The Dietary Reference Intakes for Japanese (2025): Overview and Future Directions for the Pregnant and Lactating...

Guided by the Developmental Origins of Health and Disease framework, maternal nutrition influences perinatal outcomes and lifelong offspring health. This commentary summarizes the pregnant and lactating women's section of Dietary Reference Intakes for Japanese (2025), contextualizes them within current Japanese evidence, and identifies priorities for future research and revisions.

We conducted a narrative synthesis of the Dietary Reference Intakes and recent Japanese studies on maternal diet, fetal growth, anemia, folate, vitamin D, calcium, gestational weight gain, lactation, and preconception health, with attention to guideline-practice gaps.

The Dietary Reference Intakes provide trimester-based additional energy and nutrient targets. However, Japanese cohort data show suboptimal intakes of energy, macro- and micronutrients, with persistently low folate awareness and intake. Anemia (Hb < 11 g/dL) is associated with adverse outcomes, and low vitamin D/calcium status impacts maternal bone health. While medical nutrition therapy is standard for gestational diabetes, nutrient targets have not been set yet. Guidance for hypertensive disorder of pregnancy recommends sodium restriction but lacks comprehensive nutrient specifications. Evidence gaps include body mass index-specific energy needs for appropriate gestational weight gain, robust diet-fetal growth relationships, and actionable guidance for lactation and the preconception period.

The Dietary Reference Intakes for Japanese (2025) provide a necessary framework, yet significant implementation and evidence gaps remain. Research defining body mass index-stratified energy needs, nutrient-outcome dose responses, and preconception/lactation guidance, paired with education and surveillance, is critical for improving intergenerational health.