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Obesity is a leading risk factor for impaired glucose tolerance and type 2 diabetes (T2D). Although the cause of the obesity epidemic is multi-factorial and not entirely clear, the recent acceleration in incidence is too rapid to be accounted for only by genetics, the wide availability of calorie-rich foods, and increasingly sedentary lifestyles. Accumulating data suggest that the important causes of the obesity epidemic may be related to developmental and early life environmental conditions. The concept of the developmental origins of health and disease (DOHaD) suggests that adverse influences early in development, particularly during intrauterine life, may result in permanent changes in the physiology and metabolism of the infant, which in turn result in an increased risk of non-communicable diseases in adulthood. For example, undernutrition during pregnancy and rapid postnatal weight gain are associated with obesity and T2D in the adult offspring. Moreover, increasing evidence suggests that early-life exposure to a wide range of chemicals has a significant impact on the causes of metabolic disorders. Although the underlying molecular mechanisms remain to be determined, these factors can affect epigenetic processes, such as DNA methylation, allowing the developmental environment to modulate gene transcription. The objective of this review article was to summarize recent progress in the biomedical implications of the DOHaD concept, focusing on the pathogenesis of obesity and T2D, and to discuss a future direction for preventive strategies from a public health perspective.

Intake of omega-3 polyunsaturated fatty acids (PUFAs) has favorable effects, including reducing violent and aggressive behaviors, but its association with infant maltreatment is unknown. We therefore tested the hypothesis that maternal intake of omega-3 PUFAs is associated with a lower risk of infant maltreatment. Participants were 92 191 mothers involved in the ongoing Japan Environment and Children's Study. Omega-3 PUFA intake during pregnancy was measured using a food frequency questionnaire. Infant maltreatment was assessed using a self-reported questionnaire administered at 1 and 6 months postpartum. Analysis using the lowest quintile of intake as a reference revealed that the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for cases of 'hitting' decreased as quintiles increased, with values for the second to fifth quintiles of 0.93 (95% CI 0.77-1.13), 0.79 (95% CI 0.64-0.97), 0.78 (95% CI 0.64-0.96), and 0.72 (95% CI 0.59-0.89), respectively. Adjusted ORs (95% CIs) for 'shaking very hard' at 6 months were 0.87 (0.73-1.04), 0.81 (0.67-0.97), 0.73 (0.61-0.89), and 0.78 (0.65-0.94), respectively. Adjusted ORs for 'leaving alone at home' for the second to fifth quintiles were 0.92 (0.87-0.98), 0.91 (0.86-0.97), 0.94 (0.88-0.99), and 0.85 (0.80-0.90), respectively. Higher maternal intake of omega-3 PUFAs during pregnancy was associated with fewer cases of hitting and violent shaking and leaving the child alone at home, implying a lower risk of infant maltreatment. Our results indicate the potential applicability of omega-3 PUFAs in reducing infant maltreatment.

Postpartum depression is a major mental health issue. It not only adversely affects the mother's quality of life, but also mother-infant bonding. However, the relationship between postpartum depression (at multiple points after childbirth) and mother-infant bonding failure one year after birth is not well understood. This study investigates the relationship between postpartum depression at 1-month and 6-month after birth and mother-infant bonding failure at 1 year after birth with a large cohort. Data from 83 109 mothers from the Japan Environment and Children's Study were analyzed. Mother-infant bonding 1-year after delivery was assessed using the Mother-to-Infant Bonding Scale Japanese version (MIBS-J). Postpartum depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) at 1-month and 6-month after delivery. Twenty covariates during pregnancy and one month after delivery were controlled for deriving the odds ratios (ORs) describing postpartum depression to mother-infant bonding. EPDS Total Score crude ORs and adjusted ORs against the MIBS-J Total Score at 1-month and 6-month after delivery were calculated. Crude ORs were 1.111 (95% CI 1.110-1.112) and 1.122 (95% CI 1.121-1.124) respectively. In the fully adjusted model, ORs were 1.088 (95% CI 1.086-1.089) and 1.085 (95% CI 1.083-1.087), respectively. This study demonstrated prospectively, in a large-scale cohort, that depression at multiple postpartum points, including associations with each EPDS and MIBS-J factors, may be a robust predictor of mother-infant bonding failure 1-year after birth.

Background: Many epidemiological studies have reported the association between various social factors and health status in mothers during and after pregnancy. However, little is known about their joint and longitudinal impact. We therefore examined the association of lack of social support and trust during pregnancy and at 2.5 years postpartum with health status in mothers.Methods: To adequately address time-varying exposure, marginal structural models were fitted to a pseudopopulation constructed by inverse probability weighting. The model included records of 90,071 mothers participating in the Japan Environment and Children’s Study. Social support and trust were measured using a 9-item questionnaire (Q1–9). Mental and physical health were measured using Mental and Physical Component Summary scores from the 8-item Short-Form Health Survey.Results: For the Mental Component Summary, the magnitude of the effect estimate was largest when participants lacked close friends/neighbors (Q4) at only 2.5 years postpartum (= –6.23), followed by a lack in emotional support (Q2) at the same time point (= –4.94). For the Physical Component Summary, effect estimates were negligible. The magnitude of the effect estimates of lack of social support and trust tended to be larger when there was a lack at only 2.5 years postpartum than at both time points.Conclusions: These findings suggest that, after childbirth, a loss in social support, particularly in a concrete or instrumental aspect, carries high risk, especially for mental health. Our results highlight the importance of supporting mothers for more than a few years after pregnancy.

Pregnant women require increased levels of n-3 polyunsaturated fatty acids (PUFAs) due to the demands of the growing fetus. Although some evidence indicates that maternal intake of fish and n-3 PUFAs is associated with reduced risk of postpartum depression, the results are inconsistent. We investigated whether dietary consumption of fish and/or n-3 PUFAs during pregnancy is associated with a reduced risk of maternal postpartum depression at 6 months after delivery and of serious mental illness at 1 year in a Japanese population. After exclusion and multiple imputation from a dataset comprising 103 062 pregnancies obtained in the Japan Environment and Children's Study, we evaluated 84 181 and 81 924 women at 6 months and 1 year after delivery, respectively. Multivariable logistic regression showed a reduced risk of postpartum depression at 6 months in the second to fifth quintiles v. the lowest quintile for fish and n-3 PUFA intake, with trend tests also revealing a significant linear association. At 1 year after delivery, fish intake was associated with a reduced risk of serious mental illness in the second to fifth quintiles v. the lowest quintile for fish and in the third to fifth quintiles v. the lowest quintile for n-3 PUFA intake, with trend tests also revealing a significant linear association. Women with higher fish and/or n-3 PUFA intake showed reduced risk of postpartum depression at 6 months after delivery and of serious mental illness at 1 year after delivery.

This research aimed to examine the efficacy of the early initiation of breastfeeding within 1 h of birth, early skin-to-skin contact, and rooming-in for the continuation of exclusive breastfeeding until 6 months postpartum. The research used data from the Japan Environment and Children’s Study (JECS), a nationwide government-funded birth cohort study. A total of 80,491 mothers in Japan between January 2011 and March 2014 who succeeded or failed to exclusively breastfeed to 6 months were surveyed in JECS. Multiple logistic regression model was used to analyse the data. The percentage of mothers who succeeded in exclusively breastfeeding to 6 months is 37.4%. Adjusted odds ratios were analysed for all 35 variables. Early initiation of breastfeeding (adjusted odds ratio [AOR]: 1.455 [1.401–1.512]), early skin-to-skin contact (AOR: 1.233 [1.165–1.304]), and rooming-in (AOR: 1.567 [1.454–1.690]) affected continuation of exclusive breastfeeding. Regional social capital (AOR: 1.133 [1.061–1.210]) was also discovered to support the continuation of breastfeeding. In contrast, the most influential inhibiting factors were starting childcare (AOR: 0.126 [0.113–0.141]), smoking during pregnancy (AOR: 0.557 [0.496–0.627]), and obese body type during early pregnancy (AOR: 0.667 [0.627–0.710]).

Background Lower socioeconomic status is often thought to be associated with an elevated risk of postpartum depression; however, this relationship exhibits noticeable heterogeneity between studies. The present study examined this relationship in Japan. Methods Data were obtained from 90,194 mothers in an ongoing birth cohort of the Japan Environment and Children’s Study. Socioeconomic status was assessed based on the mothers’ highest education level during pregnancy. Postpartum depression was identified at 1 and 6 months postpartum based on an Edinburgh Postnatal Depression Scale score of ≥9, and analyses were also performed based on the sub-scores for anxiety, depression, and anhedonia symptoms. Logistic and generalized linear regression model analyses were used to calculate odds ratios for postpartum depression according to education level with the highest education group (≥16 years of education) defined as the reference group, while controlling for covariates in a stepwise fashion. Results Univariate analysis revealed that a lower education level was associated with a higher prevalence of postpartum depression and related symptoms. Although these relationships weakened in the fully adjusted models, odds ratios for cases and related symptoms remained significant at 1 and 6 months postpartum. Among three symptom dimensions, the relationship was strongest and weakest in the depressive and anxiety symptoms, respectively. Conclusions A lower education level was an independent risk factor for postpartum depression. In view of the low mobility of the education level, this finding suggests the potential importance of collecting information regarding education levels at the earliest opportunity.

The aim of this study was to examine how physical activity (PA) before and during pregnancy influences pregnancy outcomes, particularly preterm delivery and mode of delivery. This study was based on the Japan Environment and Children's Study. A total of 92,796 pregnant women who gave birth to live singleton babies were included. Information on mean PA per week during pregnancy was extracted from the responses to questionnaires completed by women during the second and third trimesters of pregnancy. Information on PA before pregnancy was obtained from questionnaires answered based on recall at participation. The level of PA was stratified into the following quartiles for categorical analysis: Very low, Low, Medium, and High. Pregnancy outcomes, gestational age at delivery (whether preterm delivery or not), and mode of delivery (spontaneous, instrumental, or caesarean delivery) were compared between the different groups adjusted for multiple covariates. With respect to PA during pregnancy, the risk of preterm delivery and instrumental delivery increased significantly in the Very low group compared to that in the Medium group (odds ratios [OR] 1.16, 95% confidence interval [CI], 1.05-1.29; OR 1.12, 95% CI, 1.03-1.22, respectively). Moreover, the risks of caesarean delivery in the Low group and instrumental delivery in the High group were significantly higher than the risks in the Medium group (OR 1.07, 95% CI, 1.00-1.15; OR 1.12, 95% CI, 1.02-1.22, respectively). In contrast, with respect to PA before pregnancy, there were no statistically significant differences when the other groups were compared to the Medium group. Pre-pregnancy PA has no negative effects on preterm birth and caesarean delivery. In contrast, both may be affected by PA during pregnancy because a low level of PA appears to slightly increase the risk of preterm delivery and operative delivery (caesarean and instrumental).

Several studies have reported an apparent inverse association between cognitive social capital and depression in various groups, but insights into this association in perinatal mothers are fairly limited. Therefore, we explored the possible associations between expectant mothers' cognitive social capital (ie, neighborhood trust and reciprocity and generalized trust and reciprocity) and postpartum depression at 1 and 6 months after delivery. As part of an ongoing cohort study, the Japan Environment and Children's Study, cognitive social capital was evaluated using a questionnaire survey during mid-late pregnancy and postpartum depression was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale. This study analyzed data from 81,670 mothers. Logistic regression analysis was performed to calculate the odds ratios (ORs) for postpartum depression by the degree of neighborhood and generalized trust and reciprocity (high, relatively high, neutral, relatively low, and low) using the high category as a reference. Regardless of the measurement time point, prevalence gradually increased as the degree of neighborhood trust decreased (all < 0.001), suggesting a higher likelihood of postpartum depression with less neighborhood trust. A comparable tendency was also observed for the other three variables of cognitive social capital (all < 0.001). Moreover, the inverse association of postpartum depression with generalized trust and reciprocity was markedly stronger (ORs for low category ≥ 2.70) than that with neighborhood trust and reciprocity (ORs for low category ≤ 1.96). Our findings highlight a statistically significant inverse association between cognitive social capital during pregnancy and postpartum depression at both time points.

Background Prolonged sedentary behavior in pregnant women is reported to be associated with worse health-related indices and pregnancy outcomes. The aim of this study was to identify relevant factors that can be targeted in interventions to reduce sedentary behavior during pregnancy. Methods Of 103,057 pregnancies registered in the Japan Environment and Children’s Study, 83,733 pregnant women were included for analysis after excluding multiple enrollments, nonresponses, and missing outcome data. Data were collected using the International Physical Activity Questionnaire and analyzed using logistic regression models to calculate crude and adjusted odds ratios. Missing data were handled using multiple imputations, and statistical analyses were performed using SAS software. Results Mean sedentary behavior time increased from 5.4 h/day before pregnancy to 5.9 h/day during pregnancy. The percentage of women classified in the high sedentary behavior group increased from 25.6% before pregnancy to 31.2% during pregnancy. Factors associated with high sedentary behavior during pregnancy included longer hours spent watching television and playing video games before pregnancy, higher annual household income, and working status during pregnancy. Possible protective factors against high sedentary behavior included engaging in ≥ 150 min of moderate to vigorous physical activity per week before pregnancy. Conclusions This large-scale cohort study provides valuable insights into sedentary behavior patterns among pregnant women in Japan. To reduce the amount of time engaged in sedentary behavior during pregnancy, the planning and management of time spent watching TV and playing video games as well as establishing exercise habits before pregnancy are recommended.