Alfred Korblein and Helmut Küchenhoff
Abstract
Objective: This study investigates the trend of perinatal mortality rates in Fukushima Prefecture and four neighboring prefectures (Miyagi, Gunma, Tochigi, and Ibaraki) after the disaster at the Fukushima Daiichi nuclear power plant in March 2011.
 Material and Methods: Japanese monthly perinatal mortality data on a prefecture level are available on a website of the Japanese government. A combined regression of perinatal mortality rates from the study region and the rest of Japan (the control region) is conducted. The regression model allows for an asymptotic lower limit and a level change of perinatal mortality rates in 2012-2017 in the study region relative to the predicted trend.
 Results: In 2012-2017, perinatal mortality in the study region shows a significant 10.6% increase relative to the trend in preceding years (p=0.006). The excess mortality translates to 195 (95% CI: 28, 462) excess perinatal deaths. The increase is 3-times greater in Fukushima Prefecture than in the four neighboring prefectures and the difference in excess rates is statistically significant (p=0.010). Periodic peaks of perinatal mortality are found in 2012-2017 with maxima around April.
 Conclusion: We find an increase in perinatal mortality in Fukushima and four neighboring prefectures after the Fukushima nuclear accident. The results agree with similar observations in Germany and Ukraine after the Chernobyl disaster. Due to its ecological design, the study cannot prove a causal link between radiation exposure and perinatal mortality. Continued observation of the trend of perinatal mortality in contaminated regions of Japan is recommended.
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