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Objectives: This study aimed to evaluate the association between atopic dermatitis in pregnant women and preterm births, accounting for maternal ritodrine hydrochloride administration status. Methods: Data of 83,796 women with singleton pregnancies at and after 22 weeks of gestation (enrolled between 2011 and 2014) were analyzed. These data were obtained from the Japan Environment and Children's Study. Atopic dermatitis was defined based on self-reported questionnaire responses obtained during the first trimester. The primary outcome measures were preterm births before 37, 32, and 28 weeks of gestation. Using a multivariable logistic regression model, odds ratios for preterm births in pregnant women with atopic dermatitis were calculated, with women without atopic dermatitis included in the reference group. This analysis considered confounding factors and maternal ritodrine hydrochloride administration. Results: Among pregnant women with atopic dermatitis, the adjusted odds ratios (95% confidence intervals) for preterm births before 37, 32, and 28 weeks of gestation were 0.89 (0.81–0.98), 0.98 (0.74–1.30), and 0.88 (0.50–1.55), respectively. This trend remained consistent after excluding participants who received ritodrine hydrochloride. Conclusions for practice: Atopic dermatitis in pregnant women was significantly associated with a decreased incidence of preterm births before 37 weeks of gestation, even after accounting for the effects of maternal ritodrine hydrochloride administration. Significance: What is already known on this subject?: Atopic dermatitis is among the most prevalent chronic dermatological conditions in pregnant women. The association between atopic dermatitis in pregnant women and obstetric outcomes remains unclear owing to conflicting research findings. What this study adds?: Atopic dermatitis in pregnant women was significantly associated with a decreased incidence of preterm births before 37 weeks of gestation. The trend was the same in participants without maternal ritodrine hydrochloride administration. [ABSTRACT FROM AUTHOR]

Objective: We investigated the association between maternal antepartum intimate partner violence (IPV) and autism spectrum disorder (ASD) in 3-year-old offspring. Materials and Methods: Secondary analysis of the Japan Environment and Children's Study, a nationwide prospective birth-cohort study, for preconceptional and antepartum psychological/physical IPV against mothers was undertaken based on data obtained from a maternal self-report questionnaire. Subgroup analysis by four-level IPV frequency versus no IPV was conducted, and the incidence of ASD diagnosed during ages 2–3 years was estimated using self-reported questionnaire data of participants from when the child was 3 years old. Multivariate logistic regression was used to determine the association of preconceptional/antepartum IPV with ASD in 3-year-old offspring. Results: Among 79,324 offspring, 355 (0.45%) had ASD; preconceptionally and prenatally, 1,504 (1.9%) and 839 (1.1%) mothers were exposed to physical IPV whereas 9,162 (11.6%) and 10,240 (12.9%) mothers were exposed to psychological IPV, respectively. Multivariate logistic regression revealed a significant association of preconceptional physical IPV with ASD in offspring (adjusted odds ratio, 3.21; 95% confidence interval, 1.24–8.31), but not for antepartum physical IPV and preconceptional and antepartum psychological IPV. Conclusion: Preconceptional, but not antepartum, physical IPV was associated with ASD in 3-year-old offspring. Preconceptional and antepartum psychological IPV was unassociated with ASD in 3-year-old offspring. Preconceptional care through prevention of preconceptional physical IPV is important for neurodevelopment in offspring, and the mechanisms underlying the effects of IPV among nonpregnant individuals on ASD development in offspring should be elucidated. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between maternal asthma (MA) and obstetric complications, while considering subdivided total serum immunoglobulin E (IgE) levels. Methods: Data of the participants enrolled in the Japan Environment and Children's Study between 2011 and 2014 were analyzed. In total, 77,131 women with singleton live births at and after 22 weeks of gestation were included. MA was defined based on a self-administered questionnaire. Women with MA were stratified based on the quartile of total serum IgE levels during pregnancy as follows: low IgE levels (< 52.40 IU/mL), moderate IgE levels (52.40–331.00 IU/mL), and high IgE levels (> 331.00 IU/mL). The adjusted odds ratios (aORs) for preterm births (PTB), small for gestational age (SGA) infants, gestational diabetes mellitus, and hypertensive disorders of pregnancy (HDP) were calculated using multivariable logistic regression, while considering women without MA as reference and maternal socioeconomic factors as confounders. Results: The aORs for SGA infants and HDP in women with MA and high total serum IgE levels were 1.26 (95% confidence interval [CI], 1.05–1.50) and 1.33 (95% CI, 1.06–1.66), respectively. The aOR for SGA infants among women with MA and moderate total serum IgE levels was 0.85 (95% CI, 0.73–0.99). The aOR for PTB among women with MA and low total serum IgE levels was 1.26 (95% CI, 1.04–1.52). Conclusions for Practice: MA with subdivided total serum IgE levels was associated with obstetric complications. Total serum IgE level may be a potential prognostic marker to predict obstetric complications in pregnancies with MA. Significance: What is Already Known on this Subject? Maternal asthma (MA) is associated with several obstetric complications, including preterm births (PTB), small for gestational age (SGA) infants, and hypertensive disorders of pregnancy (HDP). Few studies with data from nationwide cohorts have elucidated the association between MA and obstetric complications comprehensively while accounting for the subdivided objective biomarkers of MA. What this Study Adds? MA with subdivided total serum IgE levels was associated with various obstetric complications. Total serum IgE level may be a potential prognostic marker for pregnant women with MA to predict the potential risk of PTB, SGA infants, and HDP. [ABSTRACT FROM AUTHOR]

Aim: Hypertensive disorders of pregnancy (HDP) are a crucial cause of morbidity and mortality. We aimed to examine whether preconception carbohydrate intake is associated with new‐onset HDP and small for gestational age (SGA) births. Methods: We identified 93 265 normotensive (primiparous, 37 387; multiparous, 55 878) participants from the Japan Environmental Children's Study database who delivered between 2011 and 2014. After excluding participants with multiple gestations, preconception hypertension, and insufficient data, primiparous and multiparous participants were categorized into five groups according to their preconception carbohydrate‐intake quintiles (Q1 and Q5 were the lowest and highest groups, respectively). Multiple logistic regression analysis was performed to identify the effect of preconception carbohydrate intake on early (<34 weeks) and late‐onset (≥34 weeks) HDP and the incidence of SGA births. Results: With the middle carbohydrate intake group (Q3) as a reference, the risk for late‐onset HDP among multiparous women was higher in the Q5 group (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 1.02–1.69). The incidence of SGA births was higher in the Q1 group among both primiparous (aOR 1.16, 95% CI 1.01–1.33) and multiparous women (aOR 1.16, 95% CI 1.02–1.32). Conclusions: Excessive carbohydrate intake increases the incidence of HDP in multiparous women, while low‐carbohydrate intake increases the incidence of SGA births. New recommendations for preconception carbohydrate intake are required to prevent major HDP‐related complications. [ABSTRACT FROM AUTHOR]

Aim: To examine the effect of weight gain during pregnancy on hypertension disorders of pregnancy among women with a prepregnancy body mass index ≥30.0 kg/m2. Methods: This retrospective cohort study included 257 Japanese women (116 primipara; 141 multipara) with singleton pregnancies with a prepregnancy body mass index ≥ 30.0 kg/m2, who gave birth during 2013 to 2020 at Ohta Nishinouchi Hospital. Multiple logistic regression analyses were performed to identify the effect of gestational weight gain on early‐onset (<34 weeks), late‐onset (≥34 weeks), and overall hypertension disorders of pregnancy. Results: The prevalence of hypertension disorders of pregnancy in primiparas and multiparas was 28.4% and 11.3%, respectively. By multiple logistic regression analysis, gestational weight gain during pregnancy increased the risk of early‐onset (adjusted odds ratio: 1.20, 95% confidence interval: 1.03–1.39, p < 0.05) and overall hypertension disorders of pregnancy (adjusted odds ratio: 1.12, 95% confidence interval: 1.03–1.22, p < 0.05) among primiparas. Based on receiver operating characteristic curve analyses for early‐onset (area under the curve 0.67, 95% confidence interval: 0.56–0.78; p < 0.05) and overall hypertension disorders of pregnancy (area under the curve 0.76, 95% confidence interval: 0.61–0.91; p < 0.05) among primiparas, we determined the cut‐off weight gain during pregnancy for early‐onset and overall hypertension disorders of pregnancy as 3.85 kg, with sensitivity/specificity of 0.76/0.59 and 0.91/0.53, respectively. Conclusion: We recommend that the optimal gestational weight gain for reducing HDP be under 3.85 kg. This information may facilitate personalized pre‐conception counseling among women with obesity. [ABSTRACT FROM AUTHOR]

Background: Dystocia is a common obstetric complication among nulliparous women, which requires medical intervention and carries the risk of negative maternal and neonatal outcomes. Our aim was to examine the association between body mass index (BMI) and the occurrence of dystocia. We also identified cutoffs of gestational weight gain, based on pre-pregnancy BMI, associated with the risk of dystocia.Methods: This was a multicenter, retrospective, cohort study conducted in two tertiary Maternal-Fetal medicine units in Fukushima, Japan. The study population included nullipara women who delivered at either of the two units between January 1, 2013, and December 31, 2020. Women (n = 2597) were categorized into six groups (G) based on their pre-pregnancy BMI: G1 (< 18.5 kg/m2), G2 (18.5 to < 20.0 kg/m2), G3 (20.0 to < 23.0 kg/m2), G4 (23.0 to < 25.0 kg/m2), G5 (25.0 to < 30.0 kg/m2), and G6 (≥ 30.0 kg/m2). Using G3 as a reference, multiple logistic regression analyses were performed to estimate the risk of dystocia for each BMI category. Receiver operating characteristic curve analyses were performed to determine the cutoff value of gestational weight gain for the risk of dystocia.Results: The highest BMI category (G6) was an independent risk factor for dystocia (adjusted odds ratio, 3.0; 95% confidence interval, 1.5-5.8). The receiver operating characteristic curve analysis revealed no association between gestational weight gain and the occurrence of dystocia in G5 and G6 (P = 0.446 and P = 0.291, respectively). For G1 to G4, AUC and predictive cutoffs of gestational weight gain for dystocia were as follows: G1, AUC 0.64 and cutoff 11.5 kg (P < 0.05); G2, AUC 0.63 and cutoff 12.3 kg (P < 0.05); G3, AUC 0.67 and cutoff 14.3 kg (P < 0.01); and G4, AUC 0.63 and cutoff 11.5 kg (P < 0.05).Conclusion: A pre-pregnancy BMI > 30.0 kg/m2 was an independent risk factor for dystocia. For women with a pre-pregnancy BMI < 25.0 kg/m2, the risk of dystocia increases as a function of gestational weight gain. These findings could inform personalized preconception care for women to optimize maternal and neonatal health. [ABSTRACT FROM AUTHOR]

Aim: To examine the effect of weight gain during pregnancy on preeclampsia among women with a prepregnancy body mass index < 18.5 kg/m2. Methods: This retrospective cohort study included 479 Japanese women with singleton pregnancies and a prepregnancy body mass index < 18.5 kg/m2, who gave birth between 2013 and 2019 at Ohta Nishinouchi Hospital. The study included 22 (18 with preeclampsia and four with gestational hypertension) and 457 patients with and without hypertensive disorders of pregnancy, respectively. Results: The prevalence of hypertensive disorders of pregnancy and preeclampsia was 4.6% and 3.8%, respectively. With weight gain during pregnancy (continuous variable) set as a reference, multiple logistic regression revealed that excessive weight gain during pregnancy increased the risk of preeclampsia (adjusted odds ratio: 1.13, 95% confidence interval: 1.00–1.28, p < 0.05) and hypertensive disorders of pregnancy (adjusted odds ratio: 1.15, 95% confidence interval: 1.03–1.29, p < 0.05). Based on receiver operating characteristic curve analyses (area under the curve 0.65, 95% confidence interval: 0.50–0.80; p < 0.05), we determined the cutoff value of weight gain during pregnancy for the occurrence of preeclampsia among women with body mass index < 18.5 kg/m2 to be 13.0 kg, with sensitivity and specificity of 0.50 and 0.78, respectively. Conclusion: This study indicates that excessive weight gain during pregnancy increases preeclampsia risk among underweight women and provides new recommendations for weight gain during pregnancy for such women. Further research regarding the pathogenesis of preeclampsia for underweight women is warranted. [ABSTRACT FROM AUTHOR]

Aim: The effect of placenta previa on age‐specific placental size has not yet been elucidated. This study aimed to examine the effect of placenta previa on the Japanese standardized z‐scores of placental size. Methods: This retrospective cohort study included Japanese participants from Ohta Nishinouchi Hospital with single pregnancies who gave birth during 2013–2019. The participants were categorized into two groups based on the presence or absence of placenta previa. Multiple linear regression analyses were used to identify the association of placenta previa with the z‐score of placental size, after adjusting for factors, such as maternal smoking status, maternal age, assisted reproductive technology, myoma uteri, uterine anomaly, maternal hypertension at the time of pregnancy, and body mass index before pregnancy. Results: A total of 4071 Japanese women (76 with placenta previa and 3995 without placenta previa) were identified. Placenta previa significantly increased the placental weight z‐score (partial regression coefficient: 0.44, 95% confidence interval 0.10–0.70, p < 0.001). Conclusion: Placenta previa increased the age‐specific placental size. Further studies are required to examine whether placenta previa is associated with the risk of obstetrics complications related to the placental size. [ABSTRACT FROM AUTHOR]

Aim: The effect of gestational weight gain on placental weight has not been elucidated. We aimed to examine the effect of body weight gain during pregnancy on the Japanese standardized z‐score of placental weight, based on the pre‐pregnancy body mass index. Methods: This retrospective cohort study included Japanese women with singleton pregnancies who gave birth during 2013–2019 at Ohta Nishinouchi Hospital. Participants (n = 3610) were categorized by their pre‐pregnancy body mass index: G1 (<18.5 kg/m2), G2 (18.5 to <20.0 kg/m2), G3 (20.0 to <23.0 kg/m2), G4 (23.0 to <25.0 kg/m2), and G5 (≥25.0 kg/m2). Multiple linear regression analysis was used to identify associations between insufficient or excessive gestational weight gain in each body mass index category and z‐score of placental weight, with adjustments for maternal age, assisted reproductive technology, and maternal pre‐pregnancy conditions, such as hypertension, diabetes mellitus, myoma uteri, and uterine anomalies. Results: Among the 3610 women assessed, 479, 692, 1292, 435, and 711 were in G1–G5, respectively. In G1, G3, and G4, excessive weight gain increased the placental weight z‐score ([B: 0.50, 95% confidence interval [CI]: 0.23–0.76], [B: 0.19, 95% CI: 0.19–0.33], and [B: 0.18, 95% CI: 0.10–0.26]). Insufficient weight gain decreased the placental weight z‐score in G3 (B: −0.19, 95% CI: −0.33 to −0.06) and G4 (B: −0.21, 95% CI: −0.29 to −0.13) women. Conclusion: The effect of weight gain during pregnancy on placental size varies by pre‐pregnancy body mass index. This result may guide personalized pre‐conception counseling to improve the outcomes of offspring. [ABSTRACT FROM AUTHOR]

Aims/Introduction: To examine adverse outcomes in women with early‐diagnosed gestational diabetes mellitus using data from a large birth cohort study in Japan. Materials and Methods: This study analyzed data from singleton pregnancies in the Japan Environment and Children's Study including births during 2011–2014. Mothers with an HbA1c level ≥6.5% in the first trimester, a history of diabetes mellitus, or steroid use during pregnancy were excluded. The participants were divided into three groups: control (without gestational diabetes mellitus), early‐diagnosed gestational diabetes mellitus (diagnosed before gestational week 24), and late‐diagnosed gestational diabetes mellitus (diagnosed after gestational week 24). Multiple logistic regression analysis was performed to calculate the risk of early‐diagnosed and late‐diagnosed gestational diabetes mellitus for adverse obstetrics outcomes. Results: In total, 100,376 eligible participants were included in this study. The number of individuals in control cases, early‐diagnosed gestational diabetes mellitus cases, and late‐diagnosed gestational diabetes mellitus cases was 98,090 (97.7%), 751 (0.7%), and 1,535 (1.5%), respectively. When control cases were used as reference, multiple logistic regression analysis revealed that early‐diagnosed gestational diabetes mellitus increased the risk of hypertensive disorders of pregnancy (adjusted odds ratio: 2.08, 95% confidence interval: 1.51–2.86), early‐onset hypertensive disorders of pregnancy (adjusted odds ratio: 1.91, 95% confidence interval: 1.01–3.65), and late‐onset hypertensive disorders of pregnancy (adjusted odds ratio: 1.92, 95% confidence interval: 1.29–2.86). Conclusion: Early‐diagnosed gestational diabetes mellitus is associated with serious obstetric complications. Our findings indicate the necessity of further investigations to validate the benefit of early screening for gestational diabetes mellitus in pregnant women. [ABSTRACT FROM AUTHOR]

Aim: There is strong evidence that weekly intramuscular (IM) injections of 250 mg of 17‐alpha‐hydroxyprogesterone caproate (17‐OHPC) reduce the risk of recurrent preterm birth (PTB); however, whether a lower dose of 17‐OHPC could reduce the risk of recurrent PTB remains unclear. This study aimed to assess whether 125 mg of 17‐OHPC reduces recurrent PTB among women with a prior singleton spontaneous PTB and cervical length >25 mm. Methods: This retrospective cohort study at a tertiary‐care medical center in Japan included women with a prior singleton spontaneous PTB between 20 and 36 weeks' gestation and cervical length >25 mm, between 2008 and 2018. Primary outcomes were PTB <37 and <34 weeks' gestation. We calculated the adjusted odds ratio (aOR) and 95% confidence interval (CI) using a multiple logistic regression model. Gestational age at delivery was compared using the Kaplan–Meier survival curve and log‐rank test. Results: Overall, 173 women met the inclusion criteria. Eighty‐four women received weekly injections of 125 mg of 17‐OHPC, and 89 did not. Treatment with 125 mg of 17‐OHPC significantly reduced the risk of recurrent spontaneous PTB <37 (aOR: 0.156 [95% CI: 0.049–0.497]) and <34 weeks' gestation (aOR: 0.156 [95% CI: 0.049–0.497]). The mean delivery gestational age was also significantly longer in the 17‐OHPC group (log‐rank p = 0.005). Conclusions: In this study population, weekly IM injections of 125 mg of 17‐OHPC reduced the risk of recurrent PTB <37 and <34 weeks' gestation. [ABSTRACT FROM AUTHOR]

Selenium (Se) acts as a cofactor of antioxidant enzymes. Preconception care may reduce the risk of gestational diabetes mellitus (GDM). We examined the association between preconception Se intake and the risk of GDM in Japanese women. Using the Japan Environment and Children's Study database, we identified 92,764 Japanese women recruited between January 2011 and March 2014. Participants were categorized into five groups according to preconception Se intake quintiles (Q1 and Q5 were the lowest and highest Se intake groups, respectively). GDM was categorized as early-onset (Eo-GDM) or late-onset (Lo-GDM) diagnosed before or after 24 weeks, respectively. Multiple logistic regressions were performed to identify the effect of preconception Se intake on GDM, Eo-GDM, and Lo-GDM. Using Q3 (the middle Se intake group) as the reference, a multiple logistic regression analysis showed that the highest (Q5) Se intake group demonstrated increased risks of GDM (adjusted odds ratio (aOR): 1.15, 95% confidence interval (CI): 1.01–1.30) and the lowest (Q1) Se intake group had increased risks of Lo-GDM (aOR: 1.19, 95% CI: 1.01–1.41). Thus, both high and low preconception Se intakes increase risks of glucose intolerance during pregnancy. This finding may indicate new recommendations for preconception Se intake to prevent GDM. [ABSTRACT FROM AUTHOR]