目　的

新生児をもつ初産婦の睡眠の質の実態および質低下の関連要因について分析し，産後早期に実施可能な睡眠の質改善に向けた支援への示唆を得ることを目的とする。

対象と方法

首都圏で分娩を取り扱う病院・診療所において，産後1か月の初産婦164名を対象に無記名自記式質問紙調査を行った。日本語版不眠重症度質問票（ISI-J）を用いて睡眠の質を評価し，睡眠の量的指標や母児の属性，サポート状況といった項目との関連をSpearmanの相関係数，多重ロジスティック回帰分析を用いて分析した。横浜市立大学研究倫理委員会の承認を得て実施した（承認番号F240900039）。

結　果

有効回答が得られた146名を分析対象とした（回収率89.0%，有効回答率100%）。結果，対象者の68.1%はISI-Jの重症度が「不眠前段階」以上であり，そのうち「不眠前段階」が48.0%と最も多かった。ISI-Jの項目の中で平均得点が最も高かった項目は「睡眠への満足度」2.62点（±0.84点）であった。多重ロジスティック回帰分析の結果，母乳栄養は混合・ミルク栄養に比べて睡眠の質を高め（OR：0.37，95%CI：0.14-0.99，p<0.05），不良な精神的健康状態の自覚は睡眠の質を低下させる（OR：2.45，95%CI：1.23-4.87，p<0.05）ことが示された。

結　論

新生児をもつ初産婦の睡眠の質低下は顕著であり，不眠症の病的水準と同程度の不眠症状を自覚している母親が多いことが示された。睡眠の質低下には，睡眠パターンに対する不満が反映され，母乳栄養でないことと不良な精神的健康状態の自覚の関連が大きいと考えられた。新生児をもつ初産婦に対して広く睡眠の質低下を予防する支援を行う必要性があり，夜間の睡眠パターン改善に向けた家族のサポート体制の整備，早期母乳育児確立，睡眠の質と精神的健康状態の相加的な向上を支援することが睡眠の質改善に有効である可能性が示唆された。

目　的

助産師の乳がん早期発見につながる乳房ケアの実践状況と実践に関連する背景を明らかにする。

対象と方法

近畿2府5県の病院と助産所の助産師923名を対象に，無記名自記式質問紙調査を実施した。調査項目は，基本属性として，年齢，経験年数，乳がんに関する教育を受けた経験，就業場所（計4項目）と，乳がん早期発見につながる実践（以下，実践）として，「乳房ケア中に乳がんを疑った経験がある」，「乳がんに関する相談を受けたことがある」，「乳房ケア中に乳がん早期発見のアセスメントしている」，「BSEの指導をしている」，「Breast Awarenessの教育をしている」，「乳がんの啓発をしている」（計6項目）を「はい」か「いいえ」で尋ね，それぞれの実践しない理由についても回答を求めた。また，実践に関連する背景を明らかにするために，基本属性と実践において，χ²検定を実施した。

結　果

有効回答は，361名（39.1%）であった。実践は，「乳がんに関する相談を受けたことがある」214名（59.3%）が最も多く，次いで「乳がんの啓発をしている」188名（52.7%）であった。最も少なかったのは，「Breast Awarenessの教育をしている」61名（17.3%），次いで「BSEの指導をしている」106名（29.7%）であった。実践しない理由は，「乳がんという視点がない」「機会がない」が多かった。実践に関連する背景として，40歳以上，経験年数10年以上，就業場所が助産所，乳がんに関する教育を受けているが，実践している人が有意に多かった。

結　論

助産師の実践は，充分とは言い難い現状であった。特に，年齢や経験年数の低い助産師の乳房ケアに関する教育の重要性が示唆された。乳房の疾患も視野に入れたフィジカルイグザミネーションの向上など，乳がん早期発見などの幅広い視野を養う教育が必要であると考える。

Purpose

This study aimed to elucidate midwives' perceptions of the characteristics of primiparous women (first-time mothers) aged 40 years and over who use postpartum care, as well as their approaches to providing postpartum care within the first two months after childbirth.

Methods

A qualitative descriptive approach was utilized. Semi-structured interviews were conducted with ten midwives experienced in providing postpartum care to primiparous women aged 40 years and over within the first two months postpartum. Interview data were analyzed inductively using content analysis. This was approved by the Ethics Review Committee of Toyama Prefectural University.

Results

Midwives described these primiparous women as often [having underlying health conditions] and [experiencing severe physical fatigue] while frequently [lack of informal support] (e.g., from family or friends). Concurrently, they perceived these mothers as [taking time to acquire parenting skills and earnestly exploring personal approaches to parenting], [making autonomous decisions], and [being more receptive to logical explanations due to high comprehension]. Sensitivity to [concerned about external judgments] (concern about others' opinions) was also noted. As supportive approaches, midwives reported consciously adapting their care by [engaging based on physical recovery], [assessing the support system], providing [being present with the mother], and utilizing [listening attentively]. Key approaches included [providing logical explanations] to enhance maternal understanding and [fostering a positive maternal outlook] (promoting a positive outlook).

Conclusion

Midwives tailored their support based on their perceptions of the mothers' characteristics. Effective support for primiparous mothers aged 40 years and over necessitates respecting their autonomous decisions and validating their parenting efforts. Furthermore, it is essential for midwives to tailor support to mothers in terms of their perceived physical, psychological, and social characteristics, such as by providing logical explanations and facilitating access to community resources, as appropriate.

Purpose

This study aimed to clarify menstrual education needs for working Japanese women.

Methods

A web survey was conducted with 500 working women in their 20s to 40s. Survey items were organized into the following categories: Menstrual education: desire for menstrual education; what participants wished to know about menstruation, menstrual symptoms, and coping strategies; preferred formats for menstrual education and the reasons for these preferences. Workplace environment: colleagues' understanding when symptoms interfere with work; workplace responses to women's health issues; and participants' desire for additional workplace support regarding women's health issues; and so on. The Chi-square test for independence was used to analyze relationships between the desire for menstrual education and each of the above variables in quotation marks. Free-text responses were analyzed with KH Coder 3 to explore the structure of women's needs regarding menstrual education.

Results

Approximately 40% of respondents expressed a desire for menstrual education. Significant difference was seen in desire for menstrual education and presence of what they wish to know about menstruation, presence of responses by their workplace women's health issues so on (p<0.001). For the item “what they wish to know about menstruation, menstrual symptoms and coping with menstrual symptoms”, a co-occurrence network was created by the automatic grouping function, and 10 codes were generated based on the similarity among words. Moreover, as a result of a hierarchical cluster analysis among the codes, they were divided into three clusters, named [Symptoms and degrees differing in each person], [How to cope with menstrual symptoms] and [Correct knowledge about menstrual bleeding and oral administration]. For “their desire for response of their workplace for women's health issues”, a co-occurrence network was created by the automatic grouping function, and 4 codes were generated based on the similarity among words. As a result of a hierarchical cluster analysis among the codes, they were divided into three clusters, named [Ease of taking leave and resting], [Reassignment to lighter tasks] and [Understanding from colleagues].

Conclusion

Although menstrual education is provided from elementary school in Japan, the study revealed that even women who regularly experience menstruation continue to seek practical knowledge, particularly about coping behaviors. Additionally, working women desire understanding of menstrual symptoms from supervisors and colleagues, particularly from male supervisors. These findings highlight the need for continuous menstrual education tailored to developmental stages and situational contexts for both men and women is necessary.

Objectives

This study aimed to compare physical activity levels during the second trimester of pregnancy according to differences in pre-pregnancy body shape perception.

Method

Demographic information and data from the Pregnancy Physical Activity Questionnaire were extracted from the second-trimester dataset of the Japan Pregnancy Eating and Activity Cohort Study. Based on body shape perception, pre-pregnancy body mass index (BMI), and the discrepancy between body image and BMI, participants were divided into three groups. Metabolic equivalents of task (MET)-hours per week were then compared by activity intensity and activity type.

Results

Of the 1489 pregnant women who consented to participate, data from 970 women were analyzed. Light-intensity physical activity was significantly more common among women who perceived their pre-pregnancy body shape as overweight rather than underweight. Moreover, household/caregiving physical activity was significantly less common among women who perceived their pre-pregnancy body shape as underweight compared to those who perceived it as normal or overweight. Physical activity levels across eight categories of activity intensity and type did not significantly differ among the three pre-pregnancy BMI groups. When comparing physical activity levels based on the presence or absence of a discrepancy between body shape perception and actual BMI, household/caregiving physical activity was significantly less common among women whose perception was appropriate rather than overestimated.

Conclusion

This study revealed that physical activity during the second trimester varies according to pre-pregnancy body shape perception. These findings may help inform strategies to promote physical activity among pregnant women.

Purpose

To support the practical use of the 37-item Quality of Life (QOL) Scale for Pregnant Japanese Women developed in clinical settings, we aimed to clarify the actual quality of life (QOL) status of pregnant women in Japan by demographic categories. The findings obtained in this study are expected to contribute to nursing support tailored to the individual circumstances of pregnant women within the time-constrained environment of prenatal health checkups, and ultimately to improve the QOL for pregnant women.

Methods

An anonymous, self-administered questionnaire was distributed to pregnant Japanese women visiting five medical institutions (2 hospitals and 3 clinics) in the Kōshinetsu region of Japan during their prenatal health checkups. The survey period was from October 2021 to March 2022. The survey predominantly incorporated a QOL Scale specifically designed for pregnant Japanese women, as developed by the researchers. Additionally, it examined various demographic characteristics of the participants, including gestational period, parity, pregnancy planning, and employment status. Statistical analyses were conducted using SPSS software. The Mann–Whitney U test was applied to compare scores between two groups for each specific demographic characteristic, while the Kruskal–Wallis test, followed by Bonferroni post-hoc adjustments was employed for comparisons among three groups. This study received approval from the Ethics Committee of Ishikawa Prefectural Nursing University.

Results

The analysis included a total of 541 respondents, resulting in a valid response rate of 69.0%. A comparison of QOL scores across different pregnancy stages showed that the daily activities score was significantly reduced during the first trimester compared to the second and third trimesters. The results further indicated significantly lower scores for unpleasant symptoms associated with the pregnancy as well as daily life functions during the third trimester compared to the second. The comparison of QOL scores across parity categories showed notable differences. Multiparous women exhibited significantly lower scores than primiparous women in aspects such as relationships with their partner/family and life control associated with the pregnancy. Conversely, primiparous women demonstrated significantly lower scores in domains including living environment, negative emotions, life functions, and peace of mind compared to multiparous women. A comparison of QOL scores based on pregnancy planning categories demonstrated that individuals with unplanned pregnancies exhibited significantly lower scores in attachment to the child compared to those with planned pregnancies. Analysis of the QOL scores based on employment category showed no significant differences between groups.

Conclusions

The Quality of Life (QOL) Scale for Pregnant Japanese Women showed variations in QOL component scores based on the demographic characteristics of the participants. Considering the demographic characteristics of pregnant women and adopting a multifaceted perspective on each component of QOL during prenatal health checkups may facilitate the development of nursing support tailored to the unique circumstances of each individual.

Purpose

This study aimed to examine the associations between specific dimensions of social support and distinct components of perinatal depressive symptoms―such as anhedonia, anxiety, and non-specific depressive symptoms―and determine whether these associations differ between the prenatal and postnatal periods among migrant mothers in Japan. Given the unique cultural, linguistic, and social challenges faced by migrant mothers during the perinatal period, understanding these nuanced relationships between types of support and mental health symptoms can inform the development of culturally responsive interventions.

Methods

A cross-sectional online survey was conducted between September 2020 and May 2021. The study included 51 migrant mothers residing in Japan, from 4 weeks of pregnancy to 24 months postpartum, were included in the study. Four dimensions of perceived social support―tangible support, emotional/informational support, affectionate support, and positive social interaction―were assessed using the Medical Outcomes Study Social Support Survey (MOS-SSS). Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) and analysed using a validated three-factor model comprising anhedonia, anxiety, and non-specific depressive symptoms. Data were analysed using t-tests, one-way analysis of variance (ANOVA), and Pearson's correlation coefficients using IBM SPSS Statistics (version 28). A p value of <.05 was considered significant.

Results

The mean total EPDS score was 8.56 (SD = 5.59), with 23.5% of participants scoring above the clinical cutoff (≥13), suggesting elevated perinatal depressive symptoms. During the prenatal period, all support types other than tangible support were strongly negatively correlated with anhedonia (r = −.59 to −.71), correlations were weaker postnatally (r = −.38 to −.45). Emotional/informational support was most strongly associated with anhedonia (r = −.70, p < .01) and anxiety prenatally (r = −.53, p < .05) and broadly linked to anhedonia (r = −.45, p < .01) and non-specific depressive symptoms (r = −.49, p < .01) postnatally. Tangible support was not significantly correlated with any depressive symptom domain in either period.

Conclusions

These findings suggest that both the type and timing of social support may be differentially related to specific depressive symptom dimensions among migrant mothers in Japan. In particular, during pregnancy, community and hospital staff can play an important role by understanding migrant mothers' needs for social support, which may help support staff offer appropriate support options and identify emerging depressive symptoms in the early stage. Postnatally, routine assessment of emotional/informational support by healthcare providers may facilitate culturally sensitive care. Such outreach may support migrant mothers and help reduce anhedonia and non-specific depressive symptoms during the child-rearing period. Further studies with larger and more diverse populations are needed to confirm these patterns and develop tailored culturally sensitive care that enhance emotional/informational support and positive social interaction for migrant mothers.

Purpose

There are limited studies on the effects of environmental changes brought about by the COVID-19 pandemic on soon-to-be fathers. Though studies have analyzed the effects of the pandemic on child and maternal health, the impact of first-time fathers' involvement in perinatal education and subsequent support during child rearing have not been studied. Therefore, this study examined the association between perinatal care participation and subsequent participation in housework and child-rearing among first-time fathers during the COVID-19 pandemic, to inform support strategies aimed at promoting paternal role adaptation during future pandemic emergencies.

Methods

A cross-sectional study was conducted based on an anonymous, self-administered online questionnaire. The study analyzed the following data from 415 men across Japan who became fathers in 2020–2023: personal characteristics, perinatal care participation, and participation in housework/childcare. Chi-square and t-tests, as well as binary logistic regression analysis using the forced entry method, were conducted to examine the association.

Results

The results showed that fathers' participation in housework and child-rearing was significantly associated with perinatal care participation and personal characteristics. The restrictions implemented during the COVID-19 pandemic led to a decline in fathers' participation in perinatal care. Restrictions on presence during childbirth and limited postpartum visitation may have negatively impacted their adaptation to the paternal role.

Conclusions

The findings highlight the need for continued monitoring and support to families during crises such as pandemics. This study offers valuable knowledge for nurses who provide perinatal care that can help them improve the quality of health care provided to new families.

Introduction

Contraceptive education and counseling have been shown to be effective in other countries, but there are no standardized programs currently in use. The purpose of this study is to develop a standardized program of contraceptive education and counseling, and to provide a detailed protocol for testing the effectiveness of midwives' implementation of this program.

Methods

The study will be a prospective randomized controlled trial for women aged 18–30 years who wish to use or consider contraception. As a preparatory step, a standard contraceptive education video will be produced in the first phase and an educational program for midwives responsible for counseling will be implemented in the second phase. In the third phase of the intervention, subjects will be stratified into healthcare-related and non-healthcare-related groups, and then randomize into two groups: an intervention group that will receive video viewing and midwifery counseling; and a control group that will receive video viewing only. The primary outcome is the percentage of participants who indicated self-determined use of contraception, with questionnaires administered before, immediately after, and 3 months after the program. Secondary outcomes include knowledge test scores, self-affirmation scale scores on contraception, frequency of opportunities to talk about contraception, and frequency of contraceptive (or non-contraceptive) sexual activity. Data will be analyzed using χ2 or t-tests for descriptive statistics and pre- and post-intervention comparisons, and one-way analysis of variance will be used to assess changes over time from baseline to 3 months after the program.

Discussion

This study will be the first in Japan to examine the effects of individualized contraceptive counseling provided by midwives as preconception care for the younger generation. Therefore, it is expected to contribute to a participants' decision-making and satisfaction with counseling, and may enable more appropriate self-determination, taking into consideration participants' relationships with their partners and other relevant factors.

Purpose

This study explores how diabetes type is associated with gestational weight gain (GWG), hypertensive disorders of pregnancy (HDP), and postpartum glycemic control levels in women with gestational hyperglycemia.

Methods

Participants comprised 757 women with diabetes mellitus, categorized as type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), overt diabetes in pregnancy (ODM), and gestational diabetes mellitus (GDM), who had delivered at 22 weeks gestation or later between January 2013 and December 2022, at X University, Japan. Data were extracted on pre-pregnancy body mass index (BMI), GWG, diabetes type, treatment during pregnancy and one-month postpartum, glycated albumin (GA) levels in the third trimester of pregnancy and one month postpartum, and other relevant variables. Kruskal-Wallis test was used to examine the association between pre-pregnancy BMI and diabetes type, and binomial logistic regression analysis was used to determine how GWG and the development of HDP is associated with pre-pregnancy BMI and diabetes type. Multiple regression analysis was performed to examine how differences in GA between the third trimester of pregnancy and the first postpartum month are associated with pre-pregnancy BMI and diabetes type.

Results

The mean pre-pregnancy BMI (mean ± SD, kg/m²) among the T1DM, T2DM, ODM, and GDM groups differed significantly (21.7 ± 3.1, 29.3 ± 5.8, 29.3 ± 6.8, and 24.2 ± 5.8, respectively, p < .001). T1DM (Adjusted Odd Ratio [aOR]: 2.35, p = .013) and pre-pregnancy BMI ≧ 30.0 (aOR: 53.3, p < .001) were significantly associated with excessive GWG. ODM (aOR: 4.14, p = .003) was significantly associated with HDP, and T2DM (β = .33, p = .036) was significantly associated with increased GA.

Conclusion

This study examined the association between diabetes type and pre-pregnancy BMI and weight gain during pregnancy, gestational hypertension, and postpartum glycemic control in women with diabetic-metabolic pregnancy. Results showed that T1DM and 2 categories of obesity were associated with excessive weight gain during pregnancy. ODM was also associated with a significantly higher risk of developing HDP, and T2DM was associated with significantly higher GA in the first postpartum month. The results suggest the need to support pregnant women from preconception to postpartum, taking into account the characteristics of each diabetes type, its mechanism of onset, and health behaviors.