Journal of Japan Academy of Midwifery
Online ISSN : 1882-4307
Print ISSN : 0917-6357
ISSN-L : 0917-6357
Current issue
Displaying 1-8 of 8 articles from this issue
Foreword
Original articles
  • Satoko TAKAOKA, Yasue KOBAYASHI, Ryoji SHINOHARA, Sayaka HORIUCHI, Meg ...
    2023 Volume 37 Issue 3 Pages 219-230
    Published: 2023
    Released on J-STAGE: December 20, 2023
    Advance online publication: May 25, 2023
    JOURNAL FREE ACCESS

    Purpose

    The clinical guideline on gestational weight gain for Japanese twin pregnant women has not been presented in Japan so far. As a process of determining optimal weight gain, this study aimed to describe the gestational weight gain by pregnancy period in Japanese twin pregnant women with favorable perinatal outcomes.

    Methods

    This descriptive study used the data of the Japan Environment and Children's Study (JECS) that recruited pregnant women between 2011 and 2014 in Japan. From JECS data, we selected twin pregnant women with favorable perinatal outcomes, which were defined from the aspects of newborn's birth weight, gestational birth weeks and maternal complications, and their maternal weight gain at specific weeks of pregnancy were estimated retrospectively using a regression curve. Estimated maternal weight gain at each time was compared with United States of America Institute of Medicine (IOM) criteria which is cited to Japanese clinical guideline.

    Results

    The 321 twin pregnancies were analyzed. The estimated median weight gain at 36 weeks in Japanese twin pregnant with favorable perinatal outcomes was 12.98 kg (interquartile range: 9.89–16.07), and the actual weight gain at delivery was 13.00 kg (10.00–16.23). The estimated cumulative weight gain at 13, 26, and 36 weeks were 1.08 kg (−0.57–2.38), 8.22 kg (5.78–9.84), and 13.10 kg (10.18–16.15) for women with normal BMI, 1.87 kg (0.05–2.78), 9.40 kg (7.68–11.44), and 14.57 kg (12.47–18.08) for women with underweight BMI, and 0.52 kg (−1.27–1.59), 4.10 kg (2.35–7.01), 8.58 kg (5.05–11.52) for women with overweight BMI, respectively. Most of the median values observed in this study did not reach even the lowest limit of IOM criteria.

    Conclusion

    Gestational weight gain at each trimester based on the IOM criteria seems excess for Japanese twin pregnant women.

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  • Rikako KANAI, Emi TAHARA-SASAGAWA, Kaori YONEZAWA, Naoko HIKITA, Yurik ...
    2023 Volume 37 Issue 3 Pages 231-242
    Published: 2023
    Released on J-STAGE: December 20, 2023
    Advance online publication: August 25, 2023
    JOURNAL FREE ACCESS

    Purpose

    Many Japanese women continue to work during pregnancy, but half of them quit work. Several symptoms and discomfort during pregnancy are known to interfere with daily life and to be a reason for taking sick leaves or retiring during pregnancy. However, little is known about the factors behind their motivation to continue working throughout pregnancy. Work engagement is a concept defined as “a positive, fulfilling, work-related state of mind characterized by vigor, dedication, and absorption of workers”, and can predict positive work outcomes, such as job performance, job satisfaction and motivation. This study has two hypotheses: (1) job resources would be positively associated with work engagement, and (2) the perceived symptoms during pregnancy would be negatively associated with work engagement. Then, this study aimed to explore the factors associated with work engagement among Japanese pregnant women.

    Methods

    Between July and November 2019, a cross-sectional study was conducted at two general hospitals in the urban area of Tokyo. Pregnant women were recruited during antenatal health check-ups and asked to answer self-administered questionnaires after obtaining written informed consent. The eligibility criteria were having a single pregnancy, being at ≥16 weeks of gestation, and being able to read and write Japanese. The outcome variable was work engagement using the 3-item version of the Utrecht Work Engagement Scale. Furthermore, work-related variables, such as job demands and job resources, perceived physical and mental symptoms, and demographic characteristics were obtained. To examine the relationships between the independent variables and work engagement, a bivariate analysis was conducted. Then, multivariate regression analysis was performed on the variables that were significantly associated with work engagement in the bivariate analysis.

    Results

    Of 252 participants at ≥16 weeks' gestation who agreed to participate, 226 completed the questionnaires. After excluding 86 women who were not working at the time of recruitment, the data of 140 working pregnant women were included in the analyses. Participants' age (mean ± standard deviation) was 33.1 ± 4.3 years, and the mean score of work engagement was 3.6 ± 1.3. The results of the multivariate analysis showed that the factors associated with a higher level of work engagement were higher supervisor support (β = 0.259, p = 0.008), higher job demands (β = 0.267, p = 0.006), higher sense of coherence (β = 0.276, p = 0.001), and higher age (β = 0.188, p = 0.024). As for the hypotheses, this study revealed that (1) job resources were positively associated with work engagement, and (2) the perceived symptoms during pregnancy were not associated with work engagement.

    Conclusion

    Higher supervisor support was significantly associated with a higher level of work engagement. The finding demonstrates the importance of social support in the workplace in promoting work engagement among pregnant women.

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  • Ryoko MURAYAMA, Sayaka ASHIDA, Mariko MINATANI, Masayo MATSUZAKI, Mika ...
    2023 Volume 37 Issue 3 Pages 243-251
    Published: 2023
    Released on J-STAGE: December 20, 2023
    Advance online publication: August 17, 2023
    JOURNAL FREE ACCESS

    Purpose

    Pregnancy and childbirth are the most common risk factors leading to pelvic floor disorders including pelvic organ prolapse (POP). POP is caused by the descent of pelvic organs due to increased intra-abdominal pressure and load on the birth canal. POP presents various symptoms. Therefore, it is difficult to diagnose through interview. If the relationship between the prevalence of specific POP symptoms and risk factors including habits that increase intra-abdominal pressure can be determined, the incidence of POP in women after childbirth may be prevented. This study aimed to clarify the prevalence of POP symptoms for each postpartum period during 5 years after childbirth and to determine the risk factors of these symptoms.

    Methods

    This cross-sectional study included participants who underwent vaginal delivery at the University of Tokyo Hospital in Japan. We used the Japanese version of the Pelvic Floor Distress Inventory – short form 20, which includes the Prolapse Distress Inventory, to assess POP. The rate of women experiencing POP symptoms was calculated every 6 months after childbirth. Participants’ characteristics including lifestyle, delivery records, and other variables were obtained from the questionnaire or medical records. The participants were divided into two groups: group with and without symptoms. Logistic regression analysis was performed using variables that showed a significant difference between the two groups. The research procedures were approved by the Research Ethics Committee of the University of Tokyo.

    Results

    Questionnaires were distributed to 3776 women, and 1056 (28.0%) were returned. The number of valid responses was 681. Approximately 36% and 43% of women had POP symptoms during 5 years and 6 months after childbirth, respectively. There was no significant difference in the rate of POP symptoms in each postpartum period. Women with POP symptoms were significantly more likely to experience incontinence, hard stools before and after pregnancy, and straining habits during defecation before pregnancy than those without.

    Conclusion

    Lifestyle habits before pregnancy and defecation conditions during the postpartum period were related to POP symptoms after childbirth. The study suggested the need for care to prevent the onset and worsening of POP symptoms, including advice on daily living behaviors such as early postpartum monitoring for the presence or absence of symptoms, voiding care, and avoiding increased intra-abdominal pressure that could stress the pelvic floor.

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  • Natsuki HORI, Mie SHIRAISHI, Toshiko IGARASHI
    2023 Volume 37 Issue 3 Pages 252-264
    Published: 2023
    Released on J-STAGE: December 20, 2023
    Advance online publication: October 20, 2023
    JOURNAL FREE ACCESS

    Purpose

    Social life changes caused by the coronavirus disease 2019 (COVID-19) pandemic have affected the lifestyle of pregnant women, including physical activity and dietary behaviors. However, it remains unclear how social restrictions affect lifestyle. This study aimed to clarify the experiences related to the physical activity and dietary behaviors of Japanese women who found pregnant during the COVID-19 pandemic.

    Methods

    We conducted a qualitative study involving semi-structured interviews with 19 women two to three months postpartum in Tokyo, Japan, between July and November 2021. We asked participants about their physical activity and dietary behaviors during their pregnancies. Data were analyzed using a qualitative descriptive approach. In this study, “lifestyle” was defined as limited to physical activity and dietary behavior.

    Results

    We identified six categories as experiences related to prenatal lifestyle during the COVID-19 pandemic. Pregnancy triggered [lifestyle changes to improve maternal and fetal health while self-isolating to prevent infection], [lifestyle changes due to an increased awareness of the importance of infection prevention compared with before pregnancy], [lifestyle changes to reduce the psychological stress caused by social restrictions], and [lifestyle changes during pregnancy because of the husband's remote work]. Some chose [continuation of a pre-pregnancy lifestyle while implementing infection prevention measures] and [continuation of a lifestyle centered on caring for older children].

    Conclusions

    Japanese women adjust their physical activity and dietary behaviors during pregnancy to reduce the risk of infection, promote maternal and fetal health, and support family members. Considering attitudes toward infectious diseases and infection risks due to living conditions, healthcare professionals must encourage healthier lifestyles when providing pregnant women health guidance during a pandemic.

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  • Kaori YONEZAWA, Minako KIDO, Megumi HARUNA, Emi TAHARA-SASAGAWA, Yurik ...
    2023 Volume 37 Issue 3 Pages 265-272
    Published: 2023
    Released on J-STAGE: December 20, 2023
    Advance online publication: November 24, 2023
    JOURNAL FREE ACCESS

    Purpose

    Cultural differences in complementary infant foods across countries and regions are unclear. Therefore, this study aimed to clarify the differences in guidelines and recommendations for complementary infant foods worldwide, especially focusing on foods that infants eat first and the order in which they are consumed.

    Methods

    Web questionnaires were sent to midwifery associations or nurses' associations in 166 countries that are members of the International Council of Midwives (ICM) or the International Council of Nursing (ICN). Midwives or nurses were asked about recommended foods for infants to eat first and recommendations for the order in which they should be eaten. For the analysis, we categorized the recommendations for complementary foods in each country, focusing on the order in which they were consumed. Chi-square test was used to analyze the differences in eating order classification and region.

    Results

    Responses were received from a total of 46 countries. Thirty-seven out of 46 countries, or 80.4%, responded that they had guidelines on complementary foods. Six patterns were found for complementary diets, including 2 patterns starting with grains and 3 with vegetables and patterns of parents' and infant-led diets. Grains were the most common starting pattern in Asia and Africa, while vegetables were the most common in Europe and America.

    Conclusion

    We believe that international nutritional intake and disease prevention guidelines should be considered as recommendations for complementary foods suitable for each country and region.

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Data
  • Yoko HAYAKARI, Risa KAMATA, Naoko MISAKI, Atsushi ODA
    2023 Volume 37 Issue 3 Pages 273-283
    Published: 2023
    Released on J-STAGE: December 20, 2023
    Advance online publication: June 28, 2023
    JOURNAL FREE ACCESS

    Purpose

    This study aimed to clarify the relationship between foot and postural changes and low back pain during pregnancy.

    Methods

    The study consisted of a questionnaire about low back pain during pregnancy and measurement surveys. The first survey was conducted at 14–16 weeks of gestation, the second at 24–26 weeks, and the third at 34–36 weeks. The participants were 14 pregnant women. We attached a spherical marker to the anterior superior iliac spine and posterior superior iliac spine. Using a digital camera, we photographed their standing postures from the sagittal plane and calculated the pelvic tilt angle. We applied a free curve ruler to measure the spinal curve, which was then traced on paper to calculate the thoracic kyphosis and lumbar lordosis angles. Participants were asked to adopt a natural standing posture barefoot on the flat glass plate of the pedoscope, and the state of the plantar surface touching the ground was photographed using a digital camera. The lower end of the navicular tuberosity was marked in the standing position, after which we measured the foot length and navicular height, divided the navicular height by the foot length, and multiplied by 100 to calculate the arch height. Statistical analysis was performed for each measurement item and a value of less than 5% was set as the significance level.

    Results

    The participants were nine primiparous women and five multiparous women, and 10 women developed low back pain during pregnancy; there was a tendency for the pelvis to tilt forward, the foot arch to flatten, and lordosis of the lumbar spine changed from decreased to increased as the pregnancy progressed, but the differences were not significant. The left ground contact plantar surface area ratio decreased significantly over time, and the ground contact area decreased as the pregnancy progressed (p<0.01). There were no significant differences over time in the pelvic tilt, thoracic kyphosis, and lumbar lordosis angles, arch height ratios, and ground contact plantar surface area ratios between those with and without low back pain during pregnancy, and between childbirth experiences.

    Conclusions

    Pregnant women tended to exhibit an increased pelvic tilt angle and decreased lumbar lordosis from the first to the second trimester of gestation, and increased values from the third trimester. Although the foot tended to flatten owing to the increasing load of the uterus, the ground contact area of the foot did not necessarily increase, and the toes were considered in a floating state because of the weight support by the heel. The anatomical characteristics of the uterus showed that pregnant women were more likely to bear weight on the right side during the third trimester of gestation. The onset of low back pain during pregnancy was associated with multiparous women, flattening of the foot arch, and lumbar spine alignment, which addressed the protrusion of the abdomen associated with uterine enlargement.

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