Ryoko Murayama

A prospective study of the relationship between breastfeeding and postpartum depressive symptoms appearing at 1–5 months after delivery

Despite the fact that more than 90% of mothers in Japan prefer breastfeeding, the breastfeeding rate at 6 months postpartum is as low as approximately 35%. Postpartum depression and bonding disorder are recognized as factors associated with discontinuation of breastfeeding. However, these factors remain controversial. The purpose of the present study was to clarify the effect of postpartum depressive symptoms and bonding on the feeding pattern from 1- to 5-month postpartum. A longitudinal study was conducted at 1- and at 5-month postpartum, in 405 mothers who attended health check at three hospitals in the Tokyo metropolitan area at 1-month postpartum, and completed longitudinal questionnaires. A high proportion of breastfeeding mothers at 1 month postpartum had Edinburgh Postpartum Depression Scale (EPDS) score of ≥ 9 at 5 months postpartum (p=0.01), and these mothers changed to formula milk-based feeding at 5-month postpartum, when compared with those of the breastfeeding-based group at both 1- and 5-month postpartum,. The appearance of depressive symptoms seems to promote discontinuation of breastfeeding at 5-month postpartum.

Exploring the prevalence of skin tears and skin properties related to skin tears in elderly patients at a long-term medical facility in Japan.

The identification of appropriate skin tear prevention guidelines for the elderly requires clinicians to focus on local risk factors such as structural alterations of the epidermis and dermis related to skin tears. The aim of this cross‐sectional study is to explore the prevalence of skin tears and to explore skin properties related to skin tears in elderly Japanese patients at a long‐term medical facility. After doing the prevalence study, 18 participants with skin tears and 18 without were recruited and an evaluation of their skin properties using 20‐MHz ultrasonography, skin blotting and also Corneometer CM‐825, Skin‐pH‐meterPH905, VapoMeter, Moisture Meter‐D and CutometerMPA580 was undertaken. A total of 410 patients were examined, the median age was 87 years and 73·2% were women. The prevalence of skin tears was 3·9%, and 50% of skin tears occurred on the dorsal forearm. The changes in skin properties associated with skin tears included increased low‐echogenic pixels (LEP) by 20‐MHz ultrasonography, decreased type IV collagen and matrix metalloproteinase‐2, and increased tumour necrosis factor‐α by skin blotting. In conclusion, this study suggests that increased dermal LEP, including solar elastosis, may represent a risk factor for skin tears; this indicates that skin tear risk factors might not only represent chronological ageing but also photoageing.

Validity and reproducibility of folate and vitamin B12 intakes estimated from a self-administered diet history questionnaire in Japanese pregnant women

BackgroundNo validated dietary questionnaire for assessing folate and vitamin B12 intakes during pregnancy is available in Japan. We evaluated the validity and reproducibility of intakes of folate and vitamin B12 estimated from a self-administered diet history questionnaire (DHQ) in Japanese pregnant women.MethodsA sample of 167 healthy subjects with singleton pregnancies in the second trimester was recruited at a private obstetric hospital in metropolitan Tokyo from June to October 2008 (n = 76), and at a university hospital in Tokyo from June 2010 to June 2011 (n = 91). The dietary intakes of folate and vitamin B12 were assessed using the DHQ. The serum concentrations of folate and vitamin B12 were measured as reference values in the validation study. To assess the reproducibility of the results, 58 pregnant women completed the DHQ twice within 4-5 week interval.ResultsSignificantly positive correlations were found between energy-adjusted intakes and serum concentrations of folate and vitamin B12 (r = 0.286, p < 0.001 and r = 0.222, p = 0.004, respectively). After excluding the participants with nausea (n = 121), the correlation coefficient for vitamin B12 increased to 0.313 (p = 0.001). When participants were classified into quintiles based on intakes and serum concentrations of folate and vitamin B12 , approximately 60% were classified in the same or adjacent quintile. The intraclass correlation coefficients of the two-time DHQ were 0.725 for folate and 0.512 for vitamin B12 .ConclusionThe present study indicated that the DHQ had acceptable validity and reproducibility for assessing folate and vitamin B12 intakes in Japanese pregnant women.

Estimation of eicosapentaenoic acid and docosahexaenoic acid intakes in pregnant Japanese women without nausea by using a self-administered diet history questionnaire

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intakes during pregnancy affect fetal development and maternal mental health; therefore, an accurate assessment of EPA and DHA intakes is required. We hypothesized that a self-administered diet history questionnaire (DHQ) that was developed for non-pregnant adults could be used for estimating EPA and DHA intakes in pregnant Japanese women; thus, we evaluated the validity and reproducibility of the DHQ during pregnancy. We recruited 262 healthy participants with singleton pregnancies during their second trimester at a university hospital in Tokyo between June 2010 and July 2011. Plasma concentrations of EPA and DHA were measured as reference values. Fifty-eight women completed the DHQ twice, within a 4- to 5-week period to assess the reproducibility of the results. Among the participants without pregnancy-associated nausea (n = 180), significantly positive correlations were observed between energy-adjusted intakes and plasma concentrations of EPA (r(s) = 0.388), DHA (r(s) = 0.264), and EPA + DHA (r(s) = 0.328). More than 60% of the participants without nausea fell into the same or adjacent quintiles according to energy-adjusted intakes and plasma concentrations of EPA, DHA, and EPA + DHA. Meanwhile, among the participants with nausea, a low correlation for EPA and no correlation for DHA and EPA + DHA were found. Intraclass correlation coefficients for the 2-time DHQ measurements were 0.691 (EPA) and 0.663 (DHA). The results indicate that the DHQ has an acceptable level of validity and reproducibility for assessing EPA, DHA, and EPA + DHA intakes in pregnant Japanese women without nausea.

Validity of a diet history questionnaire estimating β-carotene, vitamin C and α-tocopherol intakes in Japanese pregnant women

Abstract We investigated the validity and reproducibility of a self-administered diet history questionnaire (DHQ) that estimates the intakes of β-carotene, vitamin C and α-tocopherol. Ninety-five healthy women with singleton pregnancies in the second trimester were examined at a university hospital in Tokyo. The intakes of β-carotene, vitamin C and α-tocopherol assessed by the DHQ were compared to the corresponding serum concentrations. To assess the reproducibility, 58 pregnant women completed it in two sessions within a 4–5 week interval. We found significantly positive correlations between the energy-adjusted intakes and serum concentrations of β-carotene and vitamin C (r = 0.254 and r = 0.323, respectively). However, α-tocopherol intake was not associated with the corresponding serum concentration. The intraclass correlation coefficients of the two-time DHQ were 0.743 (β-carotene), 0.665 (vitamin C) and 0.718 (α-tocopherol). DHQ has acceptable validity and reproducibility for β-carotene and vitamin C intakes in Japanese pregnant women.

Translation and validation of the Japanese version of the Wijma Delivery Expectancy/Experience Questionnaire version A.

Severe antenatal fear of childbirth causes adverse effects on emotional well-being during the postpartum period. The Wijma Delivery Expectancy/Experience Questionnaire is widely used to measure fear of childbirth among women before (version A) and after (version B) delivery. In this study, the original Swedish version was translated into Japanese, and its validity and reliability were examined among healthy, pregnant Japanese women. The Japanese-translated version presented a multidimensional structure with four factors: fear, lack of positive anticipation, isolation, and riskiness. Exhibiting concurrent/convergent validity, the Japanese version correlated with other psychological measures at expected levels. The Cronbachs α (0.90) and the intraclass correlation coefficient (0.86, P < 0.001) were high. In conclusion, the results provide support for the Japanese version to be considered a valid and reliable measure of prenatal fear of childbirth among pregnant Japanese women.

Associations of dietary intake and plasma concentrations of eicosapentaenoic and docosahexaenoic acid with prenatal depressive symptoms in Japan

The association between depression and omega-3 polyunsaturated fatty acids, including eicosapentaenoic and docosahexaenoic acid, continues to gain focus. In this study, we examined whether dietary intakes and plasma concentrations of eicosapentaenoic and docosahexaenoic acid were associated with depressive symptoms during pregnancy. Healthy Japanese women with singleton pregnancies were recruited at a university hospital in Tokyo between 2010 and 2012. The depressive-symptom group included participants with Edinburgh Postnatal Depression Scale scores greater than eight. Of the 329 participants, 19 (5.8%) had depressive symptoms. Lower plasma docosahexaenoic acid concentration was significantly associated with prenatal depressive symptoms. Women with depressive symptoms had a higher rate of pregnancy-associated nausea than those with non-depressive symptoms (52.6% vs 28.7%, respectively). Although we adjusted for the presence of pregnancy-associated nausea, dietary fatty acid intake was not associated with depressive symptoms in the multiple logistic regression analyses. Further large studies would be required to examine any preventive effect of dietary fatty acid intake on depressive symptoms among pregnant women.The association between depression and omega-3 polyunsaturated fatty acids, including eicosapentaenoic and docosahexaenoic acid, continues to gain focus. In this study, we examined whether dietary intakes and plasma concentrations of eicosapentaenoic and docosahexaenoic acid were associated with depressive symptoms during pregnancy. Healthy Japanese women with singleton pregnancies were recruited at a university hospital in Tokyo between 2010 and 2012. The depressive-symptom group included participants with Edinburgh Postnatal Depression Scale scores greater than eight. Of the 329 participants, 19 (5.8%) had depressive symptoms. Lower plasma docosahexaenoic acid concentration was significantly associated with prenatal depressive symptoms. Women with depressive symptoms had a higher rate of pregnancy-associated nausea than those with non-depressive symptoms (52.6% vs 28.7%, respectively). Although we adjusted for the presence of pregnancy-associated nausea, dietary fatty acid intake was not associated with depressive symptoms in the multiple logistic regression analyses. Further large studies would be required to examine any preventive effect of dietary fatty acid intake on depressive symptoms among pregnant women.

Validity of a self‐administered diet history questionnaire for estimating vitamin D intakes of Japanese pregnant women

Maternal vitamin D status is important for fetal development and the prevention of pregnancy complications. Mothers require both sufficient intakes and skin production of this vitamin. We investigated the validity and test-retest reliability of a self-administered diet history questionnaire (DHQ) to establish a method of assessing vitamin D intakes of Japanese pregnant women, using a serum marker. A total of 245 healthy pregnant women in the second trimester, who were not taking vitamin D supplements, were recruited at a university hospital in Tokyo between June 2010 and July 2011. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured as an indicator of vitamin D status. To assess the test-retest reliability of the DHQ, 58 pregnant women completed it twice within a 4-5-week interval. Significant positive correlations between intakes and serum concentrations of vitamin D were found (r = 0.266 for daily intakes and r = 0.249 for energy-adjusted intakes). In the winter investigation in which the serum 25(OH)D concentrations were less likely to be affected by sunlight exposure, the correlation coefficients were 0.304 for both daily and energy-adjusted intakes. After excluding participants with pregnancy-associated nausea, the coefficients increased. The intraclass correlation coefficient between vitamin D intakes estimated from the two-time DHQ was 0.638. The DHQ provides an acceptable validity and reliability of the vitamin D intake of Japanese pregnant women. However, the data of women with nausea should be interpreted with caution. We believe that the DHQ is a useful questionnaire to grasp and improve vitamin D intakes during pregnancy.

Adapting the Pregnancy Physical Activity Questionnaire for Japanese Pregnant Women

OBJECTIVE To assess the psychometric properties of the Pregnancy Physical Activity Questionnaire (PPAQ) for women who read and speak Japanese. DESIGN This longitudinal study used a self-report questionnaire and quantitative biometric and instrumental measurements (actigraph) to assess the reliability and criterion validity. SETTING A university hospital in Tokyo, Japan. PARTICIPANTS Sixty-nine pregnant women living in Tokyo and its suburbs were recruited. METHODS The test-retest reliability of the Japanese version of the Pregnancy Physical Activity Questionnaire (PPAQ-J) was evaluated through intraclass correlation coefficients (ICCs) between PPAQ-J results administered three times (at recruitment, 7 and 14 days later). Criterion validity was assessed by comparing results to actigraph measures using Spearmans correlation coefficients. Participants wore the actigraph over the 2-week research period. Data from 58 participants were analyzed for test-retest reliability. The data of 54 participants were used to analyze criterion validity. RESULTS The ICCs for the first and second and for the first and third PPAQ-J questionnaires were ≥0.56 for total activity and activities broken down by intensity and type (in metabolic equivalents [METs] × hours/day). To evaluate criterion validity, Spearmans correlation coefficients were calculated between the first measurement of the PPAQ-J and three published cut-points used to classify actigraph data (minutes/day); correlations ranged from .02 to .35 for total activity, -.21 to -.25 for vigorous activity, -.09 to .38 for moderate activity, and .01 to .28 for light activity. CONCLUSION The PPAQ-J is a psychometrically sound and comprehensive measure of physical activity in pregnant Japanese women.

Method for detection of aspiration based on B-mode video ultrasonography

In this study, we aimed to develop a new method for detection of aspiration based on B-mode video ultrasonography and to evaluate its performance. To detect aspirated boluses by B-mode video ultrasonography in patients with dysphagia, we placed a linear array transducer above the thyroid cartilage and observed the area around the vocal folds. Forty-two ultrasonographic measurements were obtained from 17 patients with dysphagia who also underwent videofluoroscopy or videoendoscopy measurements at the same time. Aspirated boluses were observed in B-mode video ultrasonographic images as hyperechoic, long, narrow objects that passed through the vocal folds beneath the anterior wall of the trachea, with movement different from that of the surrounding structure. The sensitivity of aspiration detection was 0.64, and the specificity was 0.84. This newly developed detection method will enable patients with dysphagia to receive appropriate daily swallowing care.