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Umehara K, Nakanishi S, Kojima T, Yamamoto M, Shindo R, Obata S, Miyagi E, Aoki S. Impact of changes in recommendation of optimal gestational weight gain in Japan: A retrospective study in a single tertiary center. J Obstet Gynaecol Res 2024. [PMID: 39104004 DOI: 10.1111/jog.16040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024]
Abstract
AIM In March 2021, the Japanese Ministry of Health, Labour and Welfare revised the optimal gestational weight gain standards. In this study, we examined whether this revision affected gestational weight gain and low birth weight rates. METHODS We analyzed the records of singleton pregnant women who underwent checkups from their 1st trimester and delivered at our institute after 37 weeks between 2020 and 2021 (before the revision) and between 2022 and 2023 (after the revision). Pregnancy outcomes were assessed in the following four groups stratified by pre-pregnancy body mass index (BMI): underweight (BMI: <18.5 kg/m2), normal-weight (BMI: 18.5-24.9 kg/m2), overweight (BMI: 25-29.9 kg/m2), and obese (BMI: ≥30 kg/m2). Leaflets on the optimal gestational weight gain standards for each group were distributed to all pregnant women at the first prenatal checkup. RESULTS In each group, gestational weight gain did not change before and after the revision, with the corresponding values of 10.8 kg and 11.1 kg in the underweight (p = 0.94), 10.7 kg and 10.4 kg in the normal weight (p = 0.14), 9.7 kg and 9.2 kg in the overweight (p = 0.32), and 7.4 kg and 6.7 kg in the obese (p = 0.44) groups. Furthermore, the prevalence of low birth weight did not decrease in all groups. CONCLUSIONS No significant differences in gestational weight gain or low birth weight were observed after the revision of the 2021 gestational weight gain recommendations. Merely distributing leaflets to pregnant women may not be sufficient to improve gestational weight gain or reduce low birth weight rates.
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Affiliation(s)
- Kotono Umehara
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Sayuri Nakanishi
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomoyuki Kojima
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Masafumi Yamamoto
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Shindo
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Soichiro Obata
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
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Morimoto N, Nishihama Y, Onishi K, Nakayama SF. Association between blood lipid levels in early pregnancy and urinary organophosphate metabolites in the Japan Environment and Children's Study. ENVIRONMENT INTERNATIONAL 2024; 190:108932. [PMID: 39128375 DOI: 10.1016/j.envint.2024.108932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/22/2024] [Accepted: 08/01/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND High low-density lipoprotein cholesterol levels (LDL-C) during pregnancy have been associated with adverse pregnancy and offspring outcomes. While previous studies have suggested a potential link between organophosphate pesticide (OPP) exposure and higher LDL-C in the general population and agricultural workers, the relationship in pregnant women and the effect of body mass index on this relationship remain unclear. We examined the association between the urinary concentrations of OPP metabolites (dialkylphosphates) and blood lipid levels in pregnant women. METHODS We used data from the Japan Environment and Children's Study, which included 5,169 pregnant women with urinary dialkylphosphate data. We examined the association between urinary concentrations of six dialkylphosphates (DEP, DETP, DEDTP, DMP, DMTP, DMDTP) and blood lipid levels (LDL-C, total cholesterol, high-density lipoprotein cholesterol, and triglycerides) during the first trimester using multiple linear regression under a Bayesian paradigm. We examined the association between high LDL-C, defined as ≥90th percentile of LDL-C, and urinary dialkylphosphate concentrations, using multiple logistic regression under a Bayesian paradigm. These analyses were repeated in underweight, normal-weight, and overweight participants. RESULTS DEP, DMP, and DMTP were detected in >50 % of the participants. Multiple linear regression analyses did not show associations between LDL-C and these dialkylphosphates. Stratified analyses showed a positive association between DEP and LDL-C in overweight women (beta coefficient = 2.13, 95 % credible interval = 0.86-3.38, probability of direction (PD) = 100 %); however, the association was not significant (percentage in region of practical equivalence (% in ROPE) = 84.0). Higher DEP was significantly associated with high LDL-C (odds ratio = 1.32, 95 % credible interval = 1.13-1.55, PD = 100 %, % in ROPE = 0.2). CONCLUSIONS Among overweight pregnant women in the first trimester, higher urinary DEP concentrations were associated with high LDL-C. The effects of OPP on blood lipid profiles merit further investigation.
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Affiliation(s)
- Nobuhisa Morimoto
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Ibaraki, Japan; Graduate School of Public Health, St. Luke's International University, Chuo-ku, Tokyo 104-0045, Japan
| | - Yukiko Nishihama
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Ibaraki, Japan; Paediatric Environmental Medicine, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kazunari Onishi
- Division of Environmental Health, Graduate School of Public Health, St. Luke's International University, Chuo-ku, Tokyo 104-0045, Japan
| | - Shoji F Nakayama
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Ibaraki, Japan; Graduate School of Public Health, St. Luke's International University, Chuo-ku, Tokyo 104-0045, Japan.
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Poudel K, Kobayashi S, Iwata H, Tojo M, Yamaguchi T, Yamazaki K, Tamura N, Itoh M, Obara T, Kuriyama S, Kishi R. Hokkaido birth cohort study in Japan on the growth trajectory of children born with low birth weight until 7 years of age. Early Hum Dev 2024; 189:105925. [PMID: 38199046 DOI: 10.1016/j.earlhumdev.2023.105925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Low birth weight (LBW) is a significant global health concern with potential health risks and developmental implications for infants. Catch-up growth, an accelerated growth following an inhibition period, may partially compensate for growth deficits in LBW children. AIMS This study investigated the prevalence of LBW and catch-up growth in height, weight, and body mass index (BMI) among LBW children in Japan, identified factors associated with LBW, and explored the potential for catch-up growth at different ages up to seven years. STUDY DESIGN AND SUBJECTS The Hokkaido birth cohort study included 20,926 pregnant Japanese women recruited during their first trimester from 37 hospitals and clinics. Follow-up assessments were conducted in children up to seven years of age, tracking LBW children's growth and development using the Maternal and Child Health Handbook, and providing valuable insights into catch-up growth patterns. OUTCOME MEASURES LBW was defined as a neonatal birth weight of <2500 g. The primary outcomes were catch-up growth in height, weight, and BMI at different ages. Z-scores were calculated to assess growth parameters with catch-up growth, defined as a change in z-score (> 0.67) between two time points. RESULTS AND CONCLUSIONS A LBW was prevalent in 7.6 % of the cohort, which was lower than that reported in other Japanese studies. Among LBW children, 19.3 % achieved catch-up growth in height by age seven, and 10.6 % in weight. Catch-up growth in LBW children could partially offset these deficits. Further research will help understand the long-term outcomes and inform interventions for healthy development.
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Affiliation(s)
- Kritika Poudel
- Hokkaido University Center for Environmental and Health Sciences, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan; Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Victoria, Australia
| | - Sumitaka Kobayashi
- Hokkaido University Center for Environmental and Health Sciences, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan; Division of Epidemiological Research for Chemical Disorders, Research Center for Chemical Information and Management, National Institute of Occupational Safety and Health, Japan, 6-21-1 Nagao, Tama-ku, Kawasaki 214-8585, Japan
| | - Hiroyoshi Iwata
- Hokkaido University Center for Environmental and Health Sciences, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Maki Tojo
- Hokkaido University Center for Environmental and Health Sciences, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Takeshi Yamaguchi
- Hokkaido University Center for Environmental and Health Sciences, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan; Department of Pediatrics, Hokkaido University Hospital, North-14, West-5, Kita-ku, Sapporo 060-0648, Japan
| | - Keiko Yamazaki
- Hokkaido University Center for Environmental and Health Sciences, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Naomi Tamura
- Hokkaido University Center for Environmental and Health Sciences, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Mariko Itoh
- Hokkaido University Center for Environmental and Health Sciences, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Taku Obara
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8573, Japan
| | - Shinichi Kuriyama
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8573, Japan
| | - Reiko Kishi
- Hokkaido University Center for Environmental and Health Sciences, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan.
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Ishitsuka K, Piedvache A, Kobayashi S, Iwama N, Nishimura T, Watanabe M, Metoki H, Iwata H, Miyashita C, Ishikuro M, Obara T, Sakurai K, Rahman MS, Tanaka K, Miyake Y, Horikawa R, Kishi R, Tsuchiya KJ, Mori C, Kuriyama S, Morisaki N. The Population-Attributable Fractions of Small-for-Gestational-Age Births: Results from the Japan Birth Cohort Consortium. Nutrients 2024; 16:186. [PMID: 38257079 PMCID: PMC10820645 DOI: 10.3390/nu16020186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
A fetal growth restriction is related to adverse child outcomes. We investigated risk ratios and population-attributable fractions (PAF) of small-for-gestational-age (SGA) infants in the Japanese population. Among 28,838 infants from five ongoing prospective birth cohort studies under the Japan Birth Cohort Consortium, two-stage individual-participant data meta-analyses were conducted to calculate risk ratios and PAFs for SGA in advanced maternal age, pre-pregnancy underweight, and smoking and alcohol consumption during pregnancy. Risk ratio was calculated using modified Poisson analyses with robust variance and PAF was calculated in each cohort, following common analyses protocols. Then, results from each cohort study were combined by meta-analyses using random-effects models to obtain the overall estimate for the Japanese population. In this meta-analysis, an increased risk (risk ratio, [95% confidence interval of SGA]) was significantly associated with pre-pregnancy underweight (1.72 [1.42-2.09]), gestational weight gain (1.95 [1.61-2.38]), and continued smoking during pregnancy (1.59 [1.01-2.50]). PAF of underweight, inadequate gestational weight gain, and continued smoking during pregnancy was 10.0% [4.6-15.1%], 31.4% [22.1-39.6%], and 3.2% [-4.8-10.5%], respectively. In conclusion, maternal weight status was a major contributor to SGA births in Japan. Improving maternal weight status should be prioritized to prevent fetal growth restriction.
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Affiliation(s)
- Kazue Ishitsuka
- Department of Social Medicine, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan; (A.P.); (N.M.)
| | - Aurélie Piedvache
- Department of Social Medicine, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan; (A.P.); (N.M.)
| | - Sumitaka Kobayashi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo 060-0808, Japan; (S.K.); (H.I.); (C.M.); (R.K.)
| | - Noriyuki Iwama
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8573, Japan; (N.I.); (M.I.); (T.O.); (S.K.)
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai 980-8574, Japan
| | - Tomoko Nishimura
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan; (T.N.); (K.J.T.); (M.S.R.)
| | - Masahiro Watanabe
- Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, Chiba 263-8522, Japan; (M.W.); (C.M.)
| | - Hirohito Metoki
- Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1, Fukumuro, Miyagino-ku, Sendai 983-8536, Japan;
| | - Hiroyoshi Iwata
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo 060-0808, Japan; (S.K.); (H.I.); (C.M.); (R.K.)
| | - Chihiro Miyashita
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo 060-0808, Japan; (S.K.); (H.I.); (C.M.); (R.K.)
| | - Mami Ishikuro
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8573, Japan; (N.I.); (M.I.); (T.O.); (S.K.)
| | - Taku Obara
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8573, Japan; (N.I.); (M.I.); (T.O.); (S.K.)
| | - Kenichi Sakurai
- Department of Nutrition and Metabolic Medicine, Center for Preventive Medical Sciences, Chiba University, Chiba 263-8522, Japan;
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba 263-8522, Japan
| | - Mohammad Shafiur Rahman
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan; (T.N.); (K.J.T.); (M.S.R.)
| | - Keiko Tanaka
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, 10-13 Dogo-Himata, Matsuyama 790-8577, Japan; (K.T.); (Y.M.)
| | - Yoshihiro Miyake
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, 10-13 Dogo-Himata, Matsuyama 790-8577, Japan; (K.T.); (Y.M.)
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan;
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo 060-0808, Japan; (S.K.); (H.I.); (C.M.); (R.K.)
| | - Kenji J. Tsuchiya
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan; (T.N.); (K.J.T.); (M.S.R.)
| | - Chisato Mori
- Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, Chiba 263-8522, Japan; (M.W.); (C.M.)
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba 263-8522, Japan
| | - Shinichi Kuriyama
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8573, Japan; (N.I.); (M.I.); (T.O.); (S.K.)
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan; (A.P.); (N.M.)
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Yang J, Qu Y, Zhan Y, Ma H, Li X, Man D, Wu H, Huang P, Ma L, Jiang Y. Trajectories of antepartum depressive symptoms and birthweight: a multicenter and prospective cohort study. Psychiatry Clin Neurosci 2023; 77:631-637. [PMID: 37632723 DOI: 10.1111/pcn.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Antepartum depression is a prevalent unhealthy mental health problem worldwide, particularly in low-income countries. It is a major contributor to adverse birth outcomes. Previous studies linking antepartum depression to birthweight have yielded conflicting results, which may be the reason that the depressive symptoms were only measured once during pregnancy. This study aimed to explore the associations between trajectories of antepartum depressive symptoms and birthweight. METHODS Depressive symptoms were assessed prospectively at each trimester in 3699 pregnant women from 24 hospitals across 15 provinces in China, using the Edinburgh Postpartum Depression Scale (EPDS). Higher scores of EPDS indicated higher levels of depressive symptoms. Associations between trajectories of depressive symptoms and birthweight were examined using group-based trajectory modeling (GBTM), propensity score-based inverse probability of treatment weighting (IPTW), and logistic regression. RESULTS GBTM identified five trajectories. Compared with the low-stable trajectory of depressive symptoms, only high-stable (OR = 1.35, 95% CI: 1.15-2.52) and moderate-rising (OR = 1.18, 95% CI: 1.12-1.85) had an increased risk of low birthweight (LBW) in the adjusted longitudinal analysis of IPTW. There was no significant increase in the risk of LBW in moderate-stable and high-falling trajectories. However, trajectories of depressive symptoms were not associated with the risk of macrosomia. CONCLUSION Antepartum depressive symptoms were not constant. Trajectories of depressive symptoms were associated with the risk of LBW. It is important to optimize and implement screening, tracking, and intervention protocols for antepartum depression, especially for high-risk pregnant women, to prevent LBW.
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Affiliation(s)
- Jichun Yang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yimin Qu
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongle Zhan
- School of Public Health, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Haihui Ma
- Department of Obstetrics, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing, China
| | - Xiaoxiu Li
- Department of Pediatric Gastroenterology, Dongguan Maternal and Child Health Care Hospital, Dongguan, China
| | - Dongmei Man
- Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Hongguo Wu
- Department of Perinatal Health, Jiaxian Maternal and Child Health Care Hospital, Jiaxian, China
| | - Ping Huang
- Department of Nutrition, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liangkun Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yoshimura M, Fujita M, Shibata A, Ohori R, Aoyama S, Yonezawa K, Sato Y, Sasaki S, Matsuzaki M, Suetsugu Y, Haruna M. Association of Eicosapentaenoic and Docosahexaenoic Acid Intake with Low Birth Weight in the Second Trimester: The Japan Pregnancy Eating and Activity Cohort Study. Nutrients 2023; 15:4831. [PMID: 38004224 PMCID: PMC10674964 DOI: 10.3390/nu15224831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/03/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
This study examined the association of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake during the second trimester with low birth weight (LBW) in pregnant Japanese women and was conducted in conjunction with the Japan Pregnancy Eating and Activity Cohort (J-PEACH) study. The study included 504 pregnant women from four Japanese sites. During the second trimester (14-27 weeks), the participants filled out a self-administered questionnaire assessing the frequency of DHA and EPA supplement intake in the past month, as well as a brief-type self-administered diet history questionnaire (BDHQ). The analysis involved data from two time points: responses to the BDHQ and infant data at birth. In total, 471 and 33 participants were classified into the normal birth weight and LBW groups, respectively. The participants were divided into high-, medium-, and low-intake groups based on their total dietary and EPA and DHA supplementary intakes. The Cochran-Armitage trend test was used to analyze the data; the prevalence of LBW was higher in the low-intake group (p = 0.04). There was no significant sex-based trend (p = 0.27 and p = 0.35). In Japanese women, low dietary and supplementary EPA and DHA intake until the second trimester were risk factors for LBW.
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Affiliation(s)
- Momoka Yoshimura
- Department of Clinical Nursing, Graduate School of Medical Science, Yamagata University, Yamagata 990-9585, Japan; (M.Y.); (A.S.)
| | - Megumi Fujita
- Department of Clinical Nursing, Graduate School of Medical Science, Yamagata University, Yamagata 990-9585, Japan; (M.Y.); (A.S.)
| | - Ai Shibata
- Department of Clinical Nursing, Graduate School of Medical Science, Yamagata University, Yamagata 990-9585, Japan; (M.Y.); (A.S.)
| | - Riko Ohori
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (R.O.); (S.A.); (K.Y.)
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Satoko Aoyama
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (R.O.); (S.A.); (K.Y.)
| | - Kaori Yonezawa
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (R.O.); (S.A.); (K.Y.)
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Yoko Sato
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (Y.S.); (Y.S.)
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Masayo Matsuzaki
- Department of Reproductive Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan;
- Department of Children and Women’s Health, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Yoshiko Suetsugu
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (Y.S.); (Y.S.)
| | - Megumi Haruna
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (R.O.); (S.A.); (K.Y.)
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
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7
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Suzuki S. Current Status of Maternal Gestational Weight Gain and Obstetric Outcomes in Japan. Cureus 2023; 15:e48988. [PMID: 38024027 PMCID: PMC10656633 DOI: 10.7759/cureus.48988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction In 2021, the Japanese Ministry of Health, Labour and Welfare (JMHLW) revised the standard optimal gestational weight gain (GWG) to reduce the incidence of low-birth-weight infants (LBWI) in Japan. In this study, we examined whether maternal GWG increased and LBWI decreased after the revision. Materials and methods We reviewed the obstetric records of singleton pregnant Japanese women who delivered at our institute at ≥37 weeks' gestation in 2020 (before revision) and 2022 (after revision). Results The maternal GWG was significantly increased after the revision of the JMHLW guideline; however, the expected decrease in the incidence of LBWI was not achieved. Conclusion The maternal GWG met the new criteria in the revised guidelines and did not appear to contribute to the reduced incidence of LBWI.
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Affiliation(s)
- Shunji Suzuki
- Obstetrics and Gynecology, Nippon Medical School, Tokyo, JPN
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Che X, Wang J, Sun W, He J, Wang Q, Zhu D, Zhu W, Zhang J, Dong J, Xu J, Zheng F, Zhou J, Zhao W, Lin Q, Ye L, Zhao X, Xu Z, Chen Y, Wang J, Wu W, Zhai L, Zhou Y, Zheng J, Zhang X. Effect of Mifepristone vs Placebo for Treatment of Adenomyosis With Pain Symptoms: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2317860. [PMID: 37307001 PMCID: PMC10261993 DOI: 10.1001/jamanetworkopen.2023.17860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/25/2023] [Indexed: 06/13/2023] Open
Abstract
Importance Adenomyosis is a common chronic gynecological disorder, and its treatment is an unmet need. New therapies need to be developed. Mifepristone is being tested for adenomyosis treatment. Objective To determine whether mifepristone is effective and safe for adenomyosis treatment. Design, Setting, and Participants This multicenter, placebo-controlled, double-blind randomized clinical trial was conducted in 10 hospitals in China. In total, 134 patients with adenomyosis pain symptoms were enrolled. Trial enrollment began in May 2018 and was completed in April 2019, and analyses were conducted from October 2019 to February 2020. Interventions Participants were randomized 1:1 to receive mifepristone 10 mg or placebo orally once a day for 12 weeks. Main Outcomes and Measures The primary end point was the change in adenomyosis-associated dysmenorrhea intensity, evaluated by the visual analog scale (VAS) after 12 weeks of treatment. Secondary end points included the change in menstrual blood loss, increased level of hemoglobin in patients with anemia, CA125 level, platelet count, and uterine volume after 12 weeks of treatment. Safety was assessed according to adverse events, vital signs, gynecological examinations, and laboratory evaluations. Results In total, 134 patients with adenomyosis and dysmenorrhea were randomly assigned, and 126 patients were included in the efficacy analysis, including 61 patients (mean [SD] age, 40.2 [4.6] years) randomized to receive mifepristone and 65 patients (mean [SD] age, 41.7 [5.0] years) randomized to received the placebo. The characteristics of the included patients at baseline were similar between groups. The mean (SD) change in VAS score was -6.63 (1.92) in the mifepristone group and -0.95 (1.75) in the placebo group (P < .001). The total remission rates for dysmenorrhea in the mifepristone group were significantly better than those in the placebo group (effective remission: 56 patients [91.8%] vs 15 patients [23.1%]; complete remission: 54 patients [88.5%] vs 4 patients [6.2%]). All the secondary end points showed significant improvements after mifepristone treatment for menstrual blood loss, hemoglobin (mean [SD] change from baseline: 2.13 [1.38] g/dL vs 0.48 [0.97] g/dL; P < .001), CA125 (mean [SD] change from baseline: -62.23 [76.99] U/mL vs 26.89 [118.70] U/mL; P < .001), platelet count (mean [SD] change from baseline: -28.87 [54.30]×103/µL vs 2.06 [41.78]×103/µL; P < .001), and uterine volume (mean [SD] change from baseline: -29.32 [39.34] cm3 vs 18.39 [66.46] cm3; P < .001). Safety analysis revealed no significant difference between groups, and no serious adverse events were reported. Conclusions and Relevance This randomized clinical trial showed that mifepristone could be a new option for treating patients with adenomyosis, based on its efficacy and acceptable tolerability. Trial Registration ClinicalTrials.gov Identifier: NCT03520439.
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Affiliation(s)
- Xuan Che
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China
| | - Jianzhang Wang
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wenting Sun
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiayi He
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiming Wang
- Ningbo Women and Children’s Hospital, Ningbo, China
| | - Danyang Zhu
- The First People’s Hospital of Taizhou City, Taizhou, China
| | - Weili Zhu
- Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China
| | - Jing Zhang
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Jie Dong
- Huzhou Maternity & Child Health Care Hospital, Huzhou, China
| | - Jingui Xu
- Quzhou People’s Hospital, Quzhou, China
| | - Feiyun Zheng
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianwei Zhou
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hanzhou, China
| | | | - Qiao Lin
- Taizhou Cancer Hospital, Taizhou, China
| | - Lingfang Ye
- Ningbo Women and Children’s Hospital, Ningbo, China
| | - Xiumin Zhao
- The First People’s Hospital of Taizhou City, Taizhou, China
| | - Zhengfen Xu
- Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China
| | - Yunyan Chen
- Huzhou Maternity & Child Health Care Hospital, Huzhou, China
| | - Jing Wang
- Quzhou People’s Hospital, Quzhou, China
| | - Wenlie Wu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lingyun Zhai
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hanzhou, China
| | | | | | - Xinmei Zhang
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Okubo H, Nakayama SF. Periconceptional maternal diet quality influences blood heavy metal concentrations and their effect on low birth weight: the Japan Environment and Children's Study. ENVIRONMENT INTERNATIONAL 2023; 173:107808. [PMID: 36827813 DOI: 10.1016/j.envint.2023.107808] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/09/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Both poor maternal nutrition and toxic heavy metal exposure influence foetal growth and development. However, whether consumption of a variety of healthy foods modifies the association between prenatal heavy metal exposure and foetal growth is unknown. OBJECTIVE We examined whether long-term maternal diet quality in periconception modifies the associations between maternal circulating concentrations of heavy metals and foetal growth. DESIGN Data of 72,317 Japanese women who delivered singleton infants was extracted from the Japan Environment and Children's Study. Maternal diet over a 1-year before the first trimester of pregnancy was assessed using a validated food frequency questionnaire, and overall diet quality was determined using the balanced diet score based on the Japanese Food Guide Spinning Top. Maternal whole-blood concentrations of mercury (Hg), lead (Pb) and cadmium (Cd) were measured during the second/third trimester of pregnancy. Bayesian inference of multiple linear regression analysis was performed to evaluate the relationships between maternal diet quality and the blood concentrations of heavy metals; Bayesian logistic regression was used to analyse the risk of low birth weight (LBW; <2,500 g). RESULTS After controlling for confounders, a high maternal balanced diet score was associated with low concentrations of blood Pb and Cd and high Hg. While all heavy metals assessed were positively associated with LBW risk, a higher maternal balanced diet score was negatively associated with LBW risk. A high-quality maternal diet attenuated the effect of Pb on LBW, an effect that was more marked at high blood Pb concentrations. CONCLUSION A high-quality, 'well-balanced' diet prior to conception may reduce exposure to some heavy metals and mitigate the elevated risk of LBW associated with prenatal Pb exposure in Japanese mother-child pairs.
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Affiliation(s)
- Hitomi Okubo
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Ibaraki, Japan; Research Fellow of Japan Society for the Promortion of Science, Tokyo, Japan.
| | - Shoji F Nakayama
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Ibaraki, Japan.
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