Increasing trend of spina bifida and decreasing birth weight in relation to declining body-mass index of young women in Japan

Predictors of folate status among pregnant Japanese women: the Hokkaido Study on Environment and Children’s Health, 2002–2012

The International Clearinghouse for Birth Defects, Surveillance and Research reports a rise in the prevalence rate of spina bifida in Japan. We determined first-trimester folate status of Hokkaido women and identified potential predictors. Participants were 15 266 pregnant women of the Hokkaido Study on Environment and Children’s Health Cohort. Data were extracted from self-reported questionnaires and biochemical assay results. Demographic determinants of low folate status were younger maternal age (adjusted OR (AOR) 1·48; 95 % CI 1·32, 1·66), lower educational level (AOR 1·27; 95 % CI 1·17, 1·39) and lower annual income (AOR 1·11; 95 % CI 1·01, 1·22). Plasma cotinine concentrations of 1·19–65·21 nmol/l increased the risk of low folate status (AOR 1·20; 95 % CI 1·10, 1·31) and concentrations >65·21 nmol/l further increased the risk (AOR 1·91; 95 % CI 1·70, 2·14). The most favourable predictor was use of folic acid (FA) supplements (AOR 0·19; 95 % CI 0·17, 0·22). Certain socio-demographic factors influence folate status among pregnant Japanese women. Modifiable negative and positive predictors were active and passive tobacco smoking and use of FA supplements. Avoiding both active and passive tobacco smoking and using FA supplements could improve the folate status of Japanese women.

Low birth weight as cardiometabolic risk in Japanese high school girls

OBJECTIVE

To examine the relationships between birth weight and metabolic syndrome (MS) risk factors in healthy Japanese high school girls.

METHODS

After obtaining informed consent, we carried out health surveys for the Food Educational Program (FEP) in 2007 and 2008 in 243 healthy Japanese high school girls aged 16.4 ± 1.4 years and examined anthropometric measurements, including abdominal circumference, systolic and diastolic blood pressures (SBP and DBP, respectively), triglycerides (TG), high-density lipoprotein cholesterol (HDL), insulin, and blood glucose to calculate insulin resistance after fasting for 3 hours after lunch. Birth weight was checked by maternity record book, and food customs were recorded using a questionnaire. We analyzed the prevalence of MS risk factors by Bonferroni test following 1-way analysis of variance and their relationships with birth weight by correlation analyses.

RESULTS

According to criteria for MS risk factors in Japanese children and adults, the prevalence of obesity, high blood pressure, dyslipidemia, and high blood glucose was 7.4%, 9.1%, 7.0%, and 16.0%, respectively, and MS was detected in only 1 girl who had obesity and 2 more risks (high SBP and TG). Among 180 subjects who reported their birth weights, birth weights were significantly inversely related with SBP (p = 0.007), DBP (p = 0.033), TG (p = 0.009), insulin level (p = 0.047), insulin resistance ( p= 0.050), and number of metabolic risk factors (p = 0.022). Thirteen girls (7.2%) whose birth weights were lower than 2500 g had significantly higher SBP (p = 0.037), DBP (p = 0.032), TG (p = 0.011), insulin level (p=0.037), and insulin resistance (p = 0.043), than 31 girls (17.2%) with birth weights equal to or more than 3400 g.

CONCLUSION

The association of low birth weight could be detected to be significant with such risks of MS as SBP, DBP, TG, insulin level, and insulin resistance even in healthy Japanese high school girls, indicating the importance of follow-up and FEP for children with low birth weight for the prevention of MS in the later life.

Relationship between dietary folate intakes, maternal plasma total homocysteine and B-vitamins during pregnancy and fetal growth in Japan

BACKGROUND

Adequate folate status in pregnancy is important for satisfactory pregnancy outcome.

AIM OF THE STUDY

The objective of the present study was to evaluate folate status in healthy pregnant women by assessing dietary folate intakes and measuring changes in folate-related biomarkers including plasma tHcy, serum vitamin B(12) (B(12)), and serum and RBC folate concentrations in each trimester and to examine their relation to fetal growth.

METHODS

From 94 pregnant women, 3-day-dietary records were obtained and blood was collected for plasma total homocysteine (tHcy), serum B(12), and serum and red-blood cell (RBC) folate measurements. Infant anthropometric measurements were made immediately after birth.

RESULTS

Average folate intake was less than 300 microg/day with a mean energy intake of about 1800 kcal. Mean serum and RBC folate concentrations declined significantly during gestation (p < 0.05). Mean serum B(12) also significantly decreased (p < 0.01), whereas plasma tHcy increased from 5.1 in the first trimester to 5.9 micromol/l in the third trimester (p < 0.01). Multiple regression analyses, after controlling for maternal age, parity and pre-pregnancy body-mass index indicated that a 1.0 micromol/l increase in plasma tHcy in the third trimester corresponded to a 151 g decrease in birth weight (p < 0.01). Neither B(12) nor folate concentrations in all three trimesters showed any significant associations with birthweight. Plasma pyridoxal-5'-phosphate concentrations were markedly low, and were consistent with low intake of vitamin B(6) in our population.

CONCLUSION

Our data suggest that higher plasma tHcy in the third trimester is a predictor of lower birth weight. In general, the dietary intake of B-vitamins and energy may be inadequate in our population, suggesting intervention is necessary.

A report of two linked studies of knowledge and attitudes to prenatal screening and testing in adults of reproductive age in Japan and the UK

BACKGROUND

prenatal screening for fetal abnormality is being offered routinely in many countries. The need for informed consent demands that the nature of screening is understood by prospective parents, but the opportunities for providing information early in pregnancy before decision-making may be limited.

OBJECTIVE

to assess the knowledge about, and attitudes to, prenatal screening in adults of reproductive age in two countries.

DESIGN

two groups of adults were surveyed using a specifically designed tool to assess knowledge about fetal abnormalities and potential screening tests, attitudes to screening and termination of pregnancy, and information required by parents before making decisions.

SETTING AND PARTICIPANTS

90 participants were surveyed in Japan, 72% of whom were pregnant or had a partner who was pregnant; 93 participants were surveyed in the UK, none of whom were pregnant. All respondents were aged between 18 and 45 years.

MEASUREMENTS

demographic data were collected and analysed. Frequencies were calculated for each questionnaire response. A series of t-tests and chi(2) tests were used to assess differences between the two groups. Free-text data were analysed using content analysis.

FINDINGS

overall knowledge of prenatal tests and the conditions for which screening is offered was low in both groups. Significant differences exist between the perception of the conditions for which screening or testing can be offered and the types of conditions that can actually be detected prenatally. Most respondents in both countries would consider termination of pregnancy for fetal abnormality. The information most frequently cited by respondents as important when deciding about testing were the chances of damage to the health of fetus, mother, or both.

KEY CONCLUSIONS

women and men of reproductive age in the groups studied are not well-prepared to make decisions about screening or testing in pregnancy.

IMPLICATIONS FOR PRACTICE

improvements in preconceptual education on prenatal screening and testing may be required to ensure prospective parents can make informed decisions in early pregnancy.