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Article: Impact of Introducing a Controlled-Release Dinoprostone Vaginal Insert for Labor Induction: A Retrospective Single-Center Study in Japan.

Shindo, Ryosuke / Aoki, Shigeru / Nakanishi, Sayuri / Obata, Soichiro / Miyagi, Etsuko

2024 Volume 16, Issue 1, Page(s) e53180

Abstract: Aim: Cervical ripening is commonly performed before oxytocin administration during labor induction in pregnant women with an unfavorable cervix. In Japan, a controlled-release Dinoprostone vaginal insert (CR-DVI) was approved in 2020. Although many ... ...

Abstract	Aim: Cervical ripening is commonly performed before oxytocin administration during labor induction in pregnant women with an unfavorable cervix. In Japan, a controlled-release Dinoprostone vaginal insert (CR-DVI) was approved in 2020. Although many studies have compared the mechanical methods of ripening and prostaglandins, few have examined the impact of additional options for labor induction. This study aimed to assess the impact of CR-DVI as an additional option for labor induction in women with an unfavorable cervix. Methods: In this single-center retrospective study conducted in Japan, 265 participants were divided into two groups: before (January 2018 to May 2020) and after (June 2020 to November 2022) CR-DVI introduction. Before CR-DVI was introduced, hygroscopic dilators were used for all cases instead. On the other hand, after the introduction of CR-DVI, the first choice for cervical ripening was CR-DVI. The CR-DVI was retained vaginally for up to 12 hours after insertion. However, if hyper-stimulation or non-reassuring fetal status was suspected, or if a new membrane rupture occurred, it was removed immediately according to the removal criteria. Oxytocin infusions were used during both periods if needed. We compared delivery and neonatal outcomes between the groups. Results: The 265 participants were divided into two groups: before (n=116) and after (n=149) CR-DVI introduction. There were no significant differences in maternal characteristics except for the primiparous proportion. CR-DVI was used in 93% of cases after introduction. Hygroscopic dilators also continued to be used; however, their use decreased to about 34%. The vaginal delivery rate was significantly higher after the introduction of CR-DVI than before its introduction (50.9% vs. 66.4%; p=0.01). Multivariable analysis revealed a significantly higher rate of vaginal delivery after CR-DVI introduction. Of the 149 cases in which a CR-DVI was used, 111 (79.9%) were removed before 12 hours. There were no significant differences in neonatal outcomes. Conclusion: The rate of vaginal delivery was higher after CR-DVI introduction than before its introduction, and adverse pregnancy outcomes did not increase. Therefore, introducing CR-DVI as an option for labor induction may increase the probability of vaginal delivery. Safety can also be ensured by adhering to the removal criteria.
Language	English
Publishing date	2024-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.53180
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Article ; Online: Women with elevated blood pressure and stage 1 hypertension are at high risk for preeclampsia. A retrospective study at a tertiary facility in Japan.

Shindo, Ryosuke / Aoki, Shigeru / Nakanishi, Sayuri / Obata, Soichiro / Miyagi, Etsuko

The journal of obstetrics and gynaecology research

2023 Volume 50, Issue 3, Page(s) 366–372

Abstract: Aim: In 2017, the American College of Cardiology (ACC) re-defined hypertension (HT) as follows: elevated blood pressure (EBP), systolic blood pressure (SBP) 120-129 mmHg and diastolic blood pressure (DBP) <80 mmHg; stage 1 HT, SBP 130-139 mmHg or DBP 80- ...

Abstract	Aim: In 2017, the American College of Cardiology (ACC) re-defined hypertension (HT) as follows: elevated blood pressure (EBP), systolic blood pressure (SBP) 120-129 mmHg and diastolic blood pressure (DBP) <80 mmHg; stage 1 HT, SBP 130-139 mmHg or DBP 80-89 mmHg; and stage 2 HT: SBP ≥140 mmHg or DBP ≥90 mmHg. It is well known that women with stage 2 HT are at higher risk of preeclampsia and have poorer pregnancy and delivery outcomes. While there are few reports on the risk in women with EBP and stage 1 HT, and none from Japan. This study aimed to determine whether women in Japan with EBP and stage 1 HT are at risk of preeclampsia. Methods: In this single-center retrospective study conducted in Japan, subjects were classified into stage 2 HT, stage 1 HT, EBP, and normal groups based on blood pressure measurements at the time of the first visit before 20 weeks of gestation. Women with a diagnosis of hypertension made before pregnancy were classified into the stage 2 HT group. We compared pregnancy and delivery outcomes, such as preeclampsia, between groups. Results: A total of 5129 cases (normal, n = 4283; EBP, n = 427; stage 1 HT, n = 303; stage 2 HT, n = 116) were included. Preeclampsia incidence rates were 2.7%, 5.6%, 10.6%, and 21.6%, respectively. The adjusted OR (95% CI) for preeclampsia incidence were 2.90 (1.81-4.66), 5.90 (3.87-9.20), and 13.80 (7.97-24.0), respectively. Conclusions: Women with EBP and stage 1 HT are at high risk of preeclampsia, similar to those with stage 2 HT.
MeSH term(s)	Pregnancy ; Female ; Humans ; Pre-Eclampsia/epidemiology ; Retrospective Studies ; Blood Pressure ; Japan/epidemiology ; Hypertension/epidemiology
Language	English
Publishing date	2023-12-11
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1327307-3
ISSN	1447-0756 ; 1341-8076
ISSN (online)	1447-0756
ISSN	1341-8076
DOI	10.1111/jog.15852
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Article ; Online: Use of the Japanese gestational diabetes mellitus diagnostic strategy during the COVID-19 pandemic in Japan: A questionnaire survey.

Kasuga, Yoshifumi / Miyakoshi, Kei / Yokoyama, Maki / Nakanishi, Sayuri / Iwama, Noriyuki / Ichikawa, Raishi / Abiko, Atsuko / Harashima, Shinichi / Sugiyama, Takashi

The journal of obstetrics and gynaecology research

2024

Abstract: Aim: Some concerns exist that diagnosis of gestational diabetes mellitus (GDM) may be missed when the simplified diagnostic criteria of the Japanese Society of Diabetes and Pregnancy (JSDP) for GDM (published during the COVID-19 pandemic) are used. ... ...

Abstract	Aim: Some concerns exist that diagnosis of gestational diabetes mellitus (GDM) may be missed when the simplified diagnostic criteria of the Japanese Society of Diabetes and Pregnancy (JSDP) for GDM (published during the COVID-19 pandemic) are used. Moreover, limited data is available regarding how widespread these diagnostic criteria are used when managing GDM during the COVID-19 pandemic. Therefore, this study aimed to determine how GDM diagnosis has changed during the COVID-19 pandemic in Japan. Methods: The changes in GDM diagnosis during the COVID-19 pandemic were investigated using an online questionnaire to 2159 obstetric facilities in Japan. The questionnaire collected data on facility type, awareness of Japanese GDM diagnostic strategies, modifications to diagnostic methods for early and late GDM, and opinions on GDM management, with the pandemic divided into seven periods. Results: We received responses from 593 facilities (27%). Approximately 90% of the facilities did not change their diagnostic process for early GDM or late GDM (occurring after 24 weeks gestation). However, during the COVID-19 pandemic, 19 facilities discontinued the use of 75-g oral glucose tolerance tests before 24 weeks of gestation, and 17 facilities discontinued it after 24 weeks of gestation, instead using the aforementioned Japanese GDM diagnostic strategy. Conclusions: Although a limited number of facilities modified their diagnostic method in response to the COVID-19 pandemic, this study demonstrated that those that adjusted their diagnostic method primarily used the Japanese COVID-19 GDM strategy by the JSDP.
Language	English
Publishing date	2024-03-24
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1327307-3
ISSN	1447-0756 ; 1341-8076
ISSN (online)	1447-0756
ISSN	1341-8076
DOI	10.1111/jog.15929
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Article: A deletion variant in LMX1B causing nail-patella syndrome in Japanese twins.

Kishio, Nozomu / Iwama, Kazuhiro / Nakanishi, Sayuri / Shindo, Ryosuke / Yasui, Masaki / Nicho, Naoki / Takahashi, Atsushi / Kohara, Mana / Hirata, Michisato / Kemmotsu, Takahiro / Tanoshima, Miki / Ito, Shuichi

Human genome variation

2024 Volume 11, Issue 1, Page(s) 10

Abstract: Nail-patella syndrome (NPS) is a hereditary disease caused by pathogenic variants in LMX1B and characterized by nail, limb, and renal symptoms. This study revealed a likely pathogenic LMX1B variant, NM_002316.4: c.723_726delinsC (p.Ser242del), in ... ...

Abstract	Nail-patella syndrome (NPS) is a hereditary disease caused by pathogenic variants in LMX1B and characterized by nail, limb, and renal symptoms. This study revealed a likely pathogenic LMX1B variant, NM_002316.4: c.723_726delinsC (p.Ser242del), in Japanese twins with clubfoot. The patients' mother, who shared this variant, developed proteinuria after delivery. p.Ser242del is located in the homeodomain of the protein, in which variants that cause renal disease tend to cluster. Our findings highlight p.Ser242del as a likely pathogenic variant, expanding our knowledge of NPS.
Language	English
Publishing date	2024-02-29
Publishing country	England
Document type	Journal Article
ISSN	2054-345X
ISSN	2054-345X
DOI	10.1038/s41439-024-00266-z
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Article ; Online: Do pregnancy outcomes of women with false-positive early gestational diabetes mellitus differ from those of women with normal glucose tolerance?

Nakanishi, Sayuri / Aoki, Shigeru / Shindo, Ryosuke / Obata, Soichiro / Kasai, Junko / Miyagi, Etsuko

BMC endocrine disorders

2022 Volume 22, Issue 1, Page(s) 203

Abstract: Background: To investigate whether false-positive early gestational diabetes mellitus (GDM) women can be managed similarly as normal glucose tolerance (NGT) women.: Methods: This retrospective study was conducted at a tertiary care center in Japan. ... ...

Abstract	Background: To investigate whether false-positive early gestational diabetes mellitus (GDM) women can be managed similarly as normal glucose tolerance (NGT) women. Methods: This retrospective study was conducted at a tertiary care center in Japan. Pregnancy and neonatal outcomes of 67 singleton pregnancies with false-positive early GDM and 1774 singleton pregnancies with NGT who delivered after 22 weeks of gestation were compared. GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria (patients having one or more of the following: fasting plasma glucose ≥ 92 mg/dL and a 75 g oral glucose tolerance test (OGTT) value ≥ 180 mg/dL at 1 h, or ≥ 153 mg/dL at 2 h). Pregnant women diagnosed with GDM in early pregnancy who did not meet the diagnostic criteria on the second OGTT were defined as having false-positive early GDM. Women with false-positive early GDM did not receive any therapeutic intervention during gestation. Results: Maternal age, pre-pregnancy body mass index, and gestational weight gain were significantly higher in the false-positive GDM group than in the NGT group. No significant differences were found in pregnancy outcomes, including gestational age, birth weight, large for gestational age rate, and cesarean delivery rate. Except for a higher neonatal hypoglycemia rate in the false-positive early GDM group, no significant differences were found in neonatal outcomes. Conclusions: There were no clinically significant differences between early GDM false-positive women exhibiting GDM patterns only during early pregnancy and NGT women. False-positive early GDM women can be managed similarly as NGT women, suggesting that World Health Organization diagnostic guidelines, applying the IADPSG criteria during early pregnancy, need revision.
MeSH term(s)	Diabetes, Gestational/diagnosis ; Female ; Glucose ; Glucose Tolerance Test ; Humans ; Infant, Newborn ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies
Chemical Substances	Glucose (IY9XDZ35W2)
Language	English
Publishing date	2022-08-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2091323-0
ISSN	1472-6823 ; 1472-6823
ISSN (online)	1472-6823
ISSN	1472-6823
DOI	10.1186/s12902-022-01124-1
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Article ; Online: An extremely prolonged second stage of labor increases maternal complications but has no adverse effect on neonatal outcomes.

Hagiwara, Mayumi / Nakanishi, Sayuri / Shindo, Ryosuke / Obata, Soichiro / Miyagi, Etsuko / Aoki, Shigeru

The journal of obstetrics and gynaecology research

2022 Volume 48, Issue 6, Page(s) 1364–1369

Abstract: Aim: To investigate how an extremely prolonged second stage of labor of 12 h or more affects maternal and neonatal outcomes.: Material and methods: This retrospective cohort study included nulliparous, pregnant women with 37 + 0 to 41 + 6 weeks of ... ...

Abstract	Aim: To investigate how an extremely prolonged second stage of labor of 12 h or more affects maternal and neonatal outcomes. Material and methods: This retrospective cohort study included nulliparous, pregnant women with 37 + 0 to 41 + 6 weeks of gestation whom vaginal delivery was attempted at the Yokohama City University Medical Center between 2014 and 2018. Results: In 446 cases of the prolonged second stage of labor, there were 296 women (66%) in the 2- to 6-h second stage of labor group, 112 women (25%) in the 6- to 12-h group, and 38 women (8.5%) in the 12-h or longer group. The longer the second stage of labor, the more significant was the increase in the rates of augmentation of the delivery, emergency cesarean delivery, and operative vaginal delivery. Even in the 12 h or longer group, 82% were able to have vaginal delivery. The 6- to 12-h group had a significant increase in third- or fourth-degree perineal lacerations compared to the 2- to 6-h group (aOR 8.12 [95% CI 1.55-42.6]). Clinical chorioamnionitis was significantly increased in the 12 h or longer group (aOR 4.88 [95% CI 1.62-14.8]). In terms of neonatal outcomes, comparison between the three groups showed no significant difference. Conclusion: With an extremely prolonged second stage of labor, maternal complications involved a significant increase in severe perineal lacerations and chorioamnionitis; however, there was no increase in adverse outcomes for neonates. It was not possible to conclusively determine if the duration of the second stage is acceptable.
MeSH term(s)	Chorioamnionitis/epidemiology ; Chorioamnionitis/etiology ; Delivery, Obstetric/adverse effects ; Female ; Humans ; Infant, Newborn ; Labor Stage, Second ; Lacerations/etiology ; Obstetric Labor Complications/epidemiology ; Obstetric Labor Complications/etiology ; Pregnancy ; Retrospective Studies
Language	English
Publishing date	2022-03-13
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1327307-3
ISSN	1447-0756 ; 1341-8076
ISSN (online)	1447-0756
ISSN	1341-8076
DOI	10.1111/jog.15212
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Article ; Online: Non-efficacy of early intervention strategy for non-obese patients with early-onset gestational diabetes mellitus: solely based on the short-term outcomes.

Nakanishi, Sayuri / Aoki, Shigeru / Kasai, Junko / Shindo, Ryosuke / Obata, Soichiro / Hasegawa, Yoshimi / Mochimaru, Aya / Kurasawa, Kentaro / Miyagi, Etsuko

BMJ open diabetes research & care

2023 Volume 11, Issue 3

Abstract: Introduction: To verify the effectiveness of intervention in early pregnancy for women with early-onset gestational diabetes mellitus (GDM).: Research design and methods: This study included women with a singleton pregnancy who were diagnosed with ... ...

Abstract	Introduction: To verify the effectiveness of intervention in early pregnancy for women with early-onset gestational diabetes mellitus (GDM). Research design and methods: This study included women with a singleton pregnancy who were diagnosed with early-onset GDM by 20 weeks of gestation according to the International Association of Diabetes and Pregnancy Study Group (IADPSG) threshold. We retrospectively evaluated the pregnancy outcomes in pregnant women with early-onset GDM. In the treatment from early pregnancy group (n=286), patients were diagnosed with early-onset GDM at the Yokohama City University Medical Center (YCU-MC) in 2015-2017 and were treated for GDM from early pregnancy. Concerning the treatment from mid-pregnancy group (n=248), participants were diagnosed with early-onset GDM at five sites, including the YCU-MC in 2018-2019, and were followed up without treatment until the second 75 g oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. Treatment for GDM was given only if the GDM pattern was still present in the second OGTT. Results: There were no significant differences in maternal backgrounds, including GDM risk factors and gestational weight gain, between the groups. Among the treatment from mid-pregnancy group, the false-positive early GDM was 124/248 (50%). Regarding pregnancy outcome, the rate of large for gestational age (LGA) was 8.8% in the treatment from early pregnancy group and 10% in the treatment from mid-pregnancy group, with no significant difference, whereas small for gestational age (SGA) was significantly higher in the treatment from early pregnancy group (9.4%) than in the treatment from mid-pregnancy group (4.8%) (p=0.046). There were no significant differences in maternal adverse events and neonatal outcomes between the groups. In a subanalysis limited to body mass index >25 kg/m Conclusions: The strategy for diagnosing GDM by IADPSG thresholds in early pregnancy and providing treatment to all patients from early pregnancy did not improve the pregnancy outcomes, but rather increased the SGA rate.
MeSH term(s)	Infant, Newborn ; Pregnancy ; Humans ; Female ; Diabetes, Gestational/diagnosis ; Diabetes, Gestational/epidemiology ; Diabetes, Gestational/therapy ; Retrospective Studies ; Pregnancy Outcome/epidemiology ; Glucose Tolerance Test ; Weight Gain ; Pregnancy in Diabetics
Language	English
Publishing date	2023-06-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2732918-5
ISSN	2052-4897 ; 2052-4897
ISSN (online)	2052-4897
ISSN	2052-4897
DOI	10.1136/bmjdrc-2022-003230
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Article ; Online: Impact of gestational diabetes mellitus diagnosed during the third trimester on pregnancy outcomes: a case-control study.

Shindo, Ryosuke / Aoki, Shigeru / Nakanishi, Sayuri / Misumi, Toshihiro / Miyagi, Etsuko

BMC pregnancy and childbirth

2021 Volume 21, Issue 1, Page(s) 246

Abstract: Background: In 2010, the International Association of Diabetes and Pregnancy Study Group (IADPSG) proposed new criteria indicating that gestational diabetes mellitus (GDM) can be diagnosed if the fasting threshold of ≤92 mg/dL, 1-h threshold of ≤180 mg/ ... ...

Abstract	Background: In 2010, the International Association of Diabetes and Pregnancy Study Group (IADPSG) proposed new criteria indicating that gestational diabetes mellitus (GDM) can be diagnosed if the fasting threshold of ≤92 mg/dL, 1-h threshold of ≤180 mg/dL, or 2-h threshold of ≤153 mg/dL are exceeded during the 75-g 2-h oral glucose tolerance test (OGTT) performed at 24-28 weeks of gestation. The World Health Organization (WHO) recommends using the proposed diagnostic threshold values of the IADPSG to diagnose GDM; however, it does not limit the timing of the 75-g OGTT. Since 2010 in Japan, GDM has been diagnosed using the same criteria as that proposed by the WHO. However, neither the JSOG nor the WHO has provided any evidence that it is appropriate to use a threshold beyond the range recommended by the IADPSG. Methods: This was a single-centre retrospective study based on the medical records and delivery registry database of our centre. We included women who underwent a 50-g glucose challenge test (GCT) with results < 140 mg/dL at 24-28 weeks of gestation and subsequently underwent a 75-g OGTT after 29 weeks of gestation with abnormal glucose tolerance suspected based on clinical findings. The reference values for the 75-g OGTT followed the IADPSG criteria. Subjects were classified into the normal glucose tolerance (NGT) group and the GDM group. The type of delivery and neonatal outcomes of the two groups were compared. A multivariable analysis was performed to match the backgrounds of both groups. Results: In total, the NGT and GDM group comprised 189 and 49 women, respectively. Emergency caesarean delivery rates were similar in the GDM and NGT groups (10.6 and 12.2%, respectively; adjusted odds ratio [OR], 1.25; 95% confidence interval [CI], 0.43-3.64; p = 0.74); however, the elective caesarean delivery rate was higher in the GDM group than in the NGT group (16.3 and 5.3%, respectively, adjusted OR, 3.60; 95% CI, 1.27-10.19; p = 0.01). No significant differences were observed in other maternal and neonatal outcomes between both groups. Conclusion: Although a diagnosis of GDM during the third trimester does not improve pregnancy outcomes, it increases the elective caesarean delivery rate.
MeSH term(s)	Adult ; Blood Glucose/analysis ; Case-Control Studies ; Cesarean Section/statistics & numerical data ; Diabetes, Gestational/blood ; Diabetes, Gestational/diagnosis ; Diabetes, Gestational/epidemiology ; Female ; Glucose Tolerance Test ; Humans ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Third/blood ; Retrospective Studies ; Risk Factors ; Time Factors
Chemical Substances	Blood Glucose
Language	English
Publishing date	2021-03-24
Publishing country	England
Document type	Journal Article
ISSN	1471-2393
ISSN (online)	1471-2393
DOI	10.1186/s12884-021-03730-8
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Article: A case of successful pregnancy in a septate uterus after discharge of decidual tissue in the second trimester.

Uomoto, Mari / Obata, Soichiro / Yumoto, Ami / Nakanishi, Sayuri / Sasahara, Yukiko / Otani, Masako / Miyagi, Etsuko / Aoki, Shigeru

Clinical case reports

2021 Volume 9, Issue 4, Page(s) 2382–2384

Abstract: In pregnant patients with a divided uterine cavity, the decidual tissue on the nonpregnant side may be discharged prior to the delivery of the fetus. The pregnancy can continue if the uterine contractions and vaginal bleeding are controlled and the fetus ...

Abstract	In pregnant patients with a divided uterine cavity, the decidual tissue on the nonpregnant side may be discharged prior to the delivery of the fetus. The pregnancy can continue if the uterine contractions and vaginal bleeding are controlled and the fetus is not in distress.
Language	English
Publishing date	2021-03-11
Publishing country	England
Document type	Case Reports
ZDB-ID	2740234-4
ISSN	2050-0904
ISSN	2050-0904
DOI	10.1002/ccr3.4042
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Article ; Online: Weight gain during twin pregnancy with favorable pregnancy outcomes in Japan: A retrospective investigation for new criteria based on perinatal registry data.

Obata, Soichiro / Shimura, Mai / Misumi, Toshihiro / Nakanishi, Sayuri / Shindo, Ryosuke / Miyagi, Etsuko / Aoki, Shigeru

PloS one

2021 Volume 16, Issue 7, Page(s) e0253596

Abstract: In 2009, the United States Institute of Medicine (IOM) reported the optimal gestational weight gain (GWG) during twin pregnancy based on the pre-pregnancy body mass index (BMI). However, there are ethnic variations in the relationship between GWG and ... ...

Abstract	In 2009, the United States Institute of Medicine (IOM) reported the optimal gestational weight gain (GWG) during twin pregnancy based on the pre-pregnancy body mass index (BMI). However, there are ethnic variations in the relationship between GWG and pregnancy outcomes. We aimed to establish the criteria for optimal GWG during twin pregnancy in Japan. The study included cases of dichorionic diamniotic twin pregnancy registered in the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System between 2013 and 2017. We analyzed data for cases wherein both babies were appropriate for gestational age and delivered at term. Cases were classified into four groups based on the pre-pregnancy BMI: underweight (BMI <18.5 kg/m2), normal weight (18.5 kg/m2 ≤BMI< 25.0 kg/m2), overweight (25.0 kg/m2 ≤BMI< 30.0 kg/m2), and obese (BMI ≥30.0 kg/m2) and we calculated the 25th-75th percentile range for GWG for the cases. The 3,936 cases were included. The GWG ranges were 11.5-16.5 kg, 10.3-16.0 kg, 6.9-14.7 kg, and 2.2-11.7 kg in the underweight, normal weight, overweight, and obese groups, respectively. Thus, in the current study, the optimal GWG during twin pregnancy was lower than that specified by the IOM criteria. Factoring this in maternal management may improve the outcomes of twin pregnancies in Japan.
MeSH term(s)	Adolescent ; Adult ; Female ; Gestational Weight Gain/physiology ; Humans ; Japan ; Middle Aged ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Twin/physiology ; Reference Values ; Registries/statistics & numerical data ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2021-07-02
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0253596
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