BackgroundPlacenta accreta spectrum (PAS) is a life-threating complication in the field of obstetrics. Sometimes we face with unexpected PAS cases which is potentially higher maternal mortality and morbidity compared with expected cases. The present study was conducted to examine the prevalence of PAS and to elucidate its risk factors using a large Japanese birth cohort study.MethodsWe reviewed the results of a nationwide prospective birth cohort study in Japan, and identified 90,554 participants treated from 2011 to 2014 in 15 regional centers. Multiple regression models were created to identify the risk factors for PAS. These data were obtained from self-reported questionnaires or patient medical records.ResultsThis analysis consisted of 202 cases of PAS (18 with placenta previa and 184 without placenta previa) and 90,352 cases without PAS. The multiple logistic regression analysis showed that placenta previa (adjusted odds ratio [aOR]: 12.86, 95% confidence interval [CI] 7.70–21.45, P < 0.001), assisted reproductive technology-related pregnancies (aOR: 6.78, 95% CI 4.54–10.14, P < 0.001), smoking during pregnancy (aOR: 1.95, 95% CI 1.15–3.31, P = 0.013), more than two previous cesarean sections (aOR: 2.51, 95% CI 1.35–4.67, P = 0.004), and uterine anomalies (aOR: 3.97, 95% CI 1.24–12.68, P = 0.020) increased the risk of PAS.ConclusionIn general population, placenta previa, assisted reproductive technology-related pregnancy, smoking during pregnancy, repeated cesarean sections, and uterine anomalies were risk factors for PAS in the Japanese population.

Introduction This study evaluated the risk of preterm birth, low birthweight and small‐for‐gestational‐age neonates born to mothers with adenomyosis during pregnancy. Material and methods We used the results of a Japanese nationwide prospective birth cohort study, identifying 93 668 singleton deliveries from 2011 to 2014. We identified 314 pregnancies with adenomyosis using self‐reported questionnaires. Multiple logistic regression analyses were conducted to examine whether adenomyosis was associated with adverse pregnancy outcome. Maternal age, smoking status, method of conception, history of parity, fibroids, endometriosis and body mass index before pregnancy were analyzed as confounding factors. Results Multiple logistic regression analysis showed that pregnancy with adenomyosis was a risk factor for preterm birth at less than 37 weeks (adjusted odds ratio [aOR: 2.49, 95% confidence interval [CI] 1.89‐3.41), preterm birth at less than 34 weeks (aOR 1.91, 95% CI 1.02‐3.55), low birthweight <2500 g (aOR 1.83, 95% CI 1.36‐2.45), low birthweight <1500 g (aOR 2.39, 95% CI 1.20‐4.77) and small‐for‐gestational‐age neonates (aOR 1.68, 95% CI 1.13‐2.51). Conclusions This study found that pregnancy with adenomyosis was associated with preterm birth, low birthweight and small‐for‐gestational‐age neonates.

The purpose of the present study was to clarify the relationship between bulimic behavior, dissociative phenomenon and sexual/physical abuse histories in Japanese subjects with habitual selfmutilation. Subjects consisted of 34 female outpatients who had cut their wrists or arms on more than 10 occasions. Two age-matched groups, which consisted of 31 general psychiatric outpatients and 26 non-clinical volunteers, served as controls. They were assessed with the Beck Depression Inventory-II, Bulimia Investigatory Test of Edinburgh, Adolescent Dissociative Experience Scale, and an original self-reporting questionnaire concerning various problematic behaviors and sexual/ physical abuse histories. The habitual self-mutilation and the two control groups were compared. The habitual self-mutilation group had significantly higher scores on the Beck Depression Inventory-II, Bulimia Investigatory Test of Edinburgh, and Adolescent Dissociative Experience Scale than either of the two control groups (P < 0.001). Furthermore, the habitual self-mutilation group more frequently had a history of illicit psychoactive drug use (P = 0.001), shoplifting (P < 0.001), suicide attempts (P < 0.001), overdosing with medicine (P < 0.001), sexual abuse (P = 0.011), and childhood physical abuse (P = 0.001) than the general psychiatric controls. These results are consistent with those in Western studies. Habitual self-mutilation is likely to coexist with depression, bulimia, and dissociation. Such patients frequently have clinical features similar to those of 'multiimpulsive bulimia'. Evidence supports the association between habitual self-mutilation and sexual/ childhood physical abuse in Japan.

It was examined whether bulimia and dissociation are common in male self-cutters, as has been found in female self-cutters. The subjects were 796 male inmates of a juvenile prison. A self-reporting questionnaire was used to assess self-cutting, histories of psychoactive substance use, problem behaviors, and traumatic life events in the subjects. The Adolescent Dissociative Experience Scale and the Bulimia Investigatory Test of Edinburgh were also used. Subjects were divided into two groups: self-cutting and non-cutting. Questionnaire responses and dissociation and bulimia assessments were compared between the groups. Self-cutters began smoking ( P < 0.001) and drinking ( P < 0.001) earlier, and more frequently used illicit psychoactive drugs ( P < 0.001), experienced childhood physical abuse ( P < 0.001), and reported suicide attempts ( P < 0.001), suicidal ideation ( P < 0.001), and outward violence toward a person ( P < 0.001) or object ( P < 0.001) than noncutters. Self-cutters also scored significantly higher on the bulimia ( P < 0.001) and dissociation tests ( P < 0.001). Logistic regression analysis demonstrated that suicide attempt (odds ratio, 4.311) and suicidal ideation (odds ratio, 2.336) could discriminate between male inmates with and without self-cutting. Male self-cutters showed 'multi-impulsive bulimic' tendencies resembling those of female self-cutters, although to a lesser extent. Clinical features of male as opposed to female selfcutters were influenced by gender differences.