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Knowledge translation to reduce risk of low birthweight infants in low BMI Japanese pregnant women using a comic book: a randomized controlled trial


Low birthweight (LBW, birthweight less than 2500 g) is a critical indicator of maternal nutritional status and health as well as a risk factor for adverse infant health outcomes. The prevalence of LBW in Japan is increasing. Therefore, we developed a comic book to illustrate nutritional recommendations for low body mass index (BMI) pregnant women with the aim to improve pregnancy outcomes. The effectiveness of the comic book will be evaluated in a randomized controlled trial.

Professors involved

Katharina da Silva Lopes lopes@slcn.ac.jp


Prof. Erika Ota, Global Health Nursing, Graduate School of Nursing Science, St. Luke’s International University
Dr. Yo Takemoto, Department of Obstetrics and Gynecology, School of Medicine, Juntendo University
Daichi Suzuki, Faculty of Nursing, Department of Nursing, Josai International University

Project details

Unique among developed countries, Japan still has a high rate of LBW of 9.5% and the prevalence of LBW doubled over the last three decades. The prevalence of term LBW infants increased faster from 1980 to 2010 than the prevalence of preterm LBW infants in Japan. Term LBW has been found to be associated with poor nutritional status and underweight of the mother and could be prevented with adequate food and nutrition intake.

Being born with LBW increases the risk of infant death and childhood morbidities including neuro-developmental disorders, developmental delay, cognitive anomalies and chronic pulmonary diseases. Following the Developmental Origins of Health and Disease (DOHaD) paradigm, there is also evidence that LBW increases the risk for non-communicable diseases later in life such as metabolic syndrome, diabetes mellitus type 2, cardiovascular diseases, hypertension, and cancer.

While evidence on effective interventions to reduce the risk of LBW is available, the transfer and application of these research results to the target population seems difficult. We developed a comic book (manga) as educational tool to illustrate recommendations to improve women’s nutrition status and consequently pregnancy outcomes.

In a randomized controlled trial we will test the manga in high-risk low BMI (below 18.5 kg/m2) pregnant Japanese women at first trimester and evaluate their dietary behavior and birth outcomes.

Grant funding

 Grant-in-Aid for Early-Career Scientists FY2018-2020



da Silva Lopes K, Ota E, Shakya P, Dagvadorj A, Balogun OO, Peña-Rosas JP, De-Regil LM, Mori R. Effects of nutrition interventions during pregnancy on low birth weight: an overview of systematic reviews. BMJ Glob Health 2017;0:e000389.7.