Key Points. Lower maternal midterm eGFR was independently associated with increased risks of low birth weight and small for gestational age. Adding eGFR to conventional risk models improved prediction of adverse birth outcomes, highlighting its value as a prognostic marker. Midterm eGFR assessment may help identify at-risk pregnant women without overt disease, allowing closer monitoring and timely intervention. Background. Little is known regarding whether renal function during pregnancy among healthy women is associated with pregnancy outcomes. Evidence based on the universal screening of maternal eGFR is lacking. We investigated the association of maternal eGFR during the second trimester with fetal birth weight. Methods. This prospective birth cohort study includes 1666 singleton pregnant women (median age 36 years, median body mass index 20.0) who had universal screening of eGFR during the second trimester. Participants were categorized into the quartile of eGFR. The first quartile group was defined as low eGFR, the fourth quartile group as high eGFR, and the second and third quartile group as reference. The primary outcomes are low birth weight (LBW) and small for gestational age (SGA). Multivariable logistic regression models were used to investigate the association of maternal eGFR and pregnancy outcomes. Results. As compared with the reference group, the adjusted odds ratios (95% confidence intervals [CIs]) for LBW and SGA in the low eGFR group were 2.25 (1.48 to 3.40) and 2.51 (1.63 to 3.87), respectively, and in the high eGFR group were 0.69 (0.40 to 1.19) and 0.55 (0.30 to 1.02), respectively. The adjusted odds ratios of eGFR per SD decrease (95% CI) for LBW and SGA were 1.92 (1.50 to 2.45; P = 0.013) and 2.07 (1.60 to 2.68; P < 0.001). The prediction models were improved by adding eGFR to the models including covariates for LBW (C statistics difference, +0.018; 95% CI, −0.004 to 0.040, net reclassification improvement;, 0.377; 95% CI, 0.208 to 0.545, and integrated discrimination improvement, 0.0135; 95% CI, 0.005 to 0.022) and for SGA (C statistics difference, +0.041; 95% CI, 0.003 to 0.080; net reclassification improvement, 0.408; 95% CI, 0.226 to 0.591; and integrated discrimination improvement, 0.017; 95% CI, 0.009 to 0.025). Conclusions. The lower maternal midterm eGFR is associated with LBW and SGA, while the higher eGFR is not. Evaluating midterm eGFR may help identify healthy women at risk of adverse birth outcomes.

Aim: A questionnaire survey was conducted by the scientific committee of the Japan Society for the Study of Hypertension in Pregnancy (JSSHP) to identify any discrepancies or issues with actual clinical practice regarding the revised definitions and classifications of hypertensive disorders of pregnancy in Japan in 2018. Methods: We distributed anonymous questionnaires to 623 members of the JSSHP between August and September 2022, and responses were collected using Google Forms. Results: Valid responses were obtained from 193 physicians. 71.8% of physicians requested the addition of pulmonary edema to maternal organ damage. Most physicians answered that a low platelet count <100,000/mu l was appropriate as the diagnostic reference value and that the level of proteinuria was a necessary criterion for severity. Exclusion factors for fetal growth restriction (FGR) due to preeclampsia or superimposed preeclampsia varied among physicians. 74.3% of physicians responded that atypical hypertension needs to be added to the definitions. Conclusions: The inclusion of pulmonary edema in the list of maternal organ damage, the diagnostic reference value of a low platelet count, and the inclusion of proteinuria in the severe criteria need to be reconsidered. Future challenges include standardizing diagnostic methods for FGR due to preeclampsia and defining atypical preeclampsia.

AIM:This scoping review mapped quantitative evidence on men's preconception care (PCC) focusing on: (1) knowledge, (2) behaviours and attitudes, (3) reproductive intentions and (4) outcomes of educational or counselling interventions. The review also sought to identify evidence gaps and inform future policies and practices to enhance male engagement in reproductive health. METHODS:Quantitative studies involving men aged ≥18 years from high- and upper-middle-income countries were included. Studies focusing on couples, non-English-language publications, qualitative research, reviews and commentaries were excluded. Quantitative designs were prioritised to map measurable determinants and outcomes of engagement in PCC. Searches were conducted across seven databases in September 2025, following the PRISMA-ScR framework. No critical appraisal was performed, consistent with scoping review methodology. RESULTS:Fourteen studies (n=18 733 men) were included, most of which were observational. Findings indicated low fertility awareness, inconsistent engagement in preconception behaviours, and minimal use of supplements or healthcare services. Differences were noted by age, education and fatherhood status. One intervention improved knowledge but did not address systemic barriers. CONCLUSIONS:Men remain underrepresented in PCC. Gender-transformative, system-level reforms integrating men into primary care, health education and public messaging are needed. Future research should test context-specific, equity-oriented interventions to promote inclusive PCC for all.

Introduction In the USA, studies often show that immigrants exhibit relatively favourable perinatal outcomes compared with their US-born counterparts of the same race/ethnicity, despite socioeconomic and language barriers in healthcare. However, studies with individuals in their home country are limited.Methods and results We analysed 32 028 Japanese who gave singleton births from two data sources: the US vital statistics records (N=19 462) and the Birth and Three-Generation Cohort Study conducted by the Tohoku Medical Megabank Organization (N=12 566) between 2015 and 2017. The US data were divided into two groups based on nativity: the first generation and the second generation and later. Using Japanese women who delivered in Japan as the reference, associations between nativity and perinatal outcomes were evaluated using regression models, with analyses stratified by pre-pregnancy body mass index category. The ORs (95% CI) of preterm birth were higher among Japanese women in the USA (the first generation: 1.20 (1.15 to 1.33); the second generation and later: 1.40 (1.28 to 1.54)), as were the ORs of macrosomia (1.71 (1.48 to 1.98) and 1.98 (1.68 to 2.32), respectively). In contrast, the ORs of term or post-term low birth weight were lower among Japanese women in the USA (0.77 (0.71 to 0.84) and 0.81 (0.71 to 0.91), respectively). The association of nativity on the ORs of low birth weight differed depending on the term of birth.Conclusions Japanese immigrants to the USA have heterogenous risk of perinatal outcomes compared with Japanese who remain in Japan. Including home country data in immigration studies may provide a more detailed understanding of the impact of immigration on their perinatal outcomes.

Despite growing research efforts to prevent hypertensive disorders of pregnancy (HDP) and preeclampsia (PE), the global incidence of HDP continues to rise. This trend parallels the increasing prevalence of chronic hypertension (CH) and obesity among women of reproductive age. HDP is associated with significant maternal and perinatal morbidity, and can contribute to multiple cardiovascular diseases. Therefore, preventing HDP and PE may improve pregnancy outcomes and holds promise for long-term cardiovascular health. Recent studies highlight the use of individualized prevention strategies, including tailored low‑dose aspirin regimens based on maternal pathophysiology. Angiogenic biomarkers such as the soluble fms-like tyrosine kinase-1/ placental growth factor ratio are used clinically to stratify PE risk, enabling the timely identification of high-risk women for targeted intervention. Growing recognition of the preconception and postpartum period as a critical window underscores the need for systematic follow‑up of blood pressure, lifestyle factors, and cardiovascular risk. Emerging evidence supports a life-course approach that views HDP not as a transient pregnancy complication but as a critical sentinel event of future cardiovascular diseases, emphasizing cardiovascular health from preconception to postpartum.

KEY POINTS:Lower maternal midterm eGFR was independently associated with increased risks of low birth weight and small for gestational age. Adding eGFR to conventional risk models improved prediction of adverse birth outcomes, highlighting its value as a prognostic marker. Midterm eGFR assessment may help identify at-risk pregnant women without overt disease, allowing closer monitoring and timely intervention. BACKGROUND:Little is known regarding whether renal function during pregnancy among healthy women is associated with pregnancy outcomes. Evidence based on the universal screening of maternal eGFR is lacking. We investigated the association of maternal eGFR during the second trimester with fetal birth weight. METHODS:This prospective birth cohort study includes 1666 singleton pregnant women (median age 36 years, median body mass index 20.0) who had universal screening of eGFR during the second trimester. Participants were categorized into the quartile of eGFR. The first quartile group was defined as low eGFR, the fourth quartile group as high eGFR, and the second and third quartile group as reference. The primary outcomes are low birth weight (LBW) and small for gestational age (SGA). Multivariable logistic regression models were used to investigate the association of maternal eGFR and pregnancy outcomes. RESULTS:As compared with the reference group, the adjusted odds ratios (95% confidence intervals [CIs]) for LBW and SGA in the low eGFR group were 2.25 (1.48 to 3.40) and 2.51 (1.63 to 3.87), respectively, and in the high eGFR group were 0.69 (0.40 to 1.19) and 0.55 (0.30 to 1.02), respectively. The adjusted odds ratios of eGFR per SD decrease (95% CI) for LBW and SGA were 1.92 (1.50 to 2.45; P = 0.013) and 2.07 (1.60 to 2.68; P < 0.001). The prediction models were improved by adding eGFR to the models including covariates for LBW (C statistics difference, +0.018; 95% CI, -0.004 to 0.040, net reclassification improvement;, 0.377; 95% CI, 0.208 to 0.545, and integrated discrimination improvement, 0.0135; 95% CI, 0.005 to 0.022) and for SGA (C statistics difference, +0.041; 95% CI, 0.003 to 0.080; net reclassification improvement, 0.408; 95% CI, 0.226 to 0.591; and integrated discrimination improvement, 0.017; 95% CI, 0.009 to 0.025). CONCLUSIONS:The lower maternal midterm eGFR is associated with LBW and SGA, while the higher eGFR is not. Evaluating midterm eGFR may help identify healthy women at risk of adverse birth outcomes.

Hypertensive disorders of pregnancy (HDP) significantly affect maternal and fetal health worldwide. This meta-analysis evaluated the effects of blood pressure (BP)-lowering treatment and identified the optimal BP target for improving outcomes. A systematic review and meta-analysis of randomized controlled trials were performed using data from MEDLINE, Cochrane Library, and Ichushi databases. Outcomes included severe hypertension (systolic BP ≥160 mmHg and/or diastolic BP ≥110 mmHg), eclampsia, preeclampsia (PE), PE with severe features, HELLP syndrome, placental abruption, cesarean section, neonatal death, stillbirth, neonatal intensive care unit admission, low birth weight (<2500 g), preterm birth (<34 and <37 weeks), and small-for-gestational-age infants (<10th percentile). Data were pooled using a random-effects model, and meta-regression was conducted to explore interactions by HDP subtypes and achieved BP levels. BP-lowering treatment significantly reduced the risks of severe hypertension (risk ratio [RR] 0.477, 95% confidence interval [CI], 0.391-0.582), PE (RR 0.819, 95% CI, 0.704-0.954), and preterm birth at <37 weeks (RR 0.856, 95% CI, 0.770-0.951), compared with placebo or no treatment. Moderate heterogeneity was observed for several outcomes, and publication bias was noted for severe hypertension and low birth weight. Subgroup analyses found no significant interaction between treatment effect and HDP subtypes (except for placental abruption) or achieved BP levels. Among pregnant women with non-severe hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-109 mmHg), targeting <140/90 mmHg significantly reduced the risks of severe hypertension, PE, and preterm birth at <37 weeks, suggesting this target as optimal for improving maternal and fetal outcomes.

Pregnant women with Graves' disease (GD) who have undergone thyroidectomy or radioactive iodine therapy can have high levels of thyroid-stimulating hormone (TSH) receptor antibodies, which are transferred to the fetus via the placenta, posing a risk for fetal GD. This retrospective observational study, conducted at two high-level perinatal medical centers in Tokyo and Osaka, Japan, aimed to identify predictors of fetal GD in pregnant women with GD who had undergone thyroidectomy or radioactive iodine therapy. In total, 65 women were included, and 79 singleton pregnancies and fetuses were analyzed. Fetal GD occurred in 17.7% of the 79 fetuses. Women in the fetal GD group had higher levels of TSH receptor antibodies and a higher prevalence of ophthalmopathies than did women in the non-fetal GD group. The receiver operating characteristic curve cutoff values of maternal TSH-binding inhibitory immunoglobulin (hereafter referred to as TRAb [TSH receptor antibody from a narrow perspective]) and thyroid-stimulating antibody (TSAb) levels predictive of fetal GD development were as follows: TRAb, 12.8 and 10.2 IU/L at 10 and 20 gestational weeks (GW), respectively; TSAb, 975.4% and 1,259.0% at 10 and 20 GW, respectively. Ophthalmopathy was a predictor of fetal GD; nonetheless, combining the ophthalmopathy and TRAb cutoff values did not improve predictive accuracy. A cutoff value of TRAb ≥10.2 IU/L at 20 GW (highest diagnostic accuracy found) could be a predictor of fetal GD risk for pregnant women with GD who undergo thyroidectomy or radioactive iodine therapy; thus, appropriate fetal monitoring should begin at around 20 GW.

Hypertensive disorders of pregnancy can cause hypertension in the future. Understanding how the blood pressure values of women with and without hypertensive disorders of pregnancy differ will facilitate follow-up blood pressure monitoring in clinical settings. This study investigated the association between hypertensive disorders of pregnancy and subsequent high blood pressure and hypertension. This study used Japanese data from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Follow-up systolic and diastolic blood pressures in normotensive women during pregnancy and those with hypertensive disorders of pregnancy were estimated using analysis of covariance adjusted for women with low birthweight, history of gestational diabetes mellitus, age, body mass index, pulse rate, smoking and drinking at the follow-up assessment, paternal hypertension history, and maternal hypertension or hypertensive disorders of pregnancy history. Finally, we performed a multiple logistic regression analysis. In total, 7343 women were included in the analysis. Women with a history of hypertensive disorders of pregnancy had higher blood pressure approximately three years postpartum compared with normotensive women. Hypertensive disorders of pregnancy in the most recent pregnancy in different subgroups, such as nulliparous women, multiparous women without a history of hypertensive disorders of pregnancy, and multiparous women with a history of hypertensive disorders of pregnancy, were associated with an increased risk of subsequent hypertension. Women’s birthweight was also weakly associated with hypertension. Even one experience of hypertensive disorders of pregnancy may contribute to elevated blood pressure and hypertension approximately three years postpartum. In addition, women’s birthweights may have a weak relationship with increasing blood pressure.

ObjectiveTo quantify the association between a combination of modifiable prepregnancy lifestyle factors and the risk of adverse pregnancy outcomes (APOs).DesignProspective cohort study.SettingThe Japan Environment and Children's Study.PopulationA total of 79 703 pregnant Japanese women without chronic disease.MethodsMaternal lifestyle before pregnancy was assessed using a self-administered questionnaire. A healthy lifestyle score (HLS, 0-5 points) was calculated based on adherence to five prepregnancy healthy lifestyle factors: healthy weight, high-quality diet, regular physical activity, not smoking, and not drinking alcohol. Relative risks (RRs) and 95% credible intervals (CrIs) were estimated using a Bayesian log-binomial regression model.Main Outcome MeasuresComposite APOs, defined as the development of any APO, including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, low birth weight, and small-for-gestational-age, transcribed from medical records.ResultsA total of 13 894 women (17.4%) experienced one or more APOs. HLS was inversely associated with the risk of APOs in a dose-response manner. Women with an HLS of 5 points had a 33% (RR 0.67; 95% CrI, 0.61-0.74) lower risk of APOs than those with the lowest HLS (0-1 points). The population attributable fraction of five healthy lifestyle factors was 10.3%. A 1-point increase of HLS could have reduced APO cases by 6.6%.ConclusionsA higher HLS was associated with a lower risk of APOs, suggesting that adopting a healthy lifestyle before pregnancy may reduce the risk of APOs, which can increase the risk of future chronic diseases in both mother and child.

Importance: It is anticipated that many women do not get enough sleep after delivery. However, it is unclear how poor sleep affects postpartum blood pressure. Objective: To investigate the relationship between postpartum blood pressure and sleep habits, we examined women who developed hypertensive disorders of pregnancy by using automated blood pressure monitors and accelerometers. Setting: The blood pressure, pulse rate, and sleep were monitored at home. Total sleep time, sleep efficiency, sleep fragmentation coefficient, and wake after sleep onset were measured. Participants completed a behavior chart including breastfeeding frequency. The 24-hour, awake time and sleep time mean blood pressures were calculated for each participant as well as the change in blood pressure between postpartum days 7 and 14. Participants: We recruited 11 women who delivered singletons and developed hypertensive disorders of pregnancy at the National Center for Child Health and Development from April to September 2021. Intervention or Exposure: None Main Outcomes: The relationship between the change in blood pressure and sleep measurements and frequency of breastfeeding were analyzed. Results: Seven participants were included in the final analysis. The mean total sleep time was 5.3 hours, and the mean breastfeeding frequency was 6.1 times per day. Mean systolic and diastolic blood pressure and pulse rate during sleep periods tended to be lower than those during awake periods (-8.5±4.5 mmHg, -8.8±2.7 mmHg, -8.7±2.7 bpm, respectively). Lower sleep time was significantly correlated with smaller 24h-systolic and diastolic blood pressure drop (correlation coefficient r=-0.823, p=0.023 and r=-0.812, p=0.026, respectively. No association was found between other sleep measurements and the change in 24h-blood pressure. The blood pressure and pulse rate values in six of the seven participants during the early sleep phase (≤30 min) were similar to those in later sleep phases (>30 min), showing that beneficial effects of sleep on blood pressure were apparent throughout the sleep phases. Conclusions and Relevance: Our results suggest that longer total sleep time, even if sleep is fragmented, is associated with a greater decrease in postpartum blood pressure among women who developed hypertensive disorders of pregnancy.

Background Little is known about the relationship of healthy diets, which are widely recommended to prevent diseases in general populations, with the risk of hypertensive disorders of pregnancy (HDP), particular among non‐Western populations with different dietary habits. We aimed to investigate the association between periconceptional diet quality and the risk of HDP among pregnant Japanese women. Methods and Results Dietary intake over 1 year before the first trimester of pregnancy was assessed using a validated, self‐administered food frequency questionnaire among 81 113 pregnant Japanese women who participated in a prospective cohort of the Japan Environment and Children's Study. Overall diet quality was assessed by the Balanced Diet Score (BDS) based on adherence to the country‐specific dietary guidelines and the Dietary Approaches to Stop Hypertension (DASH) score. Cases of HDP were identified by medical record transcription. The association between diet quality and HDP risk was examined using Bayesian logistic regression models with monotonic effects. We identified 2383 (2.9%) cases of HDP. A higher BDS was associated with a lower risk of HDP. When comparing the highest with the lowest quintile of the BDS, the adjusted odds ratio (aOR) of HDP was 0.83 (95% credible interval [CrI], 0.73–0.94). The DASH score and HDP risk were inversely associated in a monotonic dose–response manner (aOR per 1‐quintile increase in the DASH score, 0.92 [95% CrI, 0.89–0.95]). Conclusions A high‐quality diet, which is recommended for disease prevention in general populations, before conception may also reduce the risk of HDP among pregnant Japanese women.

Hypertensive disorders of pregnancy (HDP) is a common but potentially life-threatening complication that affects 5-10% of all pregnancies. Due to the diverse pathologies and multiorgan dysfunction associated with HDP, multidisciplinary treatment is crucial. Moreover, HDP increases the risk of developing chronic diseases later in life and may impact offspring health. In response to these challenges, the Japan Society for the Study of Hypertension in Pregnancy (JSSHP) established the HDP health care provider certification in 2023. The aim is to increase awareness of HDP among medical professionals, expand the number of health care providers with expertise on this condition, and promote women's health through specialized care during pregnancy, postpartum, and preconception phases. The certification is open to various health care professionals involved in maternity care and requires attending a training session consisting of ten lectures. The first training session, held in September 2023, attracted over 200 participants, with 186 new HDP health care providers certified in January 2024. The majority of certified providers were midwives (49.5%) and medical doctors (36.6%), predominantly obstetricians. The ultimate objective of the HDP health care provider system is to establish a comprehensive support system for women with HDP and their families, utilizing accurate medical knowledge and evidence-based information.