Pregnant Japanese Women Research Articles

Glucose Metabolism and Polyunsaturated Fatty Acids in Japanese Pregnant Women

Glucose Metabolism and Polyunsaturated Fatty Acids in Japanese Pregnant Women

Impaired fetal growth in mothers with inadequate gestational weight gain: a retrospective study in Japanese uncomplicated pregnancy

Introduction: The average birth weight in Japan has gradually decreased and the number of low birth weight infant has increased over the last 30 years. Japanese pregnant women are characterized with lower prevalence of obesity than those in other developed countries, and maternal underweight before pregnancy is independently associated with low birth weight. However, the association between maternal inadequate gestational weight gain (GWG) and the risk of small for gestational age (SGA) in Japanese uncomplicated pregnant women has not been fully understood. This study aimed to examine the effect of maternal inadequate GWG on the risk of SGA in Japanese uncomplicated pregnancies.Methods: We retrospectively analyzed uncomplicated Japanese singleton pregnancies that delivered at term gestation in our institution from 2006 to 2016. The association between GWG and birth weight was analyzed by multiple linear regression. Potential confounding factors included maternal age, parity, prepregnancy BMI, and neonatal sex. The association between inadequate GWG and SGA was also examined by logistic regression.Results: A total of 3837 mother–neonate dyads were analyzed. Maternal GWG was 10.1 ± 3.7 kg (mean ± SD), and 2529 (66%) had inadequate GWG. After adjusting for confounding factors, GWG significantly correlated with birth weight (standardized β = 0.199, p < .001). Inadequate GWG increased the risk of delivering SGA neonate (adjusted odds ratio (aOR) = 1.97 [1.45–2.68], p < .001). This association was particularly pronounced in underweight (aOR = 2.95 [1.38–6.29], p = .005) and normal weight mothers (aOR = 1.79 [1.27–2.52], p = .001), and not in overweight/obese mothers (p = .115).Conclusion: Maternal GWG is associated with birth weight in Japanese women with uncomplicated singleton pregnancies. Inadequate GWG is an important risk factor of SGA, particularly in non-obese women. The present finding would potentially provide further evidence that promoting adequate gestational weight gain in Japanese underweight and normal weight mothers would reduce SGA, as well as metabolic dysfunction in later life.

Associations of temporal changes in cervical length and lower uterine segment length with spontaneous preterm delivery risk: a prospective study of 727 Japanese women.

A prospective assessment of the risk of spontaneous preterm delivery (sPTD) by evaluating temporal changes in cervical measurements. We analyzed clinical variables, focusing on cervical length (CL) and lower uterine segment (LUS) length (LUSL) as measured by transvaginal ultrasonography in 727 pregnant Japanese women. In women undergoing term deliveries, CL increased from gestational week (GW) 8-25. In contrast, the combination of CL and LUSL (ComL for "combined length") gradually decreased and sole LUSL became almost 0mm by GW 25. Univariate logistic regression analysis suggested that a history of PTD was a risk factor for sPTD. CL, LUSL, and ComL were not significant predictors of sPTD. To assess the risk of sPTD in the second trimester, it is not necessary to distinguish the cervix from the LUS.

Distribution of PAPP-A and total hCG between 11 and 13 weeks of gestation in Japanese pregnant women

Objectives: To establish the reference values for PAPP-A and total hCG between 11 and 13 weeks of gestation for the use of risk assessment of fetal aneuploidy in Japanese pregnant women.Methods: A multicenter prospective study was conducted. The subjects included only Japanese pregnant women with viable singleton who requested the first trimester combined (nuchal translucency and maternal serum marker) screening for fetal aneuploidy. Reference values of PAPP-A and total hCG in Japanese population were made and compared with them in Caucasian.Results: Overall 1,751 Japanese pregnant women were analyzed. Median vales of maternal serum concentration in Japanese pregnant women from 11 + 0–13 + 6 weeks’ gestation were ranged from 3.01 to 9.51 mIU/mL for PAPP-A and from 70.2 to 58.3 IU/mL for total-hCG, respectively. Regression curve of median maternal serum PAPP-A and total-hCG concentration against gestational days are significantly higher in Japanese comparing with Caucasian. At most distant values, Japanese serum concentration indicated 1.45 MoM for total-hCG and 1.70 MoM for PAPP-A based on Caucasian regression curves.Conclusion: A modification of the equations by specific reference values is necessary for Japanese pregnant women at the risk assessment of chromosomal abnormalities using the first trimester maternal serum marker.

Fatty Acid Composition of the Erythrocyte Membranes Varies between Early-Term, Full-Term, and Late-Term Infants in Japan

Background: Term infants can be categorized into 3 sub-groups: early term (37w0d to 38w6d), full term (39w0d to 40w6d), and late term (41w0d and beyond). However, the fatty acid composition among the 3 groups of term infants has not been investigated. The association between fatty acid composition and gestational period of term infants in Japan is unclear. Methods: We assessed the fatty acid composition of maternal erythrocyte membranes in the third trimester and of cord erythrocyte membranes at birth in 212 healthy term Japanese infants using data from a prospective hospital-based cohort study. Results: In maternal erythrocyte membranes, docosahexaenoic acid (DHA) levels and omega-3 index were significantly higher in the late-term group than in the early-term group. In cord erythrocyte membranes, DHA levels were not significantly different between the 3 groups; late-term infants showed significantly higher DHA/arachidonic acid (ARA) and lower 20: 3n-6 and ARA levels compared to early-term infants. Gestational period positively correlated with the DHA status in maternal and cord erythrocyte membranes. Conclusions: Fatty acid composition in maternal and cord erythrocyte membranes varies between early-, full-, and late-term infants, and the greater gestational period may contribute to the relatively high n-3 polyunsaturated fatty acids status in term infants. Furthermore, maternal DHA status in the third semester directly correlates with gestational period in pregnant Japanese women.

Maternal Acrylamide Intake during Pregnancy and Sex Hormone Levels in Maternal and Umbilical Cord Blood and Birth Size of Offspring

Exposure to acrylamide during pregnancy may disturb pregnancy hormones and the growth of the fetus. The present study aimed to examine the association of maternal acrylamide intake with maternal and cord sex hormone levels during pregnancy and at birth and birth size of offspring. The study subjects were 204 pregnant Japanese women and their newborn girls. Intake of acrylamide was assessed based on 5-day diet records at approximately the 29th week of pregnancy. The concentrations of estradiol, estriol, and testosterone were measured in maternal serum at the 29th weeks of pregnancy and at delivery and umbilical cord blood at delivery. Birth weight, length, and head circumference were measured at the delivery. After controlling for covariates, higher intake of acrylamide was significantly positively associated with higher level of umbilical cord estradiol at the delivery (p for trend = .01), but not with any hormone levels measured in maternal blood. A positive association between acrylamide intake and head circumference was of borderline significance (p for trend = .06). Overall, there were no consistent associations between maternal acrylamide intake and sex hormone levels during pregnancy. However, as this is the first study to examine these associations, additional studies are needed.

Preconception dysmenorrhea as a risk factor for psychological distress in pregnancy: The Japan Environment and Children's Study

BackgroundDysmenorrhea influences emotional distress as well as physical suffering in young non-pregnant women. The aim of this study was to assess the potential association between preconception dysmenorrhea and the development of psychological distress during pregnancy. MethodsThis study was a part of the Japan Environment and Children's Study (JECS), a nationwide birth cohort study conducted between 2011 and 2014 in Japan. A total of 87,102 pregnant Japanese women with no psychological distress (Kessler 6-item psychological distress scale [K6] score ≤ 12) in early pregnancy were eligible. Among these, 7626 had mild and 1638 had severe preconception dysmenorrhea. The prevalence and risk of maternal psychological distress (K6 scores ≥ 13) in the second or third trimester were compared among preconception dysmenorrhea severity groups. ResultsA higher percentage of women with mild (2.6%) or severe preconception dysmenorrhea (3.6%) suffered psychological distress during pregnancy compared to that in women without dysmenorrhea (2.1%). A multilevel logistic regression model, adjusting for baseline characteristics and the K6 score at enrollment, showed that the severity of dysmenorrhea was associated with psychological distress (mild dysmenorrhea: adjusted odds ratio [aOR], 1.154; 95% confidence interval [95% CI], 0.980–1.359; and severe dysmenorrhea: aOR, 1.457; 95% CI, 1.087–1.951). LimitationsInformation about dysmenorrhea was obtained during early pregnancy. The JECS did not have clear diagnostic criteria for dysmenorrhea. ConclusionsPreconception dysmenorrhea is associated with an elevated incidence of psychological distress during pregnancy. Additionally, expectant mothers with a history of severe dysmenorrhea symptoms before pregnancy have a higher risk of developing psychological distress.

Effects of skipping breakfast on dietary intake and circulating and urinary nutrients during pregnancy.

More than 20% of pregnant Japanese women regularly skip breakfast, thereby resulting in a low intake of several nutrients that are required for fetal development and prevention of pregnancy complications. However, whether skipping breakfast affects circulating levels of these nutrients remains unclear. We investigated whether skipping breakfast during pregnancy was associated with decreases in dietary intake and circulating and urinary levels of several nutrients, including fatty acids and vitamins. This cross-sectional study was conducted at a university hospital in Tokyo, Japan, between June and October 2010. Nutrient intakes were assessed using a validated diet history questionnaire. Blood and 24-hour urinary samples were collected for assessing circulating and urinary excretion levels of nutrients. Skipping breakfast was defined as forgoing breakfast including a staple food, such as rice or bread, two or more times per week. Multiple linear regression analyses were used to compare nutrient levels between breakfast skippers and non-skippers after adjusting for confounders. Of 97 healthy pregnant women in the second trimester, 37 (38.1%) skipped breakfast two or more times per week. In multiple linear regression analysis, breakfast skippers had significant lower energy-adjusted intakes of protein than non-skippers (p=0.019). In addition, breakfast skippers had significantly lower levels of plasma eicosapentaenoic acid (p=0.008), plasma docosahexaenoic acid (p=0.027), serum β- carotene (p=0.013), urinary urea nitrogen (p=0.027), and urinary potassium (p=0.006), compared to non-skippers. Healthcare professionals need to suggest effective strategies for encouraging breakfast skippers to have breakfast regularly and to increase the intake of these nutrients.

Antihypertensives prescribed for pregnant women in Japan: Prevalence and timing determined from a database of health insurance claims.

The purpose of the study is to evaluate the status of prescribed antihypertensives primarily during pregnancy, but also before pregnancy and after delivery, using a large claims database in Japan. The dates of pregnancy onset and delivery were identified using reported algorithms and the birth months of infants. The prevalence and timing of prescribed antihypertensives during pregnancy were descriptively evaluated. Time trends in prescriptions were evaluated using multivariate logistic regression analyses. We also evaluated the prevalence of antihypertensives prescribed within 180days before pregnancy and 180days after delivery among women who were covered by health insurers during the entire period. At least one antihypertensive agent was prescribed for 1144 (2.74%) of 41693 pregnant women. The most frequently prescribed oral antihypertensive during pregnancy was nifedipine, followed by methyldopa, hydralazine, and furosemide. Drugs targeting the renin-angiotensin system were prescribed for 21 pregnant women (0.05%), including angiotensin II receptor blockers that were prescribed for 19 (0.05%) of them. Nicardipine was the most frequently prescribed injectable antihypertensive during pregnancy, followed by furosemide, hydralazine, and nitroglycerin. Annual prescription trends remained similar except for a significant decrease in those for oral and injectable furosemide and an annual increase in those for organic nitrate. Based on an evaluation of 33941 pregnant women, the number of prescriptions for antihypertensives increased particularly during the third trimester, then decreased from 91 to 180days after delivery. Various types of antihypertensives are prescribed for Japanese pregnant women. The effects of exposing pregnant Japanese women to these agents should be evaluated.

Reply to Shakira et al.: Validation of a food frequency questionnaire for Japanese pregnant women in mid to late pregnancy

Reply to Shakira et al.: Validation of a food frequency questionnaire for Japanese pregnant women in mid to late pregnancy

Changes in insulin requirements during pregnancy in Japanese women with type 1 diabetes.

We investigated the changes in insulin requirements, and other relevant factors, in pregnant Japanese women with type 1 diabetes. This retrospective observational study was conducted on 77 singleton pregnant women with type 1 diabetes, treated with multiple daily injections of insulin. We examined changes in daily insulin dose during pregnancy and defined the increased insulin doses as the ratio of maximum dose to the pre-pregnancy dose. The relationship between the increased insulin doses and maternal features or pregnancy outcomes was investigated. The insulin dose gradually increased during pregnancy, reaching a maximum dose that was 1.6 times of that prior to pregnancy, at 35weeks of gestation. A negative significant correlation was observed between the insulin dose increases and duration of diabetes (p=0.008). Greater increases in insulin doses were noted in women with multiparity, compared to nulliparity (p=0.047). Multiple regression analyses revealed that shorter duration of diabetes was independently associated with the increases in insulin dose during pregnancy. Women with a longer duration of diabetes required smaller increases in insulin dose during pregnancy, suggesting that long diabetic duration may decrease placental function. Further investigations are needed to clarify the mechanisms that the duration of diabetes influences on insulin requirement during pregnancy.

Factors related to vegetable intake among pregnant Japanese women: A cross-sectional study

IntroductionVegetable intake (VI) is important for both fetal and maternal health. However, VI is insufficient among many pregnant Japanese women. This study aimed to identify the factors related to VI during pregnancy. MethodsA cross-sectional study was conducted in 2014, at a university hospital in Tokyo, Japan. Dietary intake was assessed using a brief-type self-administered diet history questionnaire. Demographic, physical, and psychological characteristics, dietary habits, and health-related behaviors were investigated using another questionnaire. Multiple linear regression analysis was used to identify factors related to VI. ResultsData of 273 healthy pregnant women was analyzed. The median value of energy-adjusted VI was 140.4 g/1000 kcal. Severe pregnancy-associated nausea (β = −0.148), a habit of eating out (β = −0.174), a habit of eating confectioneries (β = −0.158), and perceived barriers to obtaining vegetables (β = −0.149) were negatively associated with the energy-adjusted VI. In contrast, exercise habits (β = 0.193), knowledge of the recommended VI amounts for non-pregnant adults (β = 0.105), and the Vegetable Intake Self-Efficacy scale scores (β = 0.193) were positively associated with the energy-adjusted VI. ConclusionsPregnant women with severe pregnancy-associated nausea, or those who habitually eat out or eat confectioneries, may be a potential high-risk population for low VI. Enhancing knowledge and self-efficacy regarding VI would be effective in increasing VI during pregnancy.

Pain in labor assessed from two discomfort aspects: Physical pain intensity and psychological stress state.

To assess two discomfort aspects of pain in labor, physical pain intensity and psychological stress state, we analyzed the association between the two parameters. Twenty-nine pregnant Japanese women with a singleton in 37-40 weeks of gestation were analyzed. Physical pain intensity was examined by the Numeric Rating Scale (NRS). Psychological stress state was measured by chromogranin A (CgA) in saliva. Data were collected thrice during labor (at 4-6 cm and 10 cm of cervical dilatation and immediately after delivery) and were accumulated from 4-6 cm and 10 cm of cervical dilatation. The study was approved by the Ethics Committees of Osaka University and Tokyo Women's Medical University. The median NRS score (10, IQR = 10-18) and the median CgA in saliva (8.0, IQR = 4.3-12.0) pmol/mg at 10 cm of cervical dilatation were significantly higher than those at the other two time points (P < 0.05). Although there were no correlations between NRS scores and concentrations of CgA in saliva at the three time points, there was a significant correlation between accumulated NRS and accumulated CgA in saliva (r = 0.68, P = 0.000). There was a significant difference in the accumulated NRS scores (P = 0.005) but not in the accumulated concentrations of CgA between primiparae and multiparae. Women in labor perceived severe pain and psychological stress with similar patterns during labor. However, these parameters were independent and need to be measured to evaluate these two discomfort aspects.

Perception of pregnant Japanese women regarding the teratogenic risk of medication exposure during pregnancy and the effect of counseling through the Japan drug information institute in pregnancy

ObjectiveTo confirm the current state of Japanese women’s perception of the teratogenic risk of medication exposure during pregnancy, and to assess the effect of counseling by Japan Drug Information Institute in Pregnancy. MethodsWe used VAS to monitor the sentiments of pregnant women, before and after face-to-face counseling, about their own teratogenic risk perception, and their intention to continue pregnancy. Pregnancy outcomes were investigated by mailed questionnaires. ResultsAmong 681 pregnant women, the median estimation of the risk of having a baby with a birth defect was 33.0% (interquartile range 16.0–50.0%) prior to counseling and 5.0% after counseling (2.0–11.0%). The median intention to continue pregnancy increased from 86.0% to 100.0% after counseling. The actual outcome survey revealed that almost all participants (97.1%) continued their pregnancies. ConclusionsPregnant women tend to overestimate the fetal risks of medication exposure during pregnancy. Counseling would prevent unnecessary termination.

Pregnancy outcomes in Japanese pregnant women with either chronic hypertension or white coat hypertension (JP-WCH): protocol for a prospective multicenter cohort study

Pregnancy outcomes in Japanese pregnant women with either chronic hypertension or white coat hypertension (JP-WCH): protocol for a prospective multicenter cohort study

Effect of individualised dietary education at medical check-ups on maternal and fetal outcomes in pregnant Japanese women.

An increased prevalence of low maternal weight and insufficient pregnancy weight gain may be responsible for an increase in low birthweight infants in Japan. We aimed to examine the effects of individualised dietary education at medical check-ups on maternal/fetal outcomes in Japanese women. Four hundred and six underweight and normal weight singleton pregnant women, who attended check-ups at an obstetric facility until ≥30 weeks gestation and delivered at 36-41 weeks gestation, were selected for analyses. Weight gain was assessed at each check-up based on the official "Dietary Guidelines for Pregnant and Lactating Women". Individual dietary advice was provided by dieticians to those with insufficient or excess weight gain status around 28 weeks gestation. The medical records from uncomplicated singleton deliveries (36-41 weeks gestation) at the same facility from 2008-2010 were used (n=792) to examine the effect of dietary education on maternal/fetal outcomes. Pre-pregnancy underweight was present in >24% of women in both the intervention and non-intervention groups. Adequate weight gain occurred more frequently in the intervention group (p<0.01). There were no significant differences in mean birthweight or the proportion of low birthweight infants. However, the proportion of extremely small for gestational age infants (birthweight <3rd percentile) was lower in the intervention group (p=0.011). There were no differences in the frequency of caesarean delivery, pregnancy induced hypertension, or infant Apgar scores <7. Dietary education during pregnancy check-ups promotes adequate maternal weight gain and helps prevent extreme fetal growth restraint.

Assessment of resting energy expenditure and body composition in Japanese pregnant women with diabetes.

Aims/IntroductionTo measure longitudinal changes in resting energy expenditure and body composition of Japanese pregnant women with or without diabetes.Materials and MethodsThe study population consisted of women who had delivered a live singleton neonate after 22 weeks’ gestation at Okayama University Hospital from July 2013 to June 2017. Resting energy expenditure and body composition were measured in the first trimester, second trimester, third trimester and postpartum.ResultsA total of 144 women participated in this study: 103 with normal glucose tolerance and 41 with diabetes. The resting energy expenditure (kcal/day) of pregnant women with normal glucose tolerance was significantly higher in the third trimester (1,644 ± 234) than in the first (1,461 ± 215) and second trimesters (1,491 ± 219), and postpartum (1,419 ± 254), whereas that of pregnant women with diabetes did not significantly change during all periods (1,568 ± 404, 1,710 ± 332, 1,716 ± 251, 1,567 ± 249). The resting energy expenditure of women with good glycemic control was lower than that of women with poor control. Fat‐free mass was closely correlated with resting energy expenditure.ConclusionsThe resting energy expenditure of Japanese pregnant women with normal glucose tolerance was significantly increased in the third trimester. The resting energy expenditure of women with good glycemic control was lower than that of women with poor control. Resting energy expenditure and fat‐free mass are potential indexes for medical nutrition therapy in pregnant women with diabetes.

Association of Maternal Factors with Perinatal Complications in Pregnancies Complicated with Diabetes: A Single-Center Retrospective Analysis.

Objective: The aim of this study was to clarify the association of maternal factors with perinatal complications in pregnancies complicated with type 1 (T1D) or type 2 diabetes (T2D). Methods: We conducted a retrospective chart review and enrolled 26 Japanese pregnant women with diabetes who received perinatal care at our hospital between 2008 and 2015. Perinatal complications were defined as one or more of the following: miscarriage, fetal death, fetal dysfunction, fetal structural anomaly, small-for-gestational age, large-for-gestational age (LGA), premature birth, neonatal hypoglycemia, pregnancy-induced hypertension (PIH), deterioration of maternal kidney function, and urgent Caesarean section (CS). The associations between perinatal complications and maternal factors were examined. Results: Approximately 70% and 50% of women with T1D and T2D experienced perinatal complications, respectively. LGA, neonatal hypoglycemia, and urgent CS were major perinatal complications in women with T1D, while PIH and urgent CS were major complications in those with T2D. In women with T1D, pre-gestational HbA1c was significantly higher in women with perinatal complications than in those without. In women with T2D, pre-gestational body mass index was significantly higher in women with perinatal complications than in those without. Conclusions: These findings suggest that while pre-gestational glycemic control remains the most important issue in women with T1D, pre-gestational weight control in addition to glycemic control should be greater emphasized in women with T2D to reduce the risk of perinatal complications.

Pre-pregnancy BMI, gestational weight gain and body image are associated with dietary under-reporting in pregnant Japanese women.

Dietary under-reporting is a common problem when using self-reported dietary assessment tools. However, there are few studies regarding under-reporting during pregnancy. This study aimed to explore the demographic and psychosocial characteristics related to dietary under-reporting in pregnant Japanese women. A cross-sectional study was conducted between 2010 and 2011 at a university hospital in Tokyo, Japan. Nutrient intake was assessed using a self-administered Diet History Questionnaire (DHQ), which had questions about the consumption frequency and portion size of selected food items. The 24-h urinary excretion levels of urea N and K were used as the dietary protein and K intake reference values, respectively. Under-reporting of protein and K was defined as the bottom 25% of the reporting accuracy (the ratio of reported intake on the DHQ to the estimated intake based on urinary excretion). Under-reporters were defined as participants who under-reported both protein and K intake. Multiple logistic regression analysis was performed to examine the factors associated with under-reporters. Of 271 healthy women at 19-23 weeks of gestation, thirty-five participants (12·9%) were identified as under-reporters. Under-reporters had a lower pre-pregnancy BMI (adjusted OR (AOR)=0·81) and lower gestational weight gain (AOR=0·82); they also reported managing their gestational weight gain with the aim to return to their pre-pregnancy weight soon after childbirth (AOR=2·99). Healthcare professionals should consider the potential for dietary under-reporting and the possible related factors when assessing the dietary intakes of pregnant Japanese women using self-administered questionnaires.

Optimal Weight Gain During Pregnancy in Japanese Women: Is It Okay?

Optimal Weight Gain During Pregnancy in Japanese Women: Is It Okay?