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Copyright of these slides belongs to the presenter and/or the Radiation Medical Science Center for the Fukushima
Health Management Survey, Fukushima Medical University (except figures, tables, etc., cited from other sources).
It is strictly prohibited to reproduce, reprint, distribute, transmit, broadcast, loan, translate, sell, modify, and/or
create derivatives of any slides, in any physical or electronic medium anywhere in the world.

2024年 福島県立医科大学『県民健康調査』国際シンポジウム
公立大学法人福島県立医科大学放射線医学県民健康管理センター
国際シンポジウム事務局（広報・国際連携室）✉ kenkani@fmu.ac.jp Tel: 024-581-5454(平日9～17時)
2024 Fukushima Medical University International Symposium on the Fukushima Health Management Survey
Secretariat of International Symposium
Office of Public Communications and International Cooperation, Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University✉ kenkani@fmu.ac.jp, TEL: +81-24-581-5454 (Weekday, 9a.m. - 5 p.m. JST)Session 1

2024 Fukushima Medical University International Symposiumon the Fukushima Health Management Survey
Insights – what we have learned from the people of Fukushima

Fukushima Health Management Survey:

Pregnancy and Birth Survey

Fukushima Medical University
Radiation Medical Science Centerfor the Fukushima Health Management Survey
Director, Pregnancy and Birth Survey
Department of Obstetrics and Gynecology
Professor and Chairman
FUJIMORI Keiya
1Current Survey and Support for Pregnant
Women in Fukushima Prefecture① FHMS Pregnancy and Birth Survey, FY 2011-FY 2020

② Follow-up Survey (to respondents from the original survey)
・1st Round (4 years postpartum) FY2011-2014 Survey Respondents
・2nd Round (8 years postpartum) FY2011-2013 Survey Respondents③ Current Status of pregnancies in Fukushima Prefecture (incidences ofspontaneous and induced abortion)– Dept. of Obstetrics and Gynecology, Fukushima Medical University④ Congenital anomaly monitoring across all prefectures by the Japan
Association of Obstetrics and Gynecology→ No report this time2

Overview of FHMS県民健康管理調査
県民健康調査Fukushima Health Management Survey (targeting all residents of Fukushima Prefecture)3

Support and Survey at the Office ofthe Pregnancy and Birth Survey
Covered Population

Phone consultation,email consultation③④

Offer appropriate care
- Phone support for those needing it- Email or phone consultation from target
population
Mail leaflet
Self-administered② return survey form Online response

Ongoing support frommunicipalities① survey form

Thank you postcard
Health care providers:midwives/doctors, etc.

municipalities

Radiation Medical Science Center for theFukushima Health Management Survey

Obstetrics &gynecology
teamRadiation
healthconsultation

Psychologicalcare teamInfo provided to target
population

Share information/request support for
those requiring ongoing support

Support result feedback
Contact with those requiring support
Calculate surveys
Confirm input data, determine need for phone support

Radiation Medical Science Center
Office for the Pregnancy and Birth Survey4(persons)

Number of Participants and Response Rate
for Pregnancy and Birth Survey (Basic Survey)（人）

18,000

Number of Participants
対象者数

58.2%
49.5%

16,000

51.8%

48.3%

47.7%

47.2%

15,21815,125

回答率
Response Rate
53.1%

51.8%

47.6%

70.0%

55.9%

50.0%

16,001

14,00060.0%

40.0%
14,572

14,51614,15430.0%

13,552
12,83812,00020.0%
11,90911,382

10,000

10.0%
0.0%

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

【参考】 Ministry of Health Labor and Welfare List of Statistics Vital Statistics (Nationwide)【Reference】
Number of births
出生数1,100,000

8.3‰

1,050,000

8.2‰

8.2‰

Birth Rate
出生率

8.5%
8.5‰

8.0‰

8.0‰

1,000,000

8.0%
8.0‰

7.8‰
7.6‰

950,000

7.4‰

900,000

7.5%
7.5‰

7.0‰

850,000

7.0%
7.0‰

6.8‰

800,000

6.5%

2011

2012

2013

2014

2015

2016

2017

2018

2019

6.5‰2020

Birth rate: per 1,000 population

5

Preterm Delivery Rate
(Preterm birth at 22-37 weeks of gestation)
6.0%

5.8%

5.8%
5.7%

5.7%

5.7%

5.6%

5.6%

5.7%
5.6%

5.6%

5.6%
5.5%

5.6%

5.4%
5.6%
5.2%

5.2%

5.3%

5.3%

5.2%

5.1%

5.3%

本調査
Main Survey

5.0%

全国調査
National Survey

4.8%
4.6%

4.6%

4.4%

4.4%

4.2%
4.0%
2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

National Survey: Ministry of Health, Labor and Welfare Statistics List Demographic Surveys

6Rate of Low Birth Weight Infants(Low birth weight: 2500ｇor less)
10.0%
9.8%

9.8%
9.6%

9.6%

9.6%

9.6%
9.6%

9.4%

9.5%
9.5%

9.2%
9.0%

9.4%

9.4%

9.4%

9.4%
9.2%

9.4%
9.2%

9.2%

9.2%
9.0%

8.8%

9.1%

8.6%
8.4%

8.6%

8.2%
8.1%

8.0%

2011

2012

2013

2014

2015
Main

本調査
Survey

2016

2017

2018

2019

2020

National Survey
全国調査7

Rate of Occurrence of Congenital Anomalies
and Birth Defects (singleton birth)

3.0%

Rate of congenital anomolies
and birth defects

先天奇形・先天異常の発生率

Rate of heart anomolies心臓奇形の発生率

2.39%

2.38%

2.85%

2.5%

2.35%

2.30%

2.0%

2.71%
2.21%

2.24%

2.55%

2.19%

1.5%
1.0%

0.91%

0.89%

0.5%

0.92%

0.91%

0.74%

0.85%

0.75%

0.79%

0.62%

0.61%

0.0%

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

※Frequency of morphological abnormalities (fetal malformations) assessed at birth is 2-3%
(Guideline for Gynecological Practice Obstetrics Edition 2023）

8

Mental Health in Mothers(Postpartum Depressive Tendencies)
30.0%

27.1%

25.5%

25.0%

24.5%

23.4%

22.0%

21.1%

20.7%

20.0%
15.0%

13.6%

12.9%

12.6%

12.1%

11.6%

11.1%

11.2%

10.0%

18.3%

18.0%

10.2%

10.1%

10.0%

9.8%

8.4%

5.0%

18.4%

9.7%

0.0%
2011

2012

2013

Main Survey:
depressive tendency

本調査：うつ傾向

2014

2015

2016

Basic Survey: Estimated rate2017

本調査：EPDSによる推定割合※
according to EPDS *

2018

2019

2020

全国調査※※
NationalSurvey

Depressive tendencies refers to those who responded “yes” to either of these survey questions:・Have you often felt down or depressed in the past month?
・Have you lost interest in activities or found no pleasure in things in the past month?

* Mishina H, et al. Pediatr Int. 2009; 51: 48.
* * Healthy Parents and Children 21: 2nd National Survey 8.4% (2013), 9.8% (2017), 9.7%9(2020)

Top 3 Topics in the Free-Write Section (by fiscal year)
2011

2012

2013

2014

１

Effects ofradiation on
fetus/child
29.6%

Effects ofradiation on
fetus/child
26.4%

Feedback/complaints
about basic
survey16.8%

Enhancingchildcare
supportservices
15.0%

２

Disseminationof informationand publishingsurvey results
19.5%

Disseminationof informationand publishingsurvey results
12.9%

Effects ofradiation on
fetus/child
12.9%

３Effects ofradiation onbreastmilk/mil
k
17.9%

Feedback/complaints
about basic
survey10.5%

Poor physical
Effects ofcondition ofradiation on
respondent
fetus/child
9.5%
11.2%

Childcare
Inquiries
15.0%

2015

2016

2017

Childcare
Inquiries

Childcare
Inquiries

Childcare
Inquiries

29.3%

27.2%

34.5%

Enhancingchildcare
supportservices
24.1%

Enhancingchildcare
supportservices
27.0%

Enhancingchildcare
supportservices
27.3%

2018
Enhancingchildcare
supportservices
25.1%

Childcare
Inquiries
23.7%

2019

2020

Childcare
Inquiries

ChildcareInquiries

28.1%

24.8%

Enhancingchildcare
supportservices
25.6%

New
coronavirus
infection
24.7%

Enriching
Poor physical Poor mental Poor physical Poor physicalmedicalcondition of condition of condition of condition ofservices and respondent
respondent
respondent
respondent
physical care
12.6%
13.3%
15.1%
11.5%
13.4%

Enhancingchildcare
supportservices
23.3%

Proportion of “Effects of radiation on fetus/child”
2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

29.6%

26.4%

12.9%

9.5%

5.2%

6.1%

4.8%

1.8%

2.1%

0.5%

10

Follow-up Survey of FY2011-2014Survey Respondents
The results of the FHMS Pregnancy and Birth Survey conducted by
Fukushima Prefecture showed a particularly high proportion of
respondents with depressive symptoms, with the free-comment
portion of the survey also including serious concerns. Due to these
responses and the possibility of new concerns arising as theirchildren grew, a follow-up survey was conducted targeting
respondents who were 4 or 8 years postpartum, in order tounderstand the state of their physical and mental health, reduce
anxiety and provide necessary support.

11Follow-Up Survey
Main SurveyFollow-Up Survey
4 Years Later

Follow-Up Survey

FY 2011

Respondents to basic survey out of

Respondents to basic survey out of

FY 2012

Respondents to basic survey out of

Respondents to basic survey out of

5,602 births: 2,021（36.1%）

5,152 births: 2,178（42.3%）

FY 2013

Respondents to basic survey out of

Respondents to basic survey out of

5,734 births: 2,706（47.2%）

5,402 births: 2,492（46.1%）

FY 2014

Respondents to basic survey out of(conducted every

fiscal year)
7,252 births: 2,554（35.2%）

8 Years Later
6,643 births: 2,354（35.4%）

5,856 births: 2,719（46.4%）

12

Follow-Up Survey at 4・8 Years Postpartum

Survey was administered in the form of a postcard with 7 questions

13

Proportion of Postpartum Depressive Tendencies
in the Follow-Up Survey(compared with regular survey of 4 or 8 years prior)
30%

27.1%
25.5%

24.5%

25%

23.4%
22.0%

20%

25.6%
24.3%

25.7%
27.1%

23.5%

21.1%

20.7%

22.5%

18.4%

18.3%

18.0%

24.9%

15%

10%
20112012

2013
Main

通常調査Survey

2014

2015

2016

Follow-Up Survey
フォローアップ4年目4 Years Later

20172018

2019

2020

Follow-Up Survey

フォローアップ8年目
8 Years Later

Depressive tendencies were found in those who answered “yes” to either of the following questions.

・Have you often felt down or depressed in the past month?
・Have you lost interest in activities or found no pleasure in things in the past month?

14

Number of respondents and contents of free-comment
section for the 2011 to 2014 Follow-Up Survey
1st

2nd

3 rd

4 th

5 th

FY 2011
Follow-Up Survey(4 Year)Concerns about effects ofradiation on fetus/child

Support for basic survey

Feedback/complaints about basic
surveyRequests to disclose survey
results and disseminate
radiation information

Requests for Thyroid
Ultrasound Examination

53（13.8%）47（12.3%）

44（11.5%）37（9.7%）23（6.0%）FY 2012
Follow-Up Survey(4 Year）

Support for basic survey

Feedback/complaints about basic
surveyConcerns about effects ofradiation on fetus/child

Questions about childcare

Requests for enhancementof childcare services

33（17.7%）24（12.9%）23（12.4%）17（9.1%）14（7.5%）FY 2013
Follow-Up Survey(4 Year)Support for basic survey

Feedback/complaints about basicsurvey

Concerns about effects ofradiation on fetus/childComplaints about mental
healthRequests for enhancementof childcare services

36（17.3%）25（12.0%）24（11.5%）16（7.7%）15（7.5%）FY 2014
Follow-Up Survey(4 Year）

Support for basic survey

Feedback/complaints about basic
surveyQuestions about childcare

Concerns about effects ofradiation on fetus/child

Requests for enhancementof childcare services

42（21.2%）

26（13.1%）

17（8.6%）14（7.1%）14（7.1%）

FY 2011
Follow-Up Survey(8 Year)

Questions about childcare

Concerns about effects ofradiation on fetus/childComplaints about PhysicalhealthSupport for basic survey

Complaints about mental
health82（27.0%）53（17.4%）

36（11.8%）28（9.2%）26（8.6%）

FY 2012
Follow-Up Survey(8 Year)related to new coronavirus
infections

Support for basic survey

Questions about childcare

Concerns about effects ofradiation on fetus/childComplaints about mental
health54（21.5%）47（19.0%）44（17.7%）

37（14.9%）30（12.1%）

FY 2013
Follow-Up Survey( Year)

Questions about childcare

Related to new coronavirus
infections

Complaints about mental
healthComplaints about PhysicalhealthConcerns about effects ofradiation on fetus/child

130（43.3%）

57（19.0%）54（18.0%）39（13.0%）27（9.0%）Survey Name

15

Characteristics of 6,875 cases according toexternal radiation dose（2011）
External radiation dose (mSv)
Toatal(missing)<1 mSv

1-2 mSv≥2 mSv

Ñ

6,875 (100.0)

3,575 (52.0)

2,267 (33.0)

979 (14.2)

54 (0.8)

P-value

Maternal age

6,875

30.9 (5.0)

30.3 (5.2)

31.5 (4.6)

31.6 (4.7)

30.5 (5.4)

0.238Child’s length (cm)6,783

49.1 (2.2)

49.1 (2.3)

49.1 (2.2)

49.2 (2.2)

49.1 (2.1)

0.397Child’s weight (g)6,815

3,029 (403)

3,026 (412)

3,036 (395)

3,028 (391)

3,006 (382)0.763

Low birth weight（<2500g）(％)

6,815

7.6

7.8

7.3

7.3

9.3

0.861

SGA（<10％）(％)

6,270

8.9

8.5

8.8

10.7

4.4

0.144

Congenital anomalies (％)

6,600

2.9

3.1

2.9

2.0

0.0

0.163

Stillbirth (％)

6,875

0.2

0.3

0.2

0.1

0.0

0.847

Preterm birth（<37 weeks） (％)

6,348

4.1

4.5

3.6

3.5

4.30.942

Forced to change health check-up
facility (%)

6,809

32.4

32.3

45.6

23.7

20.4

<0.001

One-way ANOVA was used for continuous variables and χ2 test for categorical variables (except for missing dose values)
Yasuda S, Fujimori K, et al. J Epidemiol 2022; 32: S104-114.

External radiation doses bycongenital malformations (2011)
total

<1mSv

1-2mSv≥2 mSvmissingn = 6,600

2,188944

03,414

Total ＊

189 (2.86)

64190106

Cataract

1 (0.02)

0100

Neural tube defects

3 (0.05)

1200Microcephaly

0 (0.00)

0000

Cardiac malformations

57 (0.86)204033Kidney/Urinary tract malformations

19 (0.29)

53011

Hydrocephaly

1 (0.02)

1000Cleft lip/palate

12 (0.18)

1308

Digestive tract atresia

5 (0.08)3002

Imperforate anus

4 (0.06)100

3Poly/syndactyly

18 (0.27)

7

1010Others

83 (1.26)

28

6049

* Multiple answers were allowed.

Yasuda S, Fujimori K, et al. J Epidemiol 2022; 32: S104-114.

Summary #1 of the FHMS Pregnancy and Birth Survey• The preterm birth rate and the low birth weight rate were similar
to the national average, and the incidence of congenital
malformations and birth defects was also at the same level as
generally reported data.
• Regarding maternal mental health, the percentage of depressed
mothers in this survey decreased over time from 27.1% in the2011 survey to 18.0% in the 2020 survey.
• The percentage of respondents who stated "radiation effects on
the fetus/child" in the free response section of this survey as awhole was 29.6% in the 2011 survey, but decreased over theyears to 0.5% in the 2020 survey.

18

Summary #2 of the FHMS Pregnancy and Birth Survey• In the follow-up survey conducted four years later, the percentageof respondents with depressive tendencies was 25.6% in FY 2011,25.7% in FY 2012, and 22.5% in FY 2014, showing a high trend,
although it has decreased over the years. The trend was high withan increase to 24.9% in FY2013.
• No association was found between external radiation doses fromthe baseline survey and the occurrence of congenitalmorphological abnormalities, preterm birth, low birth weight, andfetal growth failure.

19Summary of Spontaneous/Induced Abortion Rate％
Inducedabortion
Event
Inducedabortion
MonthSpontaneousabortion
EventSpontaneousabortion
Month• Periodicity studied in spontaneous and induced abortion rate of 3-month units (January through March)• A cross-sectional method is used for the event, and a longitudinal method is used for the month• Shaded areas indicate upper and lower outliers calculated from quartiles
Inoue Y, Fujimori K, et al. JOGR 2023; 49: 812-827.

Results of Study of Periodicity(Spontaneous/Induced Abortion rate based on the Month Event Occurred)
福島県全体
Fukushima
Prefecture

中通りNakadori

浜通りHamadori

会津Aizu

自然流産
SpontaneousAbortion

人工妊娠中絶InducedAbortion* Periodic study of miscarriage/abortion rate in 3-month units.
By multiplying the cycle by 3 (months), it can be converted into amonthly cycle.

In the case of analysis based on month of event occurrence• Spontaneous abortion rate and induced abortion rate were observed in a 6or 12-month cycle.
Inoue Y, Fujimori K, et al. JOGR 2023; 49: 812-827.

Results of Study of Periodicity(Spontaneous/Induced Abortion Rate based on the Month of Pregnancy)
福島県全体
FukushimaPrefecture

中通りNakadori

浜通りHamadori

会津Aizu

自然流産
SpontaneousAbortion

人工妊娠中絶InducedAbortion* Periodicity studied in spontaneous and induced abortion rates of 3-month units.
It can be converted into a monthly cycle by multiplying the cycle by 3 (months)

When Analyzing based on Month of Pregnancy••

Throughout Fukushima Prefecture, Nakadori, Aizu: spontaneous and induced
rates are shown in 6 or 12-month cycles.
Hamadori Region: Shown in 8 or 9-month cycles.
Inoue Y, Fujimori K, et al. JOGR 2023; 49: 812-827.

Summary• Spontaneous and induced abortion rates did not show asignificant increase following the earthquake.
• Induced abortion did increase immediately after the earthquake,but did not show a specific increase.
• From the periodicity results, the temporary increase following theearthquake may have overlapped with periodicity.
Inducedabortion
Event
Inducedabortion
MonthInoue Y, Fujimori K, et al. JOGR 2023; 49: 812-827.

Future Issues for Pregnant Women in Fukushima
Prefecture Following the Nuclear Disaster• Regarding low-dose radiation exposure, scientificunderstanding on “safety” has not resulted in perceptionsof “security.”• While there is little objective data, in order to create anenvironment where people can live both safely andsecurely, we will conduct prefecture-wide surveys inorder to support Fukushima residents. We believe it isimportant to proactively disclose objective scientific datain order to indicate safety.
24

● このスライドは、非営利かつ個人的な目的に限り閲覧することができます。
The following presentation slides are shared with symposium participants exclusively for personal, non-commercial,educational purposes.

● このスライドの著作権は、講演の発表者本人に帰属します（図表等の引用箇所は除く）。如何なる国・地域においても、また紙媒体やインターネット・電子データなど形態に関わらず、スライドの全部または一部を無断で複製、転載、配布、送信、放送、貸与、翻訳、販売、変造、二次的著作物を作成すること等は、固く禁止します。
Copyright of these slides belongs to the presenter and/or the Radiation Medical Science Center for the Fukushima
Health Management Survey, Fukushima Medical University (except figures, tables, etc., cited from other sources).
It is strictly prohibited to reproduce, reprint, distribute, transmit, broadcast, loan, translate, sell, modify, and/orcreate derivatives of any slides, in any physical or electronic medium anywhere in the world.

2024年 福島県立医科大学『県民健康調査』国際シンポジウム
公立大学法人福島県立医科大学放射線医学県民健康管理センター
国際シンポジウム事務局（広報・国際連携室）✉ kenkani@fmu.ac.jp Tel: 024-581-5454(平日9～17時)
2024 Fukushima Medical University International Symposium on the Fukushima Health Management Survey
Secretariat of International Symposium
Office of Public Communications and International Cooperation, Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University✉ kenkani@fmu.ac.jp, TEL: +81-24-581-5454 (Weekday, 9a.m. - 5 p.m. JST)