Why is it important that Japanese women are not gaining weight during pregnancy?


Despite being a normal weight, the nutritionist and lecturer at Osaka City University had been advised by the hospital, where she received health care to gain only 10 kilograms until delivery, slightly less than the official government directive from 7 to 12 pounds pounds), she said.

Tipping down the scales proved to be stressful for this expectant mother who was not able to attend education classes during pregnancy and was therefore advised to "take nutritional counseling twice when my weight increased above the recommended weight gain per week."

For the sessions, she created a record of her diet and this was examined by nurses "to find dietary behaviors that may be related to weight gain," she said. In your case, no specific recommendations were given because your diet and behaviors were healthy.

Other pregnant women are likely to face the same, although these sessions are not required by law, she said. Pregnant women register their pregnancies at a local government office, where they receive a Maternal and Child Health handbook, which was drafted 70 years ago. The handbook, which addresses maternal and child health as one, is a record of prenatal, childbirth, child development, and immunization examinations, and serves the same purpose, more or less, as a portable electronic medical record. Using the manual, obstetricians closely monitor the woman's prenatal weight gain.

"In my opinion, doctors, nurses and midwives (especially doctors) are strict about weight gain," Hayami-Chisuwa wrote in an e-mail. "The reason is mainly to prevent pregnancy-induced hypertension syndrome." High blood pressure during pregnancy can lead to complications during labor.

However, maintaining a low birth weight during pregnancy can harm the baby's future health and affect the overall health of the country, a researcher believes.

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"Numerous studies have shown that lower gestational weight gain causes lower birth weight," wrote Dr. Naho Morisaki, head of the Division of Epidemiology of Life Examination at the Department of Social Medicine at the National Center for Child Health and Development in Japan.

Pregnant women who do not gain enough weight can deliver babies that are very small, leading to difficulties in breastfeeding, increased risk of disease, and problems in meeting development goals, according to the Centers for Disease Control and Prevention.

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What is the recommended weight gain?

The Ministry of Health, Labor and Welfare of Japan recommends a gain of 9 to 12 kilos for women with low weight (body mass index of 18.5 or less) and 7 to 12 kilograms for normal weight women (BMI 18, 6 to less than 25). Overweight women (BMI 25-30) need to add 7 kg or less (about 15 pounds), while obese women (BMI greater than 30) should gain only 5 kg or less (about 11 pounds).

The US guidelines of the Institute of Medicine recommend that women with low weight gain between 12 and 18 pounds; normal weight women gain between 11.5 and 16 kilograms; overweight women gain 7 to 11.5 pounds; and obese women gain 5 to 9 kilograms.

The different guidelines have a tangible impact. Japanese women give birth to 300 grams (about 0.7 pounds) smaller than white mothers, Morisaki said. This is a direct result of low gestational weight gains.

Data from 2010 indicate that nearly 20% of Japanese women are gaining less weight than the guidelines suggest, Morisaki noted.

"The Japanese have extremely low gestational weight gain among women with lean and normal BMIs, which explains why birth weight is low even compared to other East Asians who tend to be generally leaner than the Japanese," he said.

Hayami-Chisuwa noted that the ministry's official guideline may be dismissed by some doctors who recommend even stricter weight-gain guidelines – as it did in her case.

Applying US standards to Japan, 68 percent of women are not earning enough, Morisaki said, "If the Japanese guidelines are not correct, we may have a big problem."

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The ministry has formed a task force to investigate whether the guidelines for gestational weight gain, released in 2001, are scientifically sound.

A team member, Kyoko Nomura, a professor in the Department of Public Health at Akita University School of Medicine, wrote in an e-mail that her team's research compared the impact of the U.S. Institute of Medicine and Japanese guidelines.

The 2017 study looked at the rates of low and high-weight cesareans and babies among women who remained within the Japanese guidelines and compared them to women who remained within US guidelines.

The results suggest that Japanese guidelines are "fairly fair and do not have to change," since the differences were insignificant, she said.

But that does not mean that both guidelines are equally beneficial to everyone, she noted: "The IOM guidelines are useful for Western countries where overweight and obese women are more prevalent, but Asian women are smaller and their weight gain is different from that of women of other ethnicities. "

"Japan is currently facing a serious problem of an increasing number of low birth weight babies," said Nomura. Before 1990, Japan's prevalence of low birth weight babies was below the 6.5 percent average found in member countries of the Organization for Economic Cooperation and Development, she said. However, over time, the number of babies with low birth weight increased, and Japan reached a prevalence rate of 9.5% in the 2018 survey.
"One of the biggest reasons" for this rising rate is the fact that a quarter of Japanese women of childbearing age are underweight, Nomura said. As a result, she emphasizes "the importance of staying in normal weight ranges for all women who are of reproductive age."

Low birth weight rate may affect life expectancy

Studies indicate that lower baby weight weights increase the risk of chronic diseases later in life. Morisaki's research shows how a mother's gestational weight gain is associated with both the baby's birth weight and height in adulthood.
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"Adult height, which is linked to the increased risk of chronic diseases in large studies inside and outside Japan, may be an indicator for lifelong health," he explained.

The rate of babies with low birth weight and adult height shows a strong inverse correlation, he said. Due to a trend in smaller infants, adult height in Japan began to decline among those born after 1980. By creating a predictive model, he estimated that the national average adult height would drop about 0.7 centimeters (about a quarter of a inch) from the current average of 170.7 centimeters (about 5 feet 6 inches) for men born in 2014.

Based on these figures, he also speculated that there will be a further 3% cardiovascular-related deaths (about 6,000 deaths) among Japanese men born in 2014 compared to those born in 1980.

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"This can also affect Japanese life expectancy," Morisaki said. Japan, where citizens can expect an average of 84.2 years, is proud of its position in the world ranking number 1 of that question.

Fearing for a future in which life expectancy decreases, Morisaki conducted a questionnaire study among pregnant women to better understand why some are reluctant to gain weight.

"Japanese women tend to self-restrict even lower weight gain than current recommendations as they think this will facilitate delivery and help them maintain a better body proportion after delivery," he said.

However, these self-imposed restrictions do nothing for women, he said: Thinner pregnancy did not decrease the risk of a cesarean section and did not change the number of extra pounds still retained a year after birth.

Hayami-Chisuwa believes that more flexibility is needed in the issue of weight gain in pregnancy, since some women who are underweight may not receive "enough nutrition for a fetus."

"Health professionals need to pay attention not only to weight gain, but also to [cases in which women] are underweight before pregnancy. "


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