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Objective: The Test of Self-Conscious Affect-3 (TOSCA-3) is a scenario-based measure of self-conscious emotions. We aimed to create an abridged version of the TOSCA-3 that is appropriate for Japanese populations and has a good fit with the data, as well as validate its subscales. Methods: The TOSCA-3 was distributed to (a) a university student population (n = 512: Study 1) and (b) a parent population (n = 260: Study 2). In both studies, items with factor loading < 0.33 were deleted one by one to select culturally appropriate scenarios for each of the six domains of self-conscious emotions. In Study 1, self-conscious emotions were correlated with the other correlates. Results: Most of the final models showed a good fit with the data. In Study 1, the six domains of self-conscious emotions showed correlations with depression and related items, dispositional coping styles, experiences in childhood, ego function, borderline and narcissistic personality traits, and adult attachment styles, almost in the expected fashions. Conclusions: The TOSCA-3 is a useful tool to measure self-conscious emotions among Japanese student and parent populations if a few culturally inappropriate scenarios are deleted.

Infantile skin problems not only cause temporary pain and discomfort, but also have a long-term impact on health. Hence, the purpose of this cross-sectional study was to clarify the relationship between inflammatory cytokines and Malassezia fungal facial skin problems in infants. Ninety-six 1-month-old infants were examined. Facial skin problems and the presence of inflammatory cytokines in the forehead skin were assessed using the infant facial skin visual assessment tool (IFSAT) and the skin blotting method, respectively. Malassezia, a fungal commensal, was detected using forehead skin swabs, and its percentage in the total fungal population was analyzed. Infants with positive interleukin-8 signals were more likely to have severe facial skin problems ( p  = 0.006) and forehead papules ( p  = 0.043). No significant association between IFSAT scores and Malassezia was found, but infants with forehead dryness had a lower percentage of M. arunalokei in the total fungal population ( p  = 0.006). No significant association was observed between inflammatory cytokines and Malassezia in the study participants. Longitudinal studies on the development of facial skin problems in infants are warranted to investigate the involvement of interleukin-8 and devise preventive strategies in the future.

Investigating the association between gestational weight gain (GWG) on low birth weight (LBW, birth weight < 2500 g) across pre‐pregnancy body mass index (BMI) categories (underweight: < 18.5, normal: 18.5–24.9 and overweight/obese: ≥ 25 kg/m²) is crucial for clinical practice. While the Institute of Medicine's (IOM) 2009 GWG guidelines are widely used, evidence‐based data from diverse populations is scarce, creating a global research gap. We explored how total GWG and adherence to IOM recommendations affected the odds of LBW across BMI categories in the Sri Lankan context. This nationwide prospective study evaluated 1499 maternal and singleton‐newborn pairs between August 2022 and April 2024. Unadjusted and adjusted logistic regression analyses were performed. An increase in total GWG z‐score was associated with decreased odds of LBW among women with underweight pre‐pregnancy BMI (aOR: 0.56, 95% CI: 0.35‒0.89), but no significant association was observed among women with normal or ≥ 25 kg/m² BMI. Women with underweight BMI whose GWG was below the IOM recommended range showed higher odds of LBW than those with GWG within the recommended range (aOR 3.05, 95% CI: 1.08‒8.61). However, among women with normal or higher BMI, GWG below the recommended range was not significantly associated with LBW. These findings suggest that the association between GWG and odds of LBW varies across pre‐pregnancy BMI categories. Among Sri Lankan women with underweight pre‐pregnancy BMI, gaining pregnancy weight within the IOM GWG recommendations was associated with significantly lower odds of delivering an LBW newborn. This association was not observed among women with normal or higher BMI. Gestational weight gain below the Institute of Medicine's recommended range was most prevalent among Sri Lankan women with underweight pre‐pregnancy body mass index and was associated with higher odds of low birth weight deliveries. Summary The impact of the Institute of Medicine's gestational weight gain recommendations on adverse birth outcomes in Asian populations is unclear and lacks evidence‐based findings. Pre‐pregnancy body mass index and gestational weight gain impact newborns' birth weight. Gaining pregnancy weight within the IOM‐recommended range was associated with reduced odds of LBW among Sri Lankan women with underweight pre‐pregnancy BMI, whereas no such association was observed among women in other BMI categories.

Aim Parents' emotions towards a child are extremely important. The Scale of Parent‐to‐Child Emotions (SPCE) consists of five basic and four self‐conscious emotion domains for assessment of parental emotional states. Abridgement of the SPCE is needed for research and clinical settings. Methods Our previous investigational data for SPCE development were used in this study. The sample of 2336 fathers and 2264 mothers, whose eldest child's age was up to 12 years old, was analyzed. Total information for each pair (form) of items corresponding to a latent trait (θ) was calculated. The form with the greatest amount of total information was selected as the best for each domain. In addition, relative efficiency for each form and correlations of raw sum scores in classical test theory (CTT) for short forms with factor scores in item response theory (IRT) were calculated. Results The SPCE was shortened to 18 items by selecting two items each for nine domains. Correlations of raw sum scores in CTT for short forms with factor scores in IRT were correlated strongly and significantly. Conclusion This abridged form of the scale, the SPCE‐18, may be applicable in a busy clinical setting or research works to investigate the trajectory of parent‐to‐child emotions across a long span of time.

Aim Clinical attention to and understanding of women with impaired fetal bonding is important for early therapeutic intervention. This study aimed to clarify the clinical characteristics of women belonging to groups derived by cluster analysis of impaired maternal–fetal bonding. Methods A mixed‐method approach was adopted. We conducted a two‐wave internet survey targeting pregnant women less than 36 gestational weeks by using a questionnaire (33‐item Dimensional Assessment of Mother Baby Organization Questionnaire [DAMBO Q33]) with subsequent online interviews (Dimensional Assessment of Mother and Baby Organization‐Research Version). The maternal–fetal bonding disorder items in the DAMBO Q33 were entered into a two‐step cluster analysis. Two representative cases from each of the clusters, except for the positive bonding cluster, were selected to describe their clinical pictures. Finally, quantitative data and qualitative data were integrated and interpreted. Results A two‐step cluster analysis elicited four clusters: bonding disorder (n = 101), ambivalent bonding (n = 156), positive bonding (n = 173), and lack of bonding emotions (n = 122). Women in the bonding disorder cluster were characterized by seriously negative feelings towards the fetus. Women in the ambivalent bonding cluster wished to be pregnant but were not sufficiently ready for the transition into parenthood. Women in the lack of bonding emotions cluster were characterized by a lack of strong interest in pregnancy and the fetus. Conclusion Patterns of impaired maternal–fetal bonding were identified. We should not think of a pathological category of mental illness among them but recognize that such parents are targets for professional assessments and supportive (therapeutic) interventions. Understanding the meaning of getting pregnant and difficulties in the process of maternal role attainment is required. Four clusters of pregnant women were identified in terms of maternal–fetal emotions. The women in each cluster had different clinical features. Early intervention and treatment tailored to clinical features should be provided by frontline staff caring for pregnant women.

Background: Depression is frequently seen among pregnant women. This is called antenatal depression (AND). Aim: Our aim was to identify clusters of AND and its core symptoms. Methods: The Patient Health Questionnaire-9 (PHQ-9), Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24), and Nausea and Vomiting of Pregnancy Quality of Life Questionnaire (NVP-QOL) were distributed to 382 pregnant women with a gestational age of 10 to 13 weeks who were attending antenatal clinics. The two PHQ-9 subscale scores were entered into a 2-step cluster analysis. The PHQ-9 items’ capacity to identify AND were examined in terms of the area under curve (AUC) of a receiver operating characteristic (ROC) analysis. The selected symptom items were examined for their diagnostic capability in terms of the graded response model (GRM) in the item response theory (IRT) analysis. Results: Three clusters emerged. Cluster 3 scored highly in the scores of the two PHQ-9 subscales and the two emesis scales. In the ROC, five items showed an AUC > 0.80. The GRM identified four items with high information: ‘loss of interest’, ‘depressed mood’, ‘self-esteem’, and ‘poor concentration’. Conclusions: The core symptoms of antenatal depression were four non-somatic symptoms; particularly, ‘depressed mood’ and ‘loss of interest’. AND did not exist alone, but was accompanied by nausea and vomiting. Hence, we propose a new category: emesis–depression complex among pregnant women.

Little is known about the causality of antenatal depression (AND). We focused on the causal relationships between AND, fear of childbirth (FOC), and obsessive-compulsive symptoms (OCS) during the COVID-19 pandemic in Japan. We also examined whether the perceived threat of COVID-19 is associated with AND. Participants were recruited for an Internet survey conducted in December 2020. A total of 245 pregnant women completed the online survey at 12 to 15 weeks’ gestational age (Time 1) and approximately 10 weeks later (Time 2). AND was estimated using the first two diagnostic items of Major Depressive Episode. The estimated prevalence of AND was 4.5% and 2.9% at Time 1 and Time 2, respectively. At both time points, no association was found between AND and the perception of COVID-19 threat. Structural equation modeling showed that AND predicted OCS (β = 0.16, p < 0.001), which, in turn, predicted FOC (β = 0.09, p = 0.042); FOC, in turn, predicted AND (β = 0.23, p < 0.001). AND, OCS, and FOC were predicted by borderline personality traits. Insecure adult attachment influenced AND and FOC via the perceived negative impact of the current pregnancy. Perinatal care providers should assess the personality and perception of pregnancy to prevent depression and pay attention to symptoms such as FOC and OCS in addition to those of depression.

Background Mental health problems during pregnancy are multifaceted major health issues. Aim To develop and validate a short screening questionnaire that covers important domains including antenatal depression, tokophobia, fetal bonding disorder, suicidality, and emesis. Methods A total of 321 pregnant women who were less than 36 weeks gestation responded to a cross‐sectional web survey and filled in the 33‐item Dimensional Assessment of Mother Baby Organization Questionnaire (DAMBO Q33, available as an e‐book). Out of these women, 111 (35%) responded to our invitation to an online research interview (Dimensional Assessment of Mother Baby Organization‐Research Version). Using theory‐driven or cluster analysis‐driven categories of the five mental health domains as a gold standard, we identified the most powerful DAMBO Q33 questionnaire items for each domain and calculated psychometric properties of cut‐off points of the domain scores for the questionnaire, including sensitivity, specificity, and positive and negative predictive values. We proposed the best cut‐off value for each domain. Results We identified 11 DAMBO Q33 items as the best predictors for five mental health domains. The psychometric properties of the best cut‐off points were acceptable for each domain. By these cut‐off points, we could identify 57%, 19%, 100%, 46%, and 46% of true cases of antenatal depression, tokophobia, fetal bonding disorder, suicidality, and emesis, respectively. Positive cases of the five domains substantially coexisted with each other. Conclusion The final 11‐item questionnaire (DAMBO Q11) may be a useful screening tool for the five major mental health problems among pregnant women.

Background: A negative response towards a current pregnancy consists of two elements: unwantedness of and unhappiness about the current pregnancy. Little is clear about whether pregnant women can be categorized in terms of unwantedness and unhappiness as well as what the correlates are of these categories. Methods: An internet survey of 696 women in their first trimester of pregnancy examined the participants’ intention of and emotional reaction towards pregnancy, borderline personality traits, adult attachment style, depression, fear of childbirth, obsessive-compulsive symptoms, fetal bonding disorder, avoidance of taking part in child care, and consideration about termination of pregnancy (TOP). About one third of the participants were followed up with in their second trimester. Results: Two-step cluster analysis using the participants’ intention of and emotional reaction towards pregnancy revealed three groups of pregnant women: those who wanted and were happy about the pregnancy (Cluster 1), those who were unhappy about the pregnancy (Cluster 2), and those who did not intend to be pregnant but were happy about pregnancy (Cluster 3). Cluster 2 women, but not Cluster 3 women, were likely to be single, with borderline personality traits as well as unstable adult attachment styles, accompanied by depression, fear of childbirth, obsessive-compulsive symptoms, and fetal bonding disorder. They were more likely to avoid caring for the baby after childbirth and consider TOP. Conclusion: Expectant women who were unhappy about their pregnancy were at risk of psychological adjustment and need specific perinatal mental health assessment and care.

Perinatal cohort studies with a prospective longitudinal design are critical for determining the effects of early-life exposures on offspring’s health outcomes. The Sri Lanka Mother and Newborn Growth cohort study aims to investigate the impact of maternal nutritional and psychosocial factors on newborns’ birth weight in the Sri Lankan context. This paper presents the methodology of participant recruitment, follow-ups, an overview of measurements, and planned data analyses. This study included a nationally representative sample of Sri Lankan pregnant women recruited in their first trimester of pregnancy. Follow-up assessments were conducted once during the second and third trimesters of pregnancy and after the baby’s birth, prospectively tracking the women’s dietary intake, mental health, hemoglobin concentrations, and gestational weight gain data. Once the participants delivered their babies, the data on gestational age, sex of the newborn, birth weight, length and occipitofrontal circumference at birth, and mode of delivery were collected. Between August 2022 and August 2023, we recruited 2000 first-trimester pregnant women to the cohort and continued to follow up with them until the baby’s birth. The response rates were 90.4%, 81.4%, and 75.2% in the first, second, and third follow-ups. We plan to analyze the data in July 2024. We expect this study to provide valuable insights into various early-life exposures affecting neonatal birth weight. The study’s findings will serve as a valuable information resource for a broader scientific community, enabling the development of effective policies to prevent low-birth-weight deliveries in low-resource settings.