Hidemi Takimoto

Risk factors for small for gestational age

Background: The purpose of the paper was to determine the risk factors for small‐for‐gestational‐age (SGA) infants at full term, in Japan.

The Cubic Functions for Spline Smoothed L, S and M Values for BMI Reference Data of Japanese Children

We have presented BMI reference data for Japanese children using the LSM method (1), where L, S and M values were smoothed by one or two segments of polynomial functions with nonsmooth connection, which was the barrier for adequate evaluation of BMI for children. So, we smoothed L, S and M values by cubic spline with several knots that are presented in this report.

Maternal antenatal body mass index gains as predictors of large-for-gestational-age infants and cesarean deliveries in Japanese singleton pregnancies

Aim:  Greater antenatal weight or body mass index (BMI) gains may lead to larger fetuses and thus increase the risk for operative deliveries, such as cesarean deliveries. In order to examine the effect of weekly maternal weight and BMI changes on large‐for‐gestational‐age (LGA) infants and cesarean delivery, delivery records from overall healthy women were analyzed.

Management of obesity in pregnancy

Maternal pregravid obesity is associated with adverse outcomes in pregnancy. There are many complications by maternal obesity during pregnancy, such as spontaneous abortion, congenital malformations, gestational hypertention, preeclampsia, gestational diabetes mellitus, fetal macrosomia, and so on. Also, at parturition, the prevalence of cesarean section and associated complications such as deep vein thrombosis, wound disruption, and infection increase. Further- more, offspring of obese women increases the risk of adolescent components of the metabolic syndrome. To improve short- and long-term adverse outcome associated with obese pregnant women, we need to encourage obese women to lose body weight before pregnancy. During pregnancy, weight gain should be limited to Institute of Medicine guidelines.

Folate and Fetal Growth

Folate is a water-soluble B vitamin that is essential for various one-carbon transfer reactions including formate oxidation, amino acid metabolism, and biosynthesis of thymidylate and purines. The term “folate” represents all folate derivatives, including its synthesized form, pteroylglutamic acid (folic acid, FA). In humans, folate is known to be absorbed from the upper-small intestine. The bioavailability of FA is estimated to be 1.7 times higher than that of natural food folate. In recent years, folate has received enthusiastic attention because of its preventive effects on fetal neural tube defects if given periconceptionally. In addition, folate became one of the hottest nutrients of research interest in the last two decades, since elevated serum or plasma homocysteine has been implicated as a risk factor for occlusive vascular disease, and its metabolism is closely regulated by folate. Although we need to understand intricate metabolic changes of folate associated with human pregnancy, we do know that folate requirement increases during pregnancy to support fetal growth. To meet this increased demand, folate is actively transferred to the fetus across the placenta. The findings in many human studies are inconsistent in terms of the association of birthweight (considered to be the best assessment of fetal growth) to maternal dietary folate intake, biomarkers of folate status, and the effect of FA supplementation. We suggest that systematic and well-designed studies be performed to better understand folate metabolism during pregnancy and the critical period for adequate folate status to achieve optimal fetal growth.

Dietary Management of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is a common metabolic disorder during pregnancy. GDM can cause significant problems including some perinatal complications, neonatal complications, and metabolic disorders to offspring in later life. The primary management mode for women with GDM is nutritional therapy. Some women with GDM need diet therapy alone, and some women require both diet therapy and insulin. Thus far, there is no universal dietary management of GDM, because there have been no universal diagnostic criteria and genomic backgrounds differ according to ethnicity. However, some consensus guidelines exist. This review details these consensus guidelines for the optimal nutritional management for GDM.