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.

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

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

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.

Purpose

Some studies have revealed factors associated with longer second stage of labor. However, none have longitudinally analyzed variables associated with second-stage duration. Thus, it is difficult to predict women who are more likely to have a longer second stage duration, before entering the second stage of labor. To explore the factors associated with second-stage labor duration longitudinally from the time of prenatal check-up to the beginning of the second stage, and to determine the degree of influence of each factor.

Methods

A retrospective chart review was conducted on women who gave birth between January and December 2019 at a tertiary hospital in Tokyo, Japan. Only variables available until the beginning of the second stage of labor were included in the bivariate analysis to determine factors that were significantly associated with the duration of the second stage. These factors were divided into three periods from the time of prenatal check-up to the beginning of the second stage and were hierarchically entered into the multiple regression analysis.

Results

The mean second-stage duration was 77.5 ± 84.4 (median; 43, interquartile range [IQR]: 20–106) minutes; 112.2 ± 95.2 minutes for nulliparas (median: 80 minutes, IQR: 39.5–167) and 32.8 ± 32.7 minutes for multiparas (median: 21.5 minutes, IQR: 12–38.8). In the final multiple regression model, multiparity, lower station of the fetal head at complete cervical dilation, and greater maternal height and OID pregnancy shortened second-stage duration, whereas the use of epidural anesthesia during the first stage of labor and larger estimated fetal weight lengthened second-stage duration.

Conclusion

Longitudinal observation of the factors identified in the study may help predict women who are likely to have a longer second stage duration, before entering the second stage of labor.

Purpose

The purpose of this study was to investigate the hiesho (sensitivity to cold) among women during early postpartum period and its relationship to physical symptoms.

Methods

A questionnaire survey was conducted among women who gave birth at a hospital in Japan between September and December 2023. The data included perceived coldness of the hands, feet, abdomen, and buttock and the degree of physical symptoms such as fatigue, insomnia, edema and pain in the early postpartum period. Spearman’s rank correlation coefficient and Mann-Whitney U test were used in analysis. This study was approved by the Ethics Review Committee of Yokohama City University (F230400056).

Results

Of the 100 valid responses received, 35 women (35.0%) were aware of the coldness after delivery, specifically in their feet (n = 27, 77.1%). The strength of the relationship between the degree of coldness in each body part was medium to strong (r = 0.59-0.78). Moreover, compared with women without a perception of coldness, women with perceived coldness experienced a stronger feeling of insomnia and edema of the hands on the third postpartum day and a stronger feeling of insomnia and hemorrhoidal pain on the fourth to fifth postpartum days.

Conclusion

During the early postpartum period, women become more commonly aware of coldness in the feet. This may affect their insomnia starting from the third postpartum day.

Background

Japan has the highest rate of low-birth-weight infants among developed countries. Inadequate gestational weight gain is related to a higher risk of low-birth-weight infants, particularly in women who were underweight before pregnancy. Women often have negative attitudes toward body shape changes during pregnancy, which can cause inadequate gestational weight gain. Thus, this study aimed to clarify how women who were underweight before pregnancy felt about their weight and shape during pregnancy.

Methods

Between 2021 and 2022, 8 Japanese women who were underweight before pregnancy were interviewed online using a semi-structured interview at 2–4 months postpartum. Participants were recruited from a cohort study conducted in Japan. The interview data were analyzed using a qualitative descriptive approach. The Ethics Committee of the University of Tokyo approved this study.

Results

Five categories, 9 subcategories, and 19 codes were identified. Most participants expressed ambivalent positive and negative feelings about changes in their body shape during pregnancy. Some participants had a [positive acceptance of body shape changes during pregnancy], viewing these changes as signs of fetal growth. Others were [less concerned about changes in body weight and shape during pregnancy] because they were satisfied with their thin body shape before pregnancy, did not anticipate excessive weight gain, recognized the changes as a natural part of pregnancy, or experienced only slight changes in their body shape. Some women had [anxiety and worry about body shape changes during pregnancy], such as anxiety about their abdominal circumference becoming larger than ever before and suspicions that a lack of significant changes in body shape was abnormal. Such anxiety led to a [desire to avoid gaining more weight than the minimum necessary] or a [desire to gain enough weight for fetal growth] even when experiencing pregnancy-related nausea. Participants with these desires adjusted lifestyle habits to suppress or promote their weight gain.

Conclusion

Women who were underweight before pregnancy exhibited diverse attitudes toward body weight and shape during pregnancy. Two attitude patterns specific to this group were identified: a [desire to gain enough weight for fetal growth] even in the presence of pregnancy-related nausea, and being [less concerned about changes in body weight and shape during pregnancy]. Particular attention may be warranted for women who had a [desire to avoid gaining more weight than the minimum necessary] during pregnancy, as this attitude may be associated with inadequate gestational weight gain. Therefore, to provide effective health guidance on weight management during pregnancy, it is essential to understand individual attitudes and tailor interventions accordingly.

Purpose

Assessing the pelvic floor muscle power in clinical obstetrics can be difficult. The levator hiatus (LH), the anatomical opening through which the urethra, vagina, and rectum pass, can be visualized using transperineal ultrasound. During contraction of the pelvic floor muscles, the anterior–posterior diameter of the LH (APD-LH) decreases. The percentage change in APD-LH from rest to contraction (ΔAPD-LH (%)) may serve as a marker of the power of pelvic floor muscle contraction. However, its validation in postpartum women remains limited. This study aimed to evaluate the intra- and inter-rater reliability of offline ΔAPD-LH (%) measurements, based on stored ultrasound recordings.

Methods

The study enrolled 25 women aged 20 years or older, all of whom were 1–2 months postpartum following a full-term singleton vaginal delivery. After voiding, participants were positioned in lithotomy with hips and knees partially flexed. A transducer was placed perineally in the midsagittal plane to acquire a two-dimensional (2D) image encompassing the symphysis pubis, urethra, vagina, and pelvic floor muscles. Video recordings were captured during rest, pelvic floor muscle contraction, and subsequent relaxation. Examiner A measured APD-LH at rest and during contraction using the video and calculated ΔAPD-LH (%) with the formula (APD-LH at rest − APD-LH during contraction)/APD-LH at rest × 100. To determine intrarater reliability, Examiner A repeated the measurements on a separate day. For inter-rater reliability, Examiner B independently measured APD-LH and calculated ΔAPD-LH (%) from the same video following the identical procedure. Reliability was evaluated using Bland–Altman plots and the intraclass correlation coefficient (ICC).

Results

On average, APD-LH decreased by 22% during muscle contraction in assessments by both examiners. The ICC (1.1) of ΔAPD-LH (%) for intrarater reliability was 0.97 (95% CI, 0.94–0.98). The ICC (2.1) for inter-rater reliability was 0.91 (95% CI, 0.81–0.96). Bland–Altman plots for both intra- and inter-rater reliability of ΔAPD-LH (%) showed randomly scattered data points. The mean difference in ΔAPD-LH (%) between the Examiner A's two measurements was 0.11 (95% CI, −0.77–0.99) and between Examiners A and B was 0.07 (95% CI, −1.57–1.71). Both CIs included zero, indicating no fixed error. Additionally, no proportional error was observed, as no systematic relationship between measurement differences and means was evident in the Bland–Altman analysis.

Conclusion

ΔAPD-LH (%) demonstrated excellent intra- and inter-rater reliability. No fixed or proportional errors were identified within or between raters. These findings suggest that ΔAPD-LH (%) is a dependable parameter for assessing pelvic floor muscle function in postpartum women.

Purpose

Childbirth experiences can have short- or long-term effects on the health and well-being of mothers and their children. The quality of professional care significantly affects the perceptions of the childbirth experience. The Pregnancy and Childbirth Questionnaire (PCQ) measures women's perceptions of the quality of care throughout pregnancy and childbirth. This study aims to develop a Japanese version of the PCQ.

Methods

The original PCQ, which consists of pregnancy (18 items) and delivery scales (7 items), was translated into Japanese and validated through a web-based study of 261 mothers from June to September 2022. Exploratory and confirmatory factor analyses were conducted to examine the factor structure. Correlations between the PCQ and Wijma Delivery Expectancy/Experience Questionnaire version B (W-DEQ-B) and between the PCQ and the Client Satisfaction Questionnaire-8 (CSQ-8) were examined for convergent and concurrent validity. Cronbach's alpha for each subscale was calculated for internal consistency.

Results

The pregnancy scale has a two-factor structure in the Japanese version of the PCQ: “personal treatment” and “educational information.” The delivery scale has a single-factor structure: “personal treatment.” Correlation coefficients of each subscale of the PCQ and W-DEQ-B were −0.29, −0.33, and −0.31, and those of the CSQ-8 were 0.63, 0.61, and 0.59, respectively. Cronbach's alpha for each subscale was 0.90, 0.89, and 0.88, respectively.

Conclusion

The Japanese version of the PCQ was found to be a valid and reliable scale for measuring women's perceptions of quality of care during pregnancy and childbirth.

Background

Fear of childbirth can cause serious emotional imbalances after birth and affect parenting roles. Thus, researchers find it necessary to detect and prevent the risk of fear of childbirth at an early stage. However, there have been few studies on the fear of childbirth in Japan, and midwives' perceptions of such fears have not been clarified.

Aims

This study aims to clarify Japanese midwives' perception of fear of childbirth and their actual practices in caring for women during childbirth.

Methods

This study used a qualitative research design. Semi-structured interviews were conducted with eight midwives. Consensual Qualitative Research was used to analyse the data in this study. This study was conducted with the approval of the Ethical Review Committee of Kagawa Prefectural University of Health Sciences (Approval No. 412).

Findings

The mean age of the midwives who participated in this study was 39.4 years. The following concepts were extracted as midwives' perceptions of fear of childbirth in Japan: ‘the experiences of women who fear childbirth’, ‘lack of midwives’ perception of ‘fear of childbirth’, and ‘identifying the background of fear of childbirth’. The following concepts were extracted as care to prevent anxiety from turning into fear during childbirth: ‘continuous midwife-led care that prevents the fear of childbirth from turning into anxiety’, ‘perceptions of blocking the connection between pain and fear during childbirth’, ‘woman-centred care to make childbirth more proactive’, ‘an opportunity to identify and prevent potential fear of childbirth’, and ‘an opportunity to identify and prevent fear of childbirth’.

Conclusion

In Japan, the midwives had never heard of the term ‘FOC’ or ‘tokophobia’; however, they were aware of the possibility that anxiety may eventually lead to fear and cause unusual deliveries like caesarean sections. The midwives also recognised the necessity of detecting and preventing potential fear of childbirth, as well as the necessity of providing care practices that help target women become aware of their actual fear of childbirth and prevent them from developing such fear at the time of childbirth.

Purpose

Enhancing fetal attachment during pregnancy has a positive impact on women's mental health and the mother–infant relationship. However, the state of fetal attachment and its related factors during pregnancy among first-time fathers remain unclear. This study clarifies fetal attachment and its associated factors among first-time fathers whose partners are pregnant with their first child.

Methods

A web-based survey of 401 first-time fathers was conducted in September 2023. Data were collected on paternal–fetal attachment using the Paternal Antenatal Attachment Scale (PAAS), as well as on marital relationships, depression, new masculinity, adult attachment styles, positive experiences, pregnancy-related information, and demographic characteristics, including emotional responses to the pregnancy. Multiple regression analysis was performed with the PAAS as the dependent variable. Ethical approval was obtained from a researcher's institution.

Results

The mean age of participants was 35.5 years, and the mean number of weeks of gestation for their partners was 23.2 weeks (range: 7–38 weeks). Multiple regression analysis revealed that marital relationships, adult attachment style, and positive experiences were significantly associated with paternal–fetal attachment. However, no associations were found for gestational age, perception of fetal movement, or infertility treatment.

Conclusions

Encouraging the development of fetal attachment during the prenatal period is important for both women and men. It is especially effective to focus on positive experiences specific to the pregnancy period and the couple's relationship. The findings also suggest that providing support tailored to men's adult attachment styles may further enhance paternal–fetal attachment.

Purpose

The purpose of this study is to identify the characteristics of changes in posture and feet when non-pregnant women wear a jacket designed to simulate pregnancy.

Methods

Measurements were conducted using a pregnancy simulation jacket manufactured by Koken Co., Ltd. (weighing approximately 7.3 kg) on 13 healthy female university students without any pregnancy or childbirth experiences. Spherical markers were attached to anatomical landmarks such as the anterior superior iliac spine and posterior superior iliac spine. Standing posture was photographed from the sagittal plane using a digital camera to calculate the pelvic tilt angle. A flexible curve ruler was used to trace the spinal curve, from which the thoracic kyphosis angle and lumbar lordosis angle were calculated. The state of foot sole contact was photographed using a Pedoscope, and image processing was applied to the captured sole contact area to extract footprints. The footprints were then classified according to the Noda classification method, and the ratio of foot sole contact area was calculated. Foot length and navicular height were measured to calculate the arch height ratio. Subsequently, participants wore the pregnancy simulation jacket and maintained a standing position for 20 minutes, after which the same measurements were taken. Statistical analysis was performed on the changes in each measurement item before and after wearing the jacket, with a significance level set at less than 5%.

Results

Wearing the pregnancy simulation jacket resulted in a significant increase in the lumbar lordosis angle (p < 0.05), a significant decrease in the arch height ratio for both the right and left feet (p < 0.01), and a significant increase in the right foot sole contact area ratio (p < 0.05). Significant changes were not observed in the pelvic tilt angle, thoracic kyphosis angle, left foot sole contact area ratio, or foot shape classification based on the Noda method because of wearing the jacket.

Conclusion

Wearing the pregnancy simulation jacket caused significant changes in the posture and feet of women. Therefore, in educational or learning settings where the jacket is used, adding scientific evidence to the physical changes experienced by the wearer can contribute to more effective interactions and a deeper understanding of the bodily changes associated with pregnancy.