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Aims This study investigated the association between maternal age and early and late gestational diabetes mellitus (GDM). Methods In total, 72,270 pregnant women were included in this prospective birth cohort study. Associations between maternal age and early GDM (diagnosed at <24 gestational weeks) and late GDM (diagnosed at ≥24 gestational weeks) were evaluated using a multinomial logistic regression model with possible confounding factors. The reference category was maternal age of 30–34.9 years. Results Higher maternal age was associated with higher odds of early and late GDM (P‐value for trend <0.0001 and <0.0001, respectively). The adjusted odds ratios (aORs) for early GDM with maternal age of 35–39.9 years and ≥40 were 1.399 (95% confidence interval [CI]: 1.134–1.725) and 2.494 (95% CI: 1.828–3.402), respectively. The aORs for late GDM with maternal age of 35–39 years and ≥40 were 1.603 (95% CI: 1.384–1.857) and 2.276 (95% CI: 1.798–2.881), respectively. Conclusions Higher maternal age was associated with an increased risk of GDM regardless of when GDM was diagnosed. The association between maternal age and early GDM was similar to that between maternal age and late GDM. Higher maternal age was associated with an increased risk of GDM regardless of when GDM was diagnosed. The association between maternal age and early GDM was similar to that between maternal age and late GDM.

Sodium‐glucose co‐transporter 2 (SGLT2) inhibitors have demonstrated blood pressure (BP)‐lowering effects; however, most studies included patients taking antihypertensive medications. Using real‐world Japanese data, we assessed factors associated with SGLT2 inhibitor‐mediated BP reduction in patients not taking antihypertensive therapy. After excluding those taking antihypertensive medications, we retrospectively analyzed 6,988 patients newly prescribed SGLT2 inhibitors (2014‒2023). BP was evaluated using health check‐up data before and after SGLT2 inhibitor prescription. The mean patient age was 61.6 years, and 66.8% were male. Systolic/diastolic BP were reduced by 2.3±7.6/2.3±8.4%, respectively, following SGLT2 inhibitor initiation. Multiple regression analysis identified baseline systolic BP as the strongest predictor (R 2 = 8.83%), while BMI change was substantially associated with SBP reduction (R 2 = 2.76%). Compared with a propensity score‐matched cohort of DPP‐4 inhibitor new users, greater BP reduction was observed in the SGLT2 inhibitor group, with differences of 2.3%/2.1% for systolic/diastolic BP. An ≈2% BP reduction may occur following SGLT2 inhibitor initiation.

Aims This study aimed to investigate the association of maternal birth weight (MBW) with early and late gestational diabetes mellitus (GDM). Methods A total of 69318 pregnant Japanese women were included in this birth cohort study. The associations between maternal birth weight and early gestational diabetes mellitus (diagnosed at <24 gestational weeks) and late GDM (diagnosed at ≥24 gestational weeks) were investigated using a multinomial logistic regression model, with an maternal birth weight of 3000–3499 g as the reference category. Results Lower maternal birth weight was associated with higher odds of developing early and late gestational diabetes mellitus (P < 0.0001 and P < 0.0001, respectively). The adjusted odds ratios (aORs) for early gestational diabetes mellitus in participants with a MBW of <2500 g and 2500–2999 g were 1.345 (95% confidence interval [CI]: 0.912–1.984) and 1.338 (95% CI: 1.098–1.629), respectively. The aORs for late gestational diabetes mellitus in participants with a MBW of <2500 g and 2500–2999 g were, 1.657 (95% CI: 1.298–2.115) and 1.218 (95% CI: 1.058–1.402), respectively. Conclusions Regardless of the gestational age when gestational diabetes mellitus was diagnosed, a lower maternal birth weight was associated with an increased risk of gestational diabetes mellitus. Furthermore, the association of a MBW <2500 g with late gestational diabetes mellitus tended to be stronger than that with early gestational diabetes mellitus. This is the first study to investigate the association between maternal birth weight (MBW) and gestational diabetes mellitus (GDM) according to gestational age when gestational diabetes mellitus was diagnosed. Lower maternal birth weight was associated with an increased risk of developing both early and late gestational diabetes mellitus.

In this study, we aimed to reveal the trends of self‐measured blood pressure (SMBP) and SMBP‐derived indices during pregnancy and the postpartum period. The Babies and Their Parents Longitudinal Observation in Suzuki Memorial Hospital in the Intrauterine Period (BOSHI) Study is a prospective cohort study in Japan. Participants were instructed to measure SMBP daily during pregnancy and for 1 month after delivery. Among 237 participants with normotensive blood pressure (BP) during pregnancy and the postpartum period who were analyzed using mixed‐effects models for repeated measures, the SMBP was measured, on average, 14.3 times from the day before delivery to 28 days postpartum. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the day before delivery were 110.6 ± 1.0 and 68.1 ± 0.8 mmHg (estimate ± standard error). Postpartum BP increased from postpartum Days 3–8 in SBP and from Days 3–22 in DBP, compared to that on the day before delivery. The SBP and DBP were 4.9 and 4.7 mmHg higher on postpartum Days 8 and 7 than the day before pregnancy, respectively. During pregnancy, the pulse rate (PR) showed an inverted U‐shaped trend and then sharply increased rapidly until the first postpartum day after delivery. The Shock Index showed a similar trend to that of the PR, decreased from labor until postpartum Day 8, and plateaued thereafter. The double product peaked during labor, remained higher than the prelabor levels for approximately 10 days, and then decreased in the postpartum period.

Background/Objectives: Perinatal mental disorders are important health issues that affect both mothers and their children. The Mediterranean diet (MD) is one of the most well-recognized healthy dietary patterns worldwide. Recent evidence suggests that MD may prevent or reduce the risk of perinatal mental disorders. This study investigated the association between MD adherence during pregnancy and psychological distress in a large cohort of Japanese births. Methods: Data were obtained from 80,271 pregnant women who participated in the Japan Environment and Children’s Study. Adherence to the MD was assessed using three scoring methods: the Mediterranean Diet Score (MDS), relative Mediterranean Diet (rMED), and Mediterranean Diet Score for Pregnancy (PMDS). Psychological distress was defined as a score of ≥13 on the Kessler 6-item Psychological Distress Scale (K6). Modified Poisson regression models were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs). Population attributable fractions (PAFs) were calculated to quantify the proportion of psychological distress attributable to low MD adherence. Results: The adjusted RR for psychological distress in the low PMDS group was 1.17 (95% CI: 1.07, 1.28) compared with the high PMDS group. The adjusted PAF for low PMDS was 10.43% (95% CI: 4.81, 16.06). No statistically significant associations were detected between psychological distress and the MDS or rMED scores. Conclusions: This study suggests that high adherence to MD based on the PMDS during pregnancy may reduce the risk of psychological distress in Japanese women. Therefore, promoting MD during pregnancy could be a potential strategy for preventing perinatal mental disorders.

ObjectivesThis study aimed to investigate the association and population-attributable fraction (PAF) of maternal smoking and secondhand smoke (SHS) exposure during pregnancy with placental abruption.DesignProspective cohort study.Setting15 regional centres in Japan.ParticipantsPregnant women registered between January 2011 and March 2014 from the Japan Environment and Children’s Study.Outcome measuresData were transcribed from medical records and two self-administered questionnaires. The outcome measure was the incidence of placental abruption. Maternal smoking exposure during pregnancy was categorised based on the number of cigarettes smoked (≤10 or ≥11 cigarettes per day). SHS exposure during pregnancy was evaluated by frequency and duration (almost never or never, 1–3 days/week and/or <1 hour/day and 4–7 days/week and ≥1 hour/day). A modified Poisson regression model, adjusted for known placental abruption risk factors, calculated the risk ratio (RR) and PAF for placental abruption with a 95% Cl.ResultsOf the 81 974 eligible pregnant women, pregnant women smoking ≥11 cigarettes/day during pregnancy had a significantly higher risk of placental abruption. The adjusted RR (aRR) was 2.21 (95% CI 1.21 to 4.06), and the adjusted PAF (aPAF) was 1.90% (95% CI 0.09 to 3.71%). Pregnant women among never-smokers with SHS exposure of 4–7 days/week and ≥1 hour/day had a significantly higher risk (aRR: 2.34, 95% CI 1.29 to 4.28), and the aPAF was 1.89% (95% CI −0.05 to 3.83). Additionally, pregnant women among those who smoked during pregnancy with similar SHS exposure had a significantly higher risk (aRR: 2.21, 95% CI 1.30 to 3.76), with the aPAF of 2.29% (95% CI 0.11 to 4.48).ConclusionsMaternal smoking and SHS exposure during pregnancy significantly contribute to the risk of placental abruption in Japan. Therefore, preventive interventions and measures to reduce exposure are required to prevent placental abruption.

Congenital malformations are functional and structural alterations in embryonic or foetal development resulting from a variety of factors including maternal health status. This study aimed to investigate the association between maternal birth weight (MBW) and the prevalence of congenital malformations in offspring using data from a nationwide birth cohort study in Japan including 103,060 pregnancies. A binary logistic regression model with adjustment for various covariates revealed that an MBW of <2500 g (low MBW) was associated with an increased risk of congenital heart disease (adjusted odds ratio: 1.388, [95% confidence interval: 1.075–1.792]), angioma (1.491 [1.079–2.059]), and inguinal hernia (1.746, [1.189–2.565]), while those with an MBW of ≥4000 g (high MBW) were associated with congenital anomalies of the urinary tract (2.194, [1.261–3.819]) and arrhythmia (1.775, [1.157–2.725]) compared with those with an MBW of 3000–3499 g. Low MBW was associated with cleft lip and/or palate (1.473, [1.052–2.064]), congenital heart disease (1.615, [1.119–2.332]), genital organs (1.648, [1.130–2.405]), hypospadias (1.804, [1.130–2.881]), and inguinal hernia (1.484, [1.189–1.851]) in male infants and CAKUT (1.619, [1.154–2.273]) in female infants, whereas high MBW was associated with congenital heart disease (1.745, [1.058–2.877]) and CAKUT (2.470, [1.350–4.517]) in male infants. The present study is the first to demonstrate a link between MBW and congenital malformations in Japanese children. While these results must be interpreted with caution, MBW should be considered a major predictor of congenital malformation risk.

This study aimed to evaluate the association between parental and infant birth weights in Japan. In total, 37,504 pregnant Japanese women and their partners were included in this birth cohort study. A multinomial logistic regression model was used to evaluate the associations of parental birth weights with small-for-gestational-age (SGA) or large-for-gestational-age (LGA) infants. Associations between parental birth weight and low birth weight (LBW) infants or macrosomia were also examined, and linear associations between parental birth weight and SGA or LGA were found. The adjusted odds ratios (aORs) for SGA infants per 500 g decrease in maternal and paternal birth weights were 1.50 (95% confidence interval [CI],1.43–1.58) and 1.31 (95% CI, 1.25–1.38), respectively. The aORs for LGA infants per 500 g increase in maternal and paternal birth weights were 1.53 (95% CI, 1.47–1.60) and 1.41 (95% CI, 1.35–1.47), respectively. The association between parental birth weight and LBW infants or macrosomia was also linear. The aORs for LBW infants per 500 g decrease in maternal and paternal birth weights were 1.47 (95% CI, 1.40–1.55) and 1.25 (95% CI, 1.19–1.31), respectively. The aORs for macrosomia per 500 g increase in maternal and paternal birth weights were 1.59 (95% CI, 1.41–1.79) and 1.40 (95% CI, 1.23–1.60), respectively. Parental birth weight was found to be associated with infant birth weight even after adjusting for various parental factors. Furthermore, maternal birth weight was more strongly associated with infant birth weight than with paternal birth weight.