled patients, age average 33.8 (SD 7.1）years old. 3,698 (28.5%) received the initial fee for Mastitis Prevention and Guide Fee, 29.6% of those who calculated for the initial fee had a second or subsequent time fee. The actual number of days of medical treatment in the group for which the initial Mastitis Prevention and Guide Fee calculated (n＝3,698 patients) was significantly lower than that in the group without fee calculation (n＝9,278 patients) (2.6 (SD 2.4) days vs. 3.6 (SD 5.4) days) (t(12,974)＝−13.62, p<.001, d＝−0.21, 95% CI [−1.07, −0.80]). The mean actual number of days of treatment for the breast abscess incision calculation group (n＝227 patients) was 13.0 (SD 12.1) days and for the non-calculation group (n＝12,749 patients) was 3.1 (SD 4.1) days, with the breast abscess calculation group having significantly longer actual days of treatment (t(12,974)＝−12.2, p<.001, d＝2.3, 95%CI [−11.4, −8.2]). Breast abscess incision was significantly less common in the group receiving the first mastitis severity prevention care and guidance fee than in the group not receiving the fee (χ²＝43.95, p<.01)

Conclusion

The current number of times the Mastitis Prevention and Guidance Fee is calculated is considered to be 4 times appropriate, suggesting that calculation of this fee contributes to reducing the actual number of treatment days and preventing severe cases of mastitis. On the other hand, the facility standards for calculating medical fees and the fact that midwifery aren't insured medical institutions did not lead to the use of medical fees, suggesting that the current medical fees are insufficient to deal with cases of severe mastitis.

Purpose

Small for gestational age (SGA) is defined as a birth weight below the 10th percentile for gestational age, with a higher incidence in twin pregnancies compared to singletons. Preventing SGA is crucial due to its short-term risks, such as delayed adaptation to extrauterine life, and long-term risks like adult lifestyle diseases. Factors contributing to SGA in twin pregnancies include chorionicity, twin-to-twin transfusion syndrome, hypertensive disorders, smoking, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG). Additionally, nutritional intake is likely associated with SGA, as previous studies have shown that nutrients promote fetal growth. In Japan, the guidelines for GWG established in the United States are not widely applicable, and there are no standardized recommendations for GWG and nutritional intake during twin pregnancies. This study aimed to examine the various factors that contribute to SGA in twin pregnancies, with a specific focus on GWG and nutritional intake.

Methods

This study was part of the Japan Pregnancy Eating and Activity Cohort Study, conducted across four regions in Japan; however, participants in this particular study were drawn from three of those regions. The recruitment phase spanned March 2020 and February 2024. Inclusion criteria were pregnant women with twins, and exclusion criteria were those with miscarriages or missing infant data. Data collection included questionnaires on maternal lifestyle, nutritional intake, and supplement use, alongside medical records for birth outcomes and maternal characteristics. Participants were grouped into SGA or appropriate for gestational age (AGA). GWG during pregnancy was assessed cumulatively and weekly by trimester, while dietary intake of nutrients, such as iron, folic acid, and omega fatty acids, was analyzed using a brief-type self-administered diet history questionnaire. Additional data included maternal demographics, pre-pregnancy BMI, pregnancy complications, twin chorionicity, and nausea severity measured by the pregnancy-unique quantification of emesis and nausea scale.

Results

This study included 20 (29.4%) and 48 (70.6%) participants in the SGA and AGA groups, respectively. In the SGA group, The SGA group had a significantly lower pre-pregnancy BMI and a higher number of underweight women than the AGA group (p = .002 and p = .027). Underweight women in the SGA group exhibited lower weekly GWG of 340 g during the third trimester (p = .030). However, no significant differences in nutritional intake were observed between the groups.

Conclusion

Exploration of SGA factors in twin pregnancies linked pre-pregnancy BMI and third-trimester GWG in underweight women to SGA, with no association found for nutritional intake. Emphasizing healthy BMI and appropriate third-trimester GWG for underweight women is crucial. Future studies should expand sample sizes and differentiate monochorionic diamniotic and DD twins to update health guidelines.

Purpose

In preconception care, education on breast cancer prevention and early detection is important. The purpose of this study was to clarify the components of breast cancer education for young women receiving preconception care and to obtain suggestions for developing educational programs within this context.

Subjects and Methods

The participants were selected by snowball sampling and were Certified Nurse in Breast Cancer Nursing who agreed to participate of their own free will. Data were collected using an interview guide either face-to-face or online. Interviews were conducted individually using a semi-structured interview method and analyzed using conventional content analysis. This study was approved by the Kagoshima University Sakuragaoka Area Epidemiological Research Ethics Committee (approval no. 230082).

Results

Consent was obtained from nine Certified Nurse in Breast Cancer Nursing, with an average nursing career of 23 years and an average Certified Nurse in Breast Cancer Nursing career of 8 years. A component of breast cancer education in preconception care was found to be [understanding the breast as it grows and changes]. To deepen understanding of this element, education that helps in understanding [the necessity of being health-conscious from a young age] with [practical measures that lead to consultation and medical examinations] for early detection of abnormalities is required: based on the components of [knowledge of breast cancer, screening and diagnosis] and [cancer is a part of life]. Thus, [the importance of e-health literacy] in accessing accurate information has become clear.

Conclusion

Education on breast cancer in preconception care based on the six categories identified in this study should focus on the menstrual cycle and breast changes and should include knowledge, attitudes, and practical approaches to breast cancer. It is necessary to develop a program to which young people can relate on their own.

Introduction

Body shape changes during pregnancy may cause fetal growth restriction and low birth weight. Therefore, this study determined physical, psychological, and social factors associated with body shape satisfaction during the second and third trimesters of pregnancy.

Methods

This prospective observational study used data from the Japan Pregnancy Eating and Activity Cohort Study. We collected data pertaining to pregnant women in their second and third trimesters from web-based questionnaires and medical records. The factors related to body shape satisfaction in the second and third trimesters were determined using multiple logistic regression analysis.

Results

Among 910 pregnant women, women with obesity before pregnancy (second trimester [T2]: adjusted odds ratio [aOR] = 2.79, 95% confidence interval [CI] = 1.42–5.49; third trimester [T3]: aOR = 2.76, 95% CI = 1.32–5.77), those dissatisfied with their body shape before pregnancy (T2: aOR = 5.04, 95% CI = 3.60–7.08; T3: aOR = 1.91, 95% CI = 1.33–2.74), those with a history of smoking (T2: aOR = 2.84, 95% CI = 1.12–7.24; T3: aOR = 1.95, 95% CI = 1.07–3.40), those who did not hope for pregnancy (T2: aOR = 5.85, 95% CI = 1.04–32.89), and those with a heavy burden of household/caregiving activities (T3: aOR = 1.01, 95% CI: 1.00–1.02) were at a higher risk of being dissatisfied with their body shape.

Conclusions

This study revealed the factors associated with body shape dissatisfaction among pregnant women. Further research is needed to understand the psychological impact of body shape dissatisfaction on pregnant women.

Purpose

The impact of teleworking on physical activity (PA) during pregnancy has not been fully elucidated. This study aimed to describe the PA level of pregnant women according to their employment and teleworking availability and evaluate the magnitude of the association between PA and these working availability in the second trimester.

Methods

This cross-sectional study was part of The Japan Pregnancy Eating and Activity Cohort Study conducted in four prefectures. Participants were recruited from March 2020 to October 2022, including the coronavirus disease 2019 pandemic. PA was assessed using the Japanese version of the self-administered Pregnancy Physical Activity Questionnaire 2020. Participants were classified as non-workers, teleworkers, and on-site workers. The data of 864 participants were stratified by parity, and analyzed via analysis of covariance.

Results

Teleworkers performed significantly more total PA than non-workers, regardless of parity. In terms of intensity and PA type, teleworkers and on-site workers were more sedentary and performed significantly more occupational PA and less household/caregiving PA than non-workers among primiparas. Only primiparous teleworkers performed significantly less light PA, with no significant difference in moderate PA, than non-workers. Among multiparas, teleworkers and on-site workers were more sedentary and performed significantly more occupational PA and less light PA and household/caregiving PA. Compared to non-workers, only multipara teleworkers showed no significant difference in moderate PA.

Conclusion

Teleworkers performed more total PA, sedentary activity, and less light PA than non-workers, like on-site workers. Increased sedentary time is related to higher risk of pregnancy complications and unfavorable birth outcomes. Therefore, healthcare professionals may need to encourage pregnant teleworkers to replace sedentary with PA of any intensity as much as possible.