Navigating the nutritional landscape during pregnancy can be complex, especially with varying guidelines and cultural dietary patterns. This article delves into the Japanese pregnancy diet guidelines, exploring their nuances, scientific basis, and practical implications. We'll examine the recommendations for weight gain, essential nutrients, and dietary patterns, while also addressing the unique challenges and considerations for Japanese women.
Introduction
Optimal maternal nutrition is paramount for healthy fetal development and positive pregnancy outcomes. In Japan, where societal factors like the increasing prevalence of underweight women and unique dietary habits influence maternal health, understanding specific dietary guidelines is crucial. This article synthesizes current research and recommendations to provide a comprehensive overview of Japanese pregnancy diet guidelines.
Weight Gain Recommendations
Historical Context and Recent Revisions
Historically, pregnant women in Japan were often advised to limit weight gain to minimize risks like gestational diabetes and pregnancy-induced hypertension. However, recognizing the rising rates of low birth weight (LBW) infants and the importance of adequate maternal nutrition, the guidelines have evolved.
Current Guidelines
The Dietary Guidelines for Pre-pregnant, Pregnant and Lactating Women in Japan, revised in 2021, emphasize the importance of addressing dietary habits even before pregnancy. The Gestational Weight Gain Guidelines published by the Japan Society of Obstetrics and Gynecology in 2021, offer specific weight gain ranges based on pre-pregnancy BMI:
- Underweight (BMI < 18.5): 12-15 kg
- Normal weight (BMI 18.5 to 24.9): 10-13 kg
It's important to note that these figures serve as a guide for healthcare professionals advising pregnant women, encouraging them to monitor their weight and seek medical advice if needed.
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Research on Optimal Weight Gain
A cross-sectional study evaluating deliveries at a Tokyo hospital between 2010 and 2013, found that the Institute of Medicine (IOM) and Japanese guidelines similarly discriminated the risks of light-for-date (LFD) or heavy-for-date (HFD) infants in underweight, normal-weight, and overweight mothers. The study also determined the optimal GWG during pregnancy in normal-weight women.
In normal-weight women, the GWG range found in this study (9.7-10.4 kg) was close to the current JMHLW recommendation (7-12 kg) compared to the GWG proposed by the IOM guideline (i.e., 11.5-17 kg).
Underweight Women in Japan
Underweight is reportedly becoming increasingly common among young women in Japan. A phenomenon specific to Japan and not seen in other developed countries, it is a problem because of its close relationship to the risk of having a low birthweight infant. Expectant mothers who are underweight are more prone to preterm delivery and delivering low birthweight infants.
Implications of weight gain
Gaining too much weight during pregnancy increases the risk of pregnancy-induced hypertension, gestational diabetes, and macrosomia, there was a time when pregnant women were advised to keep any weight gain to no more than 10 kg. Accordingly, many women might well have been instructed to avoid gaining much weight rather than to put it on. Reports on the incidence of gestational diabetes differ, varying from 4% to almost 10%.
Essential Nutrients
Folate
Folate is crucial in the early stages of pregnancy for cell division and preventing neural tube defects. However, folate consumption among young Japanese women is often lower than recommended, even for those who are not pregnant.
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Calcium
Fetal development and breastfeeding lead to significant calcium loss in the mother's body. Adequate calcium intake is essential to support both maternal and fetal bone health.
Other Important Nutrients
Pregnant women often have inadequate intakes of essential nutrients like vitamins A, D, B1, B2, B6, C, magnesium, iron, and zinc, according to national surveys. These nutrients play vital roles in various physiological processes during pregnancy.
Dietary Patterns and Food Choices
Traditional Japanese Diet
The traditional Japanese diet, influenced by the country's island geography and cultural practices, is characterized by a high intake of fish, seafood, vegetables, and rice. However, modern eating habits are becoming increasingly westernized.
Dietary Patterns and Health-Related Quality of Life (HRQOL)
Research suggests that dietary patterns during pregnancy can impact mental health. Studies have shown associations between specific dietary patterns and HRQOL in pregnant women.
A high intake of the Japanese DP was significantly associated with poor mental HRQOL and physical HRQOL. As Japanese food has generally been considered healthier overall than Western food, the results of our study are surprising.
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Reduced Rank Regression (RRR) and Partial Least Squares (PLS)
Reduced rank regression (RRR) and partial least squares (PLS) have been proposed as alternatives to PCA. RRR is a method for extracting dietary patterns that best explain variation in response variables (e.g., asymptomatic or clinical endpoints and disease-related nutrients). The dietary patterns extracted by RRR are more relevant to disease risk than PCA. However, they do not consider the variation in food intake as those of PCA, thus they do not necessarily reflect people’s actual dietary patterns. Therefore, RRR and PCA complement each other, and useful insights can be gained by comparing the results. PLS is a compromise method between RRR and PCA, which is a method for extracting dietary patterns that best explain the variation in food intake and response variables.
The Role of Cereals and Fruits
Dietary patterns extracted by RRR and PLS were similar and characterized by a high intake of cereals and fruits and a low intake of alcoholic and non-alcoholic beverages in both pre- to early pregnancy and from early to mid-pregnancy. Higher adoption of the RRR and PLS patterns in both periods was associated with an increased birth weight SD score and lower risk of SGA.
Foods to Moderate
The Japanese diet is high in vitamin B12, which is found in fish, shellfish, poultry liver, marine algae, and soybeans. Furthermore, carbohydrates are the main food group of the Japanese diet.
Dietary Guidelines for Pre-pregnant, Pregnant and Lactating Women in Japan.
The Dietary Guidelines for Pre-pregnant, Pregnant and Lactating Women in Japan set out 10 points regarding diet.
Factors Influencing Dietary Intake
Socioeconomic Factors
Annual household income and educational qualification can influence dietary choices and nutritional status during pregnancy.
Lifestyle Factors
Smoking and alcohol consumption during pregnancy can negatively impact fetal development and increase the risk of adverse outcomes.
The Influence of Family and Media
From this, we can surmise that the influences of family and media are behind the underweight of young women today. Underweight may not be a health problem if an individual’s physical activity level and intake of energy and nutrients are adequate, but those who are underweight due to low energy and nutrient intakes may need intervention
Addressing Nutritional Deficiencies
Dietary Supplements
While obtaining nutrients from a balanced diet is ideal, dietary supplements, particularly folate, can be a valuable option, especially given the lower bioavailability of food folate. Consulting with a physician before taking any supplements is crucial.
Meal Kits and Delivery Services
Using meal kits or delivery services can reduce the burden of meal preparation, making it easier for pregnant women to maintain a healthy diet.
The Importance of Health Guidance
In our research, we provided health guidance regarding weight gain to 406 healthy pregnant women and, where those women’s weight gain was above or below the benchmark at around 28 weeks of pregnancy, we had a dietitian provide them with nutritional guidance, to verify the effectiveness of dietary guidance interventions.
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