青木 恭子

Aims: To identify the course of maternal fatigue during the first 6 months postpartum and to determine factors associated with it. Design: A prospective cohort study. Methods: Women (N = 2,697) in 13 Japanese hospitals provided longitudinal data using self-report questionnaires at five time points. Maternal fatigue was assessed using the Postnatal Accumulated Fatigue Scale. We focused on the effect of maternal age and parity on the course of maternal fatigue and used a mixed between/within-subjects analysis of variance. Factors associated with maternal fatigue were analysed using stepwise multiple regression. Results: In the 6-month postpartum period, the level of fatigue was highest at 1 month and significantly decreased from 1-4 months postpartum. Primiparas showed a significantly higher level of fatigue than multiparas during hospital stay and their levels of fatigue more closely approximated the 1-month peak. Multiparas showed significantly higher levels of fatigue than younger primiparas at 6-month postpartum. Factors associated with maternal fatigue included satisfaction with sleep, concerns about child-rearing, satisfaction with social support, financial burden and meal times per day.

BACKGROUND: Depressive symptoms are common in postpartum women. The present study aimed to describe changes in the prevalence of depressive symptoms during the first 6 months postpartum, and their association with maternal age and parity. METHODS: A prospective cohort study was conducted with 3769 women at 13 hospitals in Japan. Depressive symptoms were measured during hospital stay and at 1, 2, 4, and 6 months postpartum, using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS). The effects of maternal age and parity were assessed by comparing four groups: younger primiparas (aged <35 years); older primiparas (≥35 years); younger multiparas (<35 years); and older multiparas (≥35 years). Data were analyzed using a mixed between/within-subjects analysis of variance, Cochran's Q tests, and chi-square tests. RESULTS: Mean EPDS scores significantly decreased from 1 to 2 months postpartum in all groups. The proportion of women with EPDS scores ≥9 significantly decreased during the same period for primiparas but not for multiparas. Primiparas also had significantly higher EPDS scores than multiparas during hospital stay and at 1 month postpartum. LIMITATIONS: As we used convenience sampling, our study sample was not fully representative of Japanese mothers. This study was also limited by our focus on the postpartum period. CONCLUSIONS: The first month postpartum represented peak prevalence for depressive symptoms. Primiparity was a risk factor for depressive symptoms only during the first month postpartum. Healthcare professionals should be sensitive to postpartum duration and parity when monitoring depressive symptoms.

AIM: Post-partum fatigue is a serious concern for mothers worldwide. The aim of this study was to identify age-specific determinants of self-perceived fatigue after childbirth among Japanese primiparous women. METHODS: A multicenter prospective cohort study was conducted in Japan. The degree of fatigue was assessed using the Postnatal Accumulated Fatigue Scale during the hospital stay after childbirth. Associated factors were stratified into two age groups (<35 or ≥35 years old); data were analyzed using stepwise multiple regression. RESULTS: In the younger group, significant determinants of post-partum fatigue included: anticipated difficulties in child-rearing after discharge; perception of inadequate sleep conditions; dissatisfaction with childbirth; shorter sleep and meal times; longer duration between feeding and infant bedtime; unemployment; and having hyperemesis gravidarum. In the older group, significant determinants of post-partum fatigue included: anticipated difficulties in child-rearing after discharge; perception of inadequate sleep conditions; shorter meal times; formula feeding; and dissatisfaction with childbirth. CONCLUSION: Primiparous mothers who anticipated new life with their infants to be difficult and who had an irregular lifestyle tended to report higher levels of fatigue during the post-partum hospital stay. Nurses and midwives should assess maternal sleep and eating conditions, providing support to ensure adequate maternal rest. Special efforts should be made to reduce anxiety about new life with infants among younger primiparous women who had experienced hyperemesis gravidarum.

AIM: Older maternal age has become more common in Japan. Studies suggest that older maternal age and primiparity are associated with post-partum depression. The present study aimed to identify predictors of post-partum depression in older Japanese primiparas at 1 month post-partum. METHODS: Participants were 479 primiparas aged 35 years and over, drawn from a prospective cohort study. Data were collected using self-report questionnaires. Depression was measured with the Japanese version of the Edinburgh Postnatal Depression Scale. Stepwise logistic regression analysis was conducted on binary outcome variables of depression at 1 month post-partum, along with a stratified analysis based on the risk status of depression. RESULTS: Five predictors were identified: (i) the depression score during hospital stay; (ii) financial burden; (iii) dissatisfaction with appraisal support; (iv) physical burden in daily life; and (v) concerns about infant caretaking. Stratified analysis identified dissatisfaction with instrumental support in the low-risk group, and the Child-care Value Scale score as unique predictors in the high-risk group. CONCLUSION: These results highlight the importance of early assessment of depressive symptoms and the provision of continuous care.

AIM: The number of older primiparas is increasing in Japan. These women have been shown to be more vulnerable to post-partum depression. This study aimed to identify factors for predicting post-partum depressive symptoms during hospitalization after childbirth in Japanese primiparas aged 35 years and over. METHODS: The present authors used the data of 479 primiparas aged 35 years and over from a prospective cohort study. Data were collected using self-report questionnaires on the day before hospital discharge. The questionnaire consisted of: demographics and background information; depressive symptoms; fatigue; maternal confidence and maternal satisfaction; child-care values; physical symptoms; perceptions of daily life during hospitalization; concerns about child care and daily life; and infant feeding. Additionally, vital records data were obtained from the hospitals. A stepwise logistic regression analysis was performed on the binary outcome variable of depressive symptoms, measured by the Japanese version of the Edinburgh Postnatal Depression Scale. Women who scored 9 or more were considered to be at high risk for post-partum depression. The authors obtained informed consent from all participants and institutional ethics approvals before initiating the study. RESULTS: The following six variables reliably predicted the risk of post-partum depression: emergency cesarean section, lower satisfaction with birth experience, higher physical burden in daily life, long-term complications with the newborn, more concerns about newborn caretaking after discharge, and more concerns about one's own life after discharge. CONCLUSION: Recognition of women with these factors will help nurses to identify those at risk for developing post-partum depression and to provide appropriate care during hospitalization after childbirth.

症例は35歳以上の日本人初産婦で、産後一ヵ月に陥る産後鬱病(PPD)を予防するための、看護介入の実施可能性について検討した。MEDLINE、PubMed、CINAHL、Cochrane、Database of Systematic Reviews、Cochrane central Register of Controlled Trials、PsychInfo、医中誌Webから、「ランダム化比較試験」、「準ランダム化比較試験」、「メタアナリシス」、「比較研究」、「診療ガイドライン」、「産後」、「産褥」、「看護」、「援助」、「支援」、「ケア」、「鬱」、「鬱病」および、その英語対応語を検索語として邦文および英語文献を検索した。その結果、1998〜2009年に発表された8文献がヒットした(n=4946)。8文献ともランダム化比較試験に関する英語文献で、4試験がオーストラリア、3試験が英国、1試験がカナダで実施されていた。八つの研究内容は、体験報告会(3文献、2776名)、カウンセリング(1文献、103名)、専門家または非専門家による家庭訪問(2文献、723名)、ピアサポーターによる電話訪問(1文献、612名)、グループや小冊子によるサポート(1文献、732名)の5カテゴリーに分類された。以上の分析により、PPDの予防のためには、出産体験の振り返りを含むカウンセリングと家庭訪問や電話を介した社会的サポートの2タイプの看護介入が実践的かつ有益であると考えられた。但し、全てが海外の試験例であるため、国内の実情に合わせた対応が必要である。

システマティックレビュー(SR)によって、産後1ヵ月間の高年初産婦における母乳育児推進及び母親役割の自信を高めるための看護介入のエビデンスを得ようとした。CCRCT,CDSR,MEDLINE,CINAHL,PsycINFO,PubMed,医学中央雑誌Webの七つのデータベースを用いて文献を検索した。設定した2種のキーワードのもとに検索した結果、母乳育児推進のための介入で、洋文献3、和文献0が評価対象となった。母親役割の自信を高めるための介入で洋文献2、和文献1が評価対象となった。各介入はそれぞれ一つの論文から示されたもので、エビデンスの強い介入は抽出されず、効果が認められた介入については日本の高年初産婦は含まれていなかった。産後1ヵ月迄の母乳育児推進のための介入は入院中に母子同室と頻回授乳への支援を行い、退院後は電話相談によって継続的に支援することが示された。母親役割の自信を高めるための介入は、母親がアクセスしやすい方法で情報提供を行うことなどが示された。

産後2ヵ月時の育児ストレスについて、高年初産婦と34歳以下の初産婦に違いがあるか、高年初産婦の産後2ヵ月時の育児ストレスを予測する要因を明らかにする分析を行った。産婦の背景および妊娠分娩の状況を診療録より収集した。また、産後2ヵ月時に育児ストレスショートフォーム(PSI-SF)を用いて、産後2ヵ月時の育児ストレスを測定した。産後1ヵ月時に母親役割の自信尺度と母親であることの満足感尺度を用いて母親役割の自信と満足感を測定した。また、産後1ヵ月時に疲労蓄積事故診断チェックリストを参考にして作成した尺度を用いて疲労度を測定した。高年初産婦448名、34歳以下の初産婦964名から回答を得た。分析の結果、高年初産婦は34歳以下の初産婦よりも、産後2ヵ月時において子どもの特徴に関するストレス、親自身のストレスが高かった。また、高年初産婦のストレスに関する要因は、産後1ヵ月時の疲労、手のかかる子どもと認識していることなどがあった。児の合図のよみとりと要求への応答への自信、母としての自己肯定感が高いほど産後2ヵ月時の親のストレスが低かった。

産後入院中から1ヵ月間における介護介入によって、褥婦の疲労の蓄積を予防できると仮定し、既存の研究についてシステマティックレビュー(SR)をすることで、高年初産婦における産後の蓄積疲労予防のための産後1ヵ月間の看護介入に対するエビデンスを明らかにした。既存のガイドラインとSRの検索を実施した後、CCRCT,CDSR,MEDLINE,医学中央雑誌Web版など七つを用いて検索を行った。検索の結果4件の洋文献、0件の和文献が抽出され、分析の対象となった。分析の結果、褥婦の疲労の蓄積を予防できる看護介入として、授乳時の姿勢、産後疲労要因と対処法を記したブックレットによる介入、軽度の産後運動プログラム、行動教育的睡眠介入プログラムがあることが分かった。この4種類の看護介入のエビデンス評価を行ったところ、ブックレットと行動教育的睡眠介入プログラムがエビデンスの強さはBと評価された。軽度の産後運動プログラムはC、授乳時の姿勢はDとの評価であった。

The purpose of this study was to gain a deeper understanding of the postpartum experiences of older primiparas at the time of their postpartum hospital stay. Participants were Japanese primiparas aged 35-44 years who gave birth, without abnormalities for either the mother or child. Data were obtained using a semi-structured interview with 22 participants. Thirteen themes emerged through content analysis. We found that there were distinctive experiences, which included 'the health and growth of the baby: relief and continued anxiety', 'awareness of strengths and of concerns of primiparas', 'meaning of the pregnancy and childbirth experience' and 'developing one's own child-care approach'. Findings suggest that nursing care during the post-delivery hospital stay should use the unique strengths of older primiparas to enable their smooth transition to maternal role attainment.