title: Effect of medical institution change on gestational duration after the Great East Japan Earthquake: The Fukushima Health Management Survey.
abstract: OBJECTIVE
  The aim of this study was to examine the association between medical institution change for perinatal care and gestational duration after the Great East Japan Earthquake using data from the Fukushima Health Management Survey.
  
  
  METHODS
  The data of pregnant women who experienced the earthquake in Fukushima prefecture and participated in the Pregnancy and Birth Survey as part of the Fukushima Health Management Survey were analyzed. The primary and secondary outcomes of this study were gestational duration and preterm birth, respectively. The main study factor was prenatal checkup institution (only one institution, changed institution due to self-referral, changed institution due to medical indication, and went to parents' home for childbirth). Self-referral was considered as indicative of relocation after the disaster. Multiple linear and logistic regression analyses were conducted to examine the effect of earthquake on each outcome.
  
  
  RESULTS
  A total of 5593 (60.2%) participants experienced the earthquake between the 4th and 37th weeks of their gestational period. After controlling for variables, pregnant women who changed their perinatal checkup institution due to medical indication were significantly associated with shorter gestational duration (β = -10.6, P < 0.001) and preterm birth (adjusted odds ratio, 8.5; 95% confidence interval, 5.8-12.5) compared with women who visited only one institution. Self-referral, however, was not significantly associated with the outcomes.
  
  
  CONCLUSIONS
  According to prenatal checkup status, our results suggest that the effect on gestational duration of the Great East Japan Earthquake and the subsequent Fukushima Daiichi nuclear disaster was not significant.
authors.affiliation: Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan.|Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan.
authors.forename: Kohta
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan.|Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Goto
authors.affiliation: Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan.|Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima, Japan.
authors.forename: Keiya
authors.initials: K
authors.lastname: Fujimori
mesh_terms: D000328:Adult; D004190:Disasters; D055866:Earthquakes; D005260:Female; D005865:Gestational Age; D006306:Health Surveys; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D013315:Stress, Psychological; D055815:Young Adult
keywords: Great East Japan Earthquake; gestational duration; prenatal checkup; preterm birth