101
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Katsuki S, Ushida T, Kidokoro H, Nakamura N, Iitani Y, Fuma K, Imai K, Nakano-Kobayashi T, Sato Y, Hayakawa M, Natsume J, Kajiyama H, Kotani T. Hypertensive disorders of pregnancy and alterations in brain metabolites in preterm infants: A multi-voxel proton MR spectroscopy study. Early Hum Dev 2021; 163:105479. [PMID: 34624700 DOI: 10.1016/j.earlhumdev.2021.105479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Infants born to mothers with hypertensive disorders of pregnancy (HDP) have adverse neurodevelopmental consequences in later life. Magnetic resonance spectroscopy (MRS) is used to predict subsequent neurodevelopment in the field of perinatology. AIM We aimed to determine whether exposure to HDP in utero leads to alterations in brain metabolites in preterm infants using multi-voxel proton MRS at term-equivalent age. STUDY DESIGN Retrospective cohort study. SUBJECTS A total of 103 preterm infants born before 34 weeks of gestation at Nagoya University Hospital between 2010 and 2018 were eligible. Twenty-seven infants were born to mothers with HDP (HDP group), and 76 were born to mothers without HDP (non-HDP group). OUTCOME MEASURES The peak area ratios of N-acetylaspartate (NAA)/choline (Cho), NAA/creatine (Cr), and Cho/Cr were evaluated at 10 designated regions of interest (bilateral frontal lobes, basal ganglia, thalami, temporal lobes, and occipital lobes). RESULTS The peak area ratios of NAA/Cho and NAA/Cr in the bilateral thalami were significantly higher in the HDP group than in the non-HDP group after adjustment for covariates (postmenstrual age at MRS assessment and infant sex). No significant differences were observed in other regions. Preeclampsia, abnormal umbilical artery blood flow, and fetal growth restrictions were significantly associated with increased NAA/Cho and NAA/Cr ratios in the thalami. CONCLUSIONS Based on the evidence that NAA/Cho and NAA/Cr ratios constantly increase with postmenstrual age in normal brain development, exposure to maternal HDP in utero may accelerate brain maturation and increase neuronal activity in preterm infants.
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Affiliation(s)
- Satoru Katsuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriyuki Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukako Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuya Fuma
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakano-Kobayashi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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102
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Tamagawa M, Kasuga Y, Saisho Y, Tanaka Y, Hasegawa K, Oishi M, Endo T, Sato Y, Ikenoue S, Tanaka M, Ochiai D. Predictors of later insulin therapy for gestational diabetes diagnosed in early pregnancy. Endocr J 2021; 68:1321-1328. [PMID: 34108310 DOI: 10.1507/endocrj.ej21-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Interventions for gestational diabetes mellitus (GDM), diagnosed in early pregnancy, have been a topic of controversy. This study aimed to elucidate factors that predict patients with GDM diagnosed before 24 gestational weeks (early GDM: E-GDM) who require insulin therapy later during pregnancy. Furthermore, we identified patients whose impaired glucose tolerance should be strictly controlled from early gestation onward. Women diagnosed with GDM were categorized based on the gestational age at diagnosis into E-GDM (n = 388) or late GDM (L-GDM, diagnosed after 24 weeks, n = 340) groups. Clinical features were compared between the groups, and the predictors for insulin therapy was evaluated in the E-GDM group. There were no significant between-group differences in terms of perinatal outcomes (e.g., gestational weeks at delivery, fetal growth, hypertensive disorder of pregnancy), with the exception of the Apgar score at 5 min. Moreover, there was no significant difference in the frequency of insulin therapy during pregnancy between the two groups. Using multiple logistic regression analysis, pre-pregnancy body mass index (BMI) ≥25 kg/m2, a family history of diabetes, and higher fasting plasma glucose (FPG), 1 h-plasma glucose (PG), and 2 h-PG values increased insulin therapy risk during pregnancy in the E-GDM group. Furthermore, since E-GDM patients with abnormal levels of FPG, as well as 1 h-PG or 2 h-PG, and those with pre-pregnancy BMI ≥25 kg/m2 and a family history of diabetes had a higher risk of later insulin therapy during pregnancy, they may require more careful follow-up in the perinatal period.
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Affiliation(s)
- Masumi Tamagawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Yoshifumi Saisho
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Yuya Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Keita Hasegawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Maki Oishi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Toyohide Endo
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Yu Sato
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Daigo Ochiai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan
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103
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Fudono A, Imai C, Takimoto H, Tarui I, Aoyama T, Yago S, Okamitsu M, Muramatsu M, Sato N, Miyasaka N. Trimester-specific associations between extracellular vesicle microRNAs and fetal growth. J Matern Fetal Neonatal Med 2021; 35:8728-8734. [PMID: 34779347 DOI: 10.1080/14767058.2021.2000598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Placenta-derived extracellular vesicles and their cargoes, especially microRNAs (EV-miRNAs), may contribute to fetal and placental development. During pregnancy, the levels of several maternal blood EV-miRNAs, including miRNAs of placental origin, vary among individuals and change throughout gestation. However, the effects of these miRNAs on fetal growth and trimester-specificity have not been fully elucidated. The purpose of this study is to test the hypothesis that the serum levels of two extracellular vesicles (EV)-miRNAs (miR-127-3p and miR-26b-5p), which may be involved in fetoplacental regulation, would be significantly associated with fetal growth in a trimester-specific manner. MATERIALS AND METHODS This is a single-center birth cohort of maternal serum samples obtained at both the second and third trimesters. To minimize the influence of confounding factors, the analysis was limited to singleton vaginal deliveries, resulting in 27 participants being included in this study. EV RNAs were isolated using a membrane affinity method, and the relative expression levels of miR-127-3p and miR-26b-5p were measured using the RT-qPCR method with miR-484 as control. The associations between the two EV-miRNAs and fetal and placental growth were evaluated using a linear regression model and compared between the two trimesters. RESULTS EV-miR-127-3p levels tended to correlate inversely with the z-scores of birth weight for gestational age (BWGA) and placental weight for gestational age (PWGA) in the second trimester, but not in the third trimester. EV-miR-26b-5p levels were positively associated with birth weight in the second trimester, but this association was weakened in the third trimester. CONCLUSION Our results suggest a trimester-specific association of circulating miRNA levels with fetal and placental growth. The precise roles of EV-miR-127-3p and EV-miR-26b-5p in fetal and placental development warrant further investigation.
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Affiliation(s)
- Ayako Fudono
- Comprehensive Reproductive Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chihiro Imai
- Department of Molecular Epidemiology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hidemi Takimoto
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Iori Tarui
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Tomoko Aoyama
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Satoshi Yago
- Child and Family Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoko Okamitsu
- Child and Family Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaaki Muramatsu
- Department of Molecular Epidemiology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriko Sato
- Department of Molecular Epidemiology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoyuki Miyasaka
- Comprehensive Reproductive Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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104
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Sato N, Fudono A, Imai C, Takimoto H, Tarui I, Aoyama T, Yago S, Okamitsu M, Mizutani S, Miyasaka N. Placenta mediates the effect of maternal hypertension polygenic score on offspring birth weight: a study of birth cohort with fetal growth velocity data. BMC Med 2021; 19:260. [PMID: 34732167 PMCID: PMC8567693 DOI: 10.1186/s12916-021-02131-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low birth weight (LBW) and fetal growth restriction are associated with the development of cardio-metabolic diseases later in life. A recent Mendelian randomization study concluded that the susceptibility of LBW infants to develop hypertension during adulthood is due to the inheritance of hypertension genes from the mother and not to an unfavorable intrauterine environment. Therein, a negative linear association has been assumed between genetically estimated maternal blood pressure (BP) and birth weight, while the observed relationship between maternal BP and birth weight is substantially different from that assumption. As many hypertension genes are likely involved in vasculature development and function, we hypothesized that BP-increasing genetic variants could affect birth weight by reducing the growth of the placenta, a highly vascular organ, without overtly elevating the maternal BP. METHODS Using a birth cohort in the Japanese population possessing time-series fetal growth velocity data as a target and a GWAS summary statistics of BioBank Japan as a base data, we performed polygenic score (PGS) analyses for systolic BP (SBP), diastolic BP, mean arterial pressure, and pulse pressure. A causal mediation analysis was performed to assess the meditation effect of placental weight on birth weight reduced by maternal BP-increasing PGS. Maternal genetic risk score constituted of only "vasculature-related" BP single nucleotide polymorphisms (SNPs) was constructed to examine the involvement of vascular genes in the mediation effect of placental weight. We identified gestational week in which maternal SBP-increasing PGS significantly decreased fetal growth velocity. RESULTS We observed that maternal SBP-increasing PGS was negatively associated with offspring birth weight. A causal mediation analysis revealed that a large proportion of the total maternal PGS effect on birth weight was mediated by placental weight. The placental mediation effect was remarkable when genetic risk score was constituted of "vasculature-related" BP SNPs. The inverse association between maternal SBP PGS and fetal growth velocity only became apparent in late gestation. CONCLUSIONS Our study suggests that maternal hypertension genes are strongly associated with placental growth and that fetal growth inhibition is induced through the intrauterine environment established by the placenta.
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Affiliation(s)
- Noriko Sato
- Department of Molecular Epidemiology, Medical Research Institute, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. .,Institute of Advanced Biomedical Engineering and Science, The Public Health Research Foundation, Tokyo, Japan.
| | - Ayako Fudono
- Comprehensive Reproductive Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Chihiro Imai
- Department of Molecular Epidemiology, Medical Research Institute, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hidemi Takimoto
- Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan
| | - Iori Tarui
- Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan
| | - Tomoko Aoyama
- Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan
| | - Satoshi Yago
- Child and Family Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Motoko Okamitsu
- Child and Family Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shuki Mizutani
- Institute of Advanced Biomedical Engineering and Science, The Public Health Research Foundation, Tokyo, Japan
| | - Naoyuki Miyasaka
- Comprehensive Reproductive Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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105
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Kyozuka H, Yasuda S, Murata T, Fukuda T, Yamaguchi A, Kanno A, Sato A, Ogata Y, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Adverse obstetric outcomes in early-diagnosed gestational diabetes mellitus: The Japan Environment and Children's Study. J Diabetes Investig 2021; 12:2071-2079. [PMID: 33960705 PMCID: PMC8565414 DOI: 10.1111/jdi.13569] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022] Open
Abstract
AIMS/INTRODUCTION To examine adverse outcomes in women with early-diagnosed gestational diabetes mellitus using data from a large birth cohort study in Japan. MATERIALS AND METHODS This study analyzed data from singleton pregnancies in the Japan Environment and Children's Study including births during 2011-2014. Mothers with an HbA1c level ≥6.5% in the first trimester, a history of diabetes mellitus, or steroid use during pregnancy were excluded. The participants were divided into three groups: control (without gestational diabetes mellitus), early-diagnosed gestational diabetes mellitus (diagnosed before gestational week 24), and late-diagnosed gestational diabetes mellitus (diagnosed after gestational week 24). Multiple logistic regression analysis was performed to calculate the risk of early-diagnosed and late-diagnosed gestational diabetes mellitus for adverse obstetrics outcomes. RESULTS In total, 100,376 eligible participants were included in this study. The number of individuals in control cases, early-diagnosed gestational diabetes mellitus cases, and late-diagnosed gestational diabetes mellitus cases was 98,090 (97.7%), 751 (0.7%), and 1,535 (1.5%), respectively. When control cases were used as reference, multiple logistic regression analysis revealed that early-diagnosed gestational diabetes mellitus increased the risk of hypertensive disorders of pregnancy (adjusted odds ratio: 2.08, 95% confidence interval: 1.51-2.86), early-onset hypertensive disorders of pregnancy (adjusted odds ratio: 1.91, 95% confidence interval: 1.01-3.65), and late-onset hypertensive disorders of pregnancy (adjusted odds ratio: 1.92, 95% confidence interval: 1.29-2.86). CONCLUSION Early-diagnosed gestational diabetes mellitus is associated with serious obstetric complications. Our findings indicate the necessity of further investigations to validate the benefit of early screening for gestational diabetes mellitus in pregnant women.
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Affiliation(s)
- Hyo Kyozuka
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Shun Yasuda
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Tsuyoshi Murata
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Toma Fukuda
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Akiko Yamaguchi
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Aya Kanno
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
- Department of PediatricsFukushima Medical University School of MedicineFukushimaJapan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
- Department of Public HealthFukushima Medical University School of MedicineFukushimaJapan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
- Department of PediatricsFukushima Medical University School of MedicineFukushimaJapan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
- Fukushima Medical Center for Children and WomenFukushima Medical UniversityFukushimaJapan
| | - Keiya Fujimori
- Department of Obstetrics and GynecologyFukushima Medical University School of MedicineFukushimaJapan
- Fukushima Regional Center for the Japan Environmental and Children’s StudyFukushimaJapan
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106
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Foetal growth, birth transition, enteral nutrition and brain light scattering. Sci Rep 2021; 11:21318. [PMID: 34716370 PMCID: PMC8556386 DOI: 10.1038/s41598-021-00624-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022] Open
Abstract
If the brain structure is assessed at neonatal intensive care units, covert clinical events related with subtle brain injury might be identified. The reduced scattering coefficient of near-infrared light (μS’) obtained using time-resolved near-infrared spectroscopy from the forehead of infants is associated with gestational age, body weight and Apgar scores, presumably reflecting subtle changes of the brain related to foetal growth and birth transition. One hundred twenty-eight preterm and term infants were studied to test whether μS’ obtained from the head at term-equivalent age is associated with foetal growth, birth transition and nutritional status after birth, which are key independent variables of developmental outcomes. As potential independent variables of μS’, birth weight, Apgar scores, age at full enteral feeding and post-conceptional age at the study were assessed to represent foetal growth, birth transition and nutritional status after birth. Subsequently, higher μS’ values were associated with higher Apgar scores (p = 0.003) and earlier establishment of enteral feeding (p < 0.001). The scattering property of near-infrared light within the neonatal brain might reflect changes associated with birth transition and nutritional status thereafter, which might be used as a non-invasive biomarker to identify covert independent variables of brain injury in preterm infants.
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107
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Nomura S, Kyozuka H, Jin T, Fujimori M, Suzuki D, Sato K, Imamura T, Nomura Y. First trimester heterotopic pregnancy with shock treated laparoscopically, followed by uneventful term pregnancy and normal birth. Fukushima J Med Sci 2021; 67:168-171. [PMID: 34707040 PMCID: PMC8784197 DOI: 10.5387/fms.2021-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Heterotopic pregnancy (HP), a coexistence of intrauterine and ectopic pregnancies, is extremely rare. Although there have been many reports of maternal outcomes in pregnant women with HP, they have not described fetal neurodevelopmental outcomes and survival. A 30-year-old Japanese woman in early gestation who had undergone two previous cesarean deliveries was transferred to our hospital with vital signs of shock. HP was confirmed by ultrasonography and laparoscopic surgery, and right salpingectomy was performed. At term, a 2,875 g neonate was delivered via cesarean section without any complications.
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Affiliation(s)
- Shinji Nomura
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Hyo Kyozuka
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Toki Jin
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Mimori Fujimori
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Daisuke Suzuki
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
| | - Kenichi Sato
- Department of Pediatrics, Ohta Nishinouchi Hospital
| | | | - Yasuhisa Nomura
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospitale
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108
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Kanno A, Kyozuka H, Murata T, Isogami H, Yamaguchi A, Fukuda T, Yasuda S, Suzuki D, Sato A, Ogata Y, Shinoki K, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Age at menarche and risk of adverse obstetric outcomes during the first childbirth in Japan: The Japan Environment and Children's Study. J Obstet Gynaecol Res 2021; 48:103-112. [PMID: 34708467 DOI: 10.1111/jog.15057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 12/17/2022]
Abstract
AIM Age at menarche is used as a risk indicator of gestational diabetes mellitus, preterm birth, and fetal growth. However, little is known regarding the age impact on obstetric outcomes among nulliparous women. This study investigated whether menarche age was correlated with obstetric outcomes among nulliparous women. METHODS We analyzed the data obtained for 37 645 singleton pregnancies between 2011 and 2014 in the Japan Environment and Children's Study. Age at menarche was categorized into the ≤9-, 10-, 11-, 12-, 13-, 14-, and ≥15-year-old groups (n = 363, 3155, 8390, 11 164, 6713, 5446, and 2414, respectively). We calculated the relative risk for cases of preterm birth <37 weeks, low birthweight <2500 g, small for gestational age, early and late-onset hypertension disorders of pregnancy, and early- and late-diagnosed (diagnosed < or ≧ 24 weeks) gestational diabetes mellitus using a reference of 12 years at menarche. RESULTS Women with an age at menarche ≤9 years showed an increased incidence of developing early-diagnosed gestational diabetes mellitus (relative risk: 2.42; 95% confidence interval: 1.05-5.60). A high body mass index before pregnancy increased the risk of developing gestational diabetes mellitus. CONCLUSIONS Age at menarche helped in assessing the risk of early-diagnosed gestational diabetes mellitus among nulliparous women. Future studies are needed to clarify the underlying mechanisms. This study is the first to use data from the largest prospective birth cohort study of Japan and to investigate the relationship between menarche age and obstetric outcomes among nulliparous women.
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Affiliation(s)
- Aya Kanno
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hyo Kyozuka
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Koriyama City, Fukushima, Japan
| | - Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hirotaka Isogami
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toma Fukuda
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Daisuke Suzuki
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
| | - Kosei Shinoki
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
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109
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Jin T, Kyozuka H, Fukuda T, Fujimori M, Murata T, Nomura S, Suzuki D, Nomura Y, Imamura T, Yasuda S, Yamaguchi A, Fujimori K. Effect of gestational weight gain on placental weight: A single tertiary referral center study of Japanese women. J Obstet Gynaecol Res 2021; 47:4241-4249. [PMID: 34655145 DOI: 10.1111/jog.15058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/24/2021] [Accepted: 09/29/2021] [Indexed: 01/04/2023]
Abstract
AIM The effect of gestational weight gain on placental weight has not been elucidated. We aimed to examine the effect of body weight gain during pregnancy on the Japanese standardized z-score of placental weight, based on the pre-pregnancy body mass index. METHODS This retrospective cohort study included Japanese women with singleton pregnancies who gave birth during 2013-2019 at Ohta Nishinouchi Hospital. Participants (n = 3610) were categorized by their pre-pregnancy body mass index: G1 (<18.5 kg/m2 ), G2 (18.5 to <20.0 kg/m2 ), G3 (20.0 to <23.0 kg/m2 ), G4 (23.0 to <25.0 kg/m2 ), and G5 (≥25.0 kg/m2 ). Multiple linear regression analysis was used to identify associations between insufficient or excessive gestational weight gain in each body mass index category and z-score of placental weight, with adjustments for maternal age, assisted reproductive technology, and maternal pre-pregnancy conditions, such as hypertension, diabetes mellitus, myoma uteri, and uterine anomalies. RESULTS Among the 3610 women assessed, 479, 692, 1292, 435, and 711 were in G1-G5, respectively. In G1, G3, and G4, excessive weight gain increased the placental weight z-score ([B: 0.50, 95% confidence interval [CI]: 0.23-0.76], [B: 0.19, 95% CI: 0.19-0.33], and [B: 0.18, 95% CI: 0.10-0.26]). Insufficient weight gain decreased the placental weight z-score in G3 (B: -0.19, 95% CI: -0.33 to -0.06) and G4 (B: -0.21, 95% CI: -0.29 to -0.13) women. CONCLUSION The effect of weight gain during pregnancy on placental size varies by pre-pregnancy body mass index. This result may guide personalized pre-conception counseling to improve the outcomes of offspring.
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Affiliation(s)
- Toki Jin
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Koriyama City, Japan
| | - Hyo Kyozuka
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Koriyama City, Japan
| | - Toma Fukuda
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima City, Japan
| | - Mimori Fujimori
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Koriyama City, Japan
| | - Tsuyoshi Murata
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Koriyama City, Japan
| | - Shinji Nomura
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Koriyama City, Japan
| | - Daisuke Suzuki
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Koriyama City, Japan
| | - Yasuhisa Nomura
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Koriyama City, Japan
| | - Takashi Imamura
- Department of Obstetrics and Gynecology, Ohta Nisinouchi Hospital, Koriyama City, Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima City, Japan
| | - Akiko Yamaguchi
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima City, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima City, Japan
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Correlation between Severity of Fetal Growth Restriction and Oxidative Stress in Severe Small-for-Gestational-Age Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010726. [PMID: 34682470 PMCID: PMC8535480 DOI: 10.3390/ijerph182010726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 01/04/2023]
Abstract
Severe small-for-gestational-age (sSGA) infants exhibit increased mortality and morbidity. Oxidative stress is suggested to be involved in intrauterine growth restriction. This retrospective study aimed to evaluate the oxidative stress level at birth in an sSGA population. Sera of 28 sSGA (sSGA group) and 31 non-sSGA (control group) infants, born at our hospital between March 2017 and March 2020, were evaluated. Oxidative stress (derivative of reactive oxidative metabolites: d-ROM level), biological antioxidant potential (BAP) level, and the ratio of d-ROM/BAP level (oxidative stress index: OSI) were measured. The sSGA group had a significantly lower birth weight (BW), BW z-score, head circumference, and height than the control group (all p < 0.05). No significant difference was noted in the BAP level; sSGA infants exhibited a significantly higher d-ROM level than control infants. sSGA infants showed a significantly increased OSI compared with control infants, and the BW z-score was inversely correlated with d-ROM levels and OSI in sSGA infants (R2 = 0.300; p < 0.01 and R2 = 0.319; p = 0.02, respectively) but not in controls. In conclusion, sSGA infants, including preterm infants, exhibited higher oxidative stress at birth. The severity of fetal growth restriction was significantly correlated with oxidative stress levels at birth in sSGA infants.
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Lower systolic blood pressure levels in early pregnancy are associated with a decreased risk of early-onset superimposed preeclampsia in women with chronic hypertension: a multicenter retrospective study. Hypertens Res 2021; 45:135-145. [PMID: 34635810 DOI: 10.1038/s41440-021-00763-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/10/2021] [Accepted: 08/25/2021] [Indexed: 11/08/2022]
Abstract
To clarify the impact of blood pressure (BP) management ranges on pregnancy outcomes, we conducted a multicenter retrospective analysis of 215 women with singleton pregnancies diagnosed with essential hypertension either before or within 14 weeks of gestation. Patients were classified according to systolic BP (sBP; <130, 130-139, 140-159, and ≥160 mmHg) or diastolic BP (dBP; <80, 80-89, 90-109, and ≥110 mmHg) at 8-11, 12-15, and 16-19 weeks of gestation. The risk of early-onset superimposed preeclampsia and small-for-gestational-age neonates was assessed in each BP group. Moreover, a subgroup analysis was performed in 144 eligible patients whose BP was measured at both 12-13 and 14-15 weeks of gestation. At 16-19 weeks of gestation, higher sBP significantly increased the incidence of early-onset superimposed preeclampsia (13.3%, 24.6%, 32.2% and 75.0%, respectively) and small-for-gestational-age neonates (6.0%, 13.1%, 16.9% and 50.0%, respectively). Multivariate logistic regression analyses showed that women with sBP < 130 mmHg at 16-19 weeks of gestation had a significantly lower risk of early-onset superimposed preeclampsia than women with sBP of 140-159 mmHg. Subgroup analyses also showed that even at 14-15 weeks of gestation, sBP < 130 mmHg was associated with a significantly lower risk of early-onset superimposed preeclampsia than an sBP of 140-159 mmHg. In conclusion, sBP < 130 mmHg within 14 weeks of gestation reduced the risk of developing early-onset superimposed preeclampsia in women with chronic hypertension.
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112
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Satoh M. Bone age in prepubertal children with nonfamilial or familial idiopathic short stature and prepubertal short-stature children born small for gestational age: a longitudinal data analysis. Clin Pediatr Endocrinol 2021; 30:171-177. [PMID: 34629739 PMCID: PMC8481081 DOI: 10.1297/cpe.30.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022] Open
Abstract
This retrospective study aimed to clarify the characteristics of bone maturation using
longitudinal data in short-stature prepubertal children. Children with chronological ages
(CAs) of 4.5–10.5 yr with nonfamilial idiopathic short stature (ISS, n = 95), familial ISS
(FSS, n = 21), and short-stature children born small for gestational age (SGA, n = 23)
were selected, of which 435 left-hand plain radiographic images were evaluated. Bone age
(BA) delay was defined as BA minus CA. In the ISS group, there was a statistically
significant difference in median BA delay among the CA groups (P < 0.001), as median BA
delay gradually increased from 5- to 9-yr-old groups (−1.06 [range, −2.17 to 0.27] and
−2.45 [range, −4.35 to −0.32] yr, respectively). In the FSS group, median BA delays were
approximately −1 yr in all CA groups. In the SGA group, median BA delay gradually
decreased from 7- to 10-yr-old groups (−1.96 [range, −2.99 to 0.56] and −0.04 [range,
−2.44 to 0.92] yr, respectively), but with no significant difference (P = 0.647). The
heavier weight of children with FSS and the probable earlier onset of adrenarche in
children born SGA compared to those with ISS could have affected bone maturation.
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Affiliation(s)
- Mari Satoh
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
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113
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Decreased head circumference at birth associated with maternal tobacco smoke exposure during pregnancy on the Japanese prospective birth cohort study. Sci Rep 2021; 11:18949. [PMID: 34556740 PMCID: PMC8460647 DOI: 10.1038/s41598-021-98311-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/06/2021] [Indexed: 02/08/2023] Open
Abstract
Maternal tobacco smoke exposure during pregnancy impairs fetal body size, including head circumference (HC) at birth; however, the mechanism still remains unclear. This analysis using a large prospective cohort study evaluated the impact of maternal tobacco exposure on their offspring's HC and the relationship with placental weight ratio (PWR) and placental abnormalities. Parents-children pairs (n = 84,856) were included from the 104,065 records of the Japan Environmental and Children's Study. Maternal perinatal clinical and social information by self-administered questionnaires, offspring's body size, and placental information were collected. Data were analyzed with binominal logistic regression analysis and path analysis. Logistic regression showed significantly elevated adjusted odds ratio (aOR) (1.653, 95% CI 1.387-1.969) for the impact of maternal smoking during pregnancy on their offspring's smaller HC at birth. Maternal exposure to environmental tobacco smoke in the non-smoking group did not increase aOR for the smaller HC. Path analysis showed that maternal smoking during pregnancy decreased the offspring's HC directly, but not indirectly via PWR or placental abnormalities. The quitting smoking during pregnancy group did not increase aOR for the smaller HC than the non-smoking group, suggesting that quitting smoking may reduce their offspring's neurological impairment even after pregnancy.
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Prevalence and risk factors of labor-onset hypertension: A multicenter study in Japan. Pregnancy Hypertens 2021; 26:48-53. [PMID: 34508948 DOI: 10.1016/j.preghy.2021.08.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 08/17/2021] [Accepted: 08/31/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate the prevalence and risk factors of labor-onset hypertension (LOH), defined as hypertension first detected during labor among women without hypertension prior to admission for labor. STUDY DESIGN In this multicenter retrospective study, clinical data of women who delivered vaginally at term between 2012 and 2018 were collected from 12 primary maternity care units. Blood pressure was measured at five time points from admission to 2 h postpartum in a total of 30,129 normotensive women at the last prenatal check-up. LOH was defined as systolic blood pressure (SBP) of ≥ 140 mmHg or diastolic blood pressure (DBP) of ≥ 90 mmHg during the first to fourth stages of labor. MAIN OUTCOME MEASURES Multivariate regression analyses were conducted to evaluate the risk factors of LOH and severe LOH (SBP of ≥ 160 mmHg or DBP of ≥ 110 mmHg). RESULTS Among the 30,129 women, 8,565 (28.4%) presented with LOH and 734 (2.4%) with severe LOH. The prevalence of LOH was the highest at the second stage of labor (21.7%) and decreased rapidly after delivery. The independent risk factors of LOH were maternal age of ≥ 35 years, pre-pregnancy body mass index of ≥ 25 kg/m2, and pregnancy weight gain of ≥ 15 kg. CONCLUSION LOH is common, with approximately one in four women experiencing LOH during labor and early postpartum. Meanwhile, severe LOH occurred in 2.4% of the pregnancies. Closer blood pressure monitoring during labor may enable obstetric caregivers to recognize LOH in a timely manner and reduce maternal adverse outcomes, such as eclampsia and stroke.
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115
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Fujita Y, Kouda K, Ohara K, Nakamura H, Nakama C, Nishiyama T, Iki M. Infant weight gain and DXA-measured adolescent adiposity: data from the Japan Kids Body-composition Study. J Physiol Anthropol 2021; 40:10. [PMID: 34452643 PMCID: PMC8399705 DOI: 10.1186/s40101-021-00261-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background Rapid weight gain in early life is associated with adiposity later in life. However, there is limited information on the association between weight gain and body fat mass measured using precise methods. This study aimed to investigate whether weight gain is associated with body fat mass measured by dual-energy X-ray absorptiometry (DXA) in adolescents. Methods Participants of this retrospective cohort study were 423 adolescents born at full-term who were enrolled in the Japan Kids Body-composition Study. Anthropometric measurements related to pregnancy, delivery, and child health were obtained from the Japanese Maternal and Child Health Handbook. Fat mass in adolescents was measured with a DXA scanner. Weight gain was defined as the change in body weight from birth to age 1.5 years. Associations between birthweight and fat mass, and between weight gain and fat mass, were evaluated using multiple regression analysis. Results There was a significant positive association between weight gain from birth to age 1.5 years and fat mass in adolescents (boys: standardized regression coefficient (β) = 0.253, p < 0.01; girls: β = 0.246, p < 0.01), but not between birthweight standardized for gestational age and fat mass. Conclusion Children with a greater change in weight from birth to age 1.5 years tended to have increased fat mass in adolescence. Weight gain in early life has a greater impact on fat mass in adolescents than birthweight.
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Affiliation(s)
- Yuki Fujita
- Department of Public Health, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Katsuyasu Kouda
- Department of Hygiene and Public Health, Kansai Medical University, Hirakata, Osaka, 573-1010, Japan
| | - Kumiko Ohara
- Department of Public Health, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Harunobu Nakamura
- Department of Human Development, Graduate School of Human Development and Environment, Kobe University, Kobe, 657-8501, Japan
| | - Chikako Nakama
- Department of Hygiene and Public Health, Kansai Medical University, Hirakata, Osaka, 573-1010, Japan
| | - Toshimasa Nishiyama
- Department of Hygiene and Public Health, Kansai Medical University, Hirakata, Osaka, 573-1010, Japan
| | - Masayuki Iki
- Department of Public Health, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, 589-8511, Japan
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Nakamura M, Hasegawa J, Takita H, Sekizawa A. Amnioinfusion and Bed Rest May Effectively Improve the Insufficient Circulation of the Umbilical Cord in Pregnant Women With Hyper-Coiled Cord and Oligohydramnios. J Med Cases 2021; 12:1-4. [PMID: 34434417 PMCID: PMC8383637 DOI: 10.14740/jmc3581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 11/24/2022] Open
Abstract
We experienced two cases with hyper-coiled cord in which fetal-umbilical-placental circulation was improved after amnioinfusion or bed rest. Therefore, amnioinfusion and bed rest to reduce the compression of the vulnerable umbilical cord in cases of hyper-coiled cord might improve the pathologic fetal-umbilical-placental circulation.
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Affiliation(s)
- Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroko Takita
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
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Kamijo K, Miyamoto T, Ando H, Tanaka Y, Kikuchi N, Shinagawa M, Yamada S, Asaka R, Fuseya C, Ohira S, Shiozawa T. Clinical characteristics of a novel "Type 3" vasa previa: case series at a single center. J Matern Fetal Neonatal Med 2021; 35:7730-7736. [PMID: 34372741 DOI: 10.1080/14767058.2021.1960975] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Vasa previa is a condition in which fetal blood vessels are located on fetal membranes within 2 cm of the internal cervical os. Vasa previa has been classified into two types: Type 1, in which vessels connect a velamentous umbilical cord to the placenta, and Type 2, in which vessels connect the lobes of a bilobed placenta or the placenta to a succenturiate lobe. However, there are also atypical cases that cannot be classified into these two types. These cases are manifested by a center or marginal cord insertion with a normal shaped placenta, and fetal vessels were also located on membranes around the internal cervical os. These cases were recently proposed as Type 3 vasa previa. The present study investigated the incidence of Type 3 vasa previa and elucidated differences in clinical and ultrasonographical characteristics between traditional types and Type 3. METHODS This was a single-center observational study using a cohort of all vasa previa cases between January 2010 and April 2020. RESULTS Among 8,723 deliveries, there were 14 cases (0.16%) of vasa previa, all of which were diagnosed prenatally by US, not after vaginal delivery or CS. There were 9 (64%), 0, and 5 (36%) cases of Types 1, 2, and 3, respectively. All 5 Type 3 cases had only one fetal aberrant vessel of vasa previa, while 6 out of 9 Type 1 cases (67%) had two or more aberrant vessels. Seven Type 1 cases (78%) possessed two or more known risk factors, such as velamentous cord insertion, whereas all Type 3 cases only had one. Difficulties were associated with diagnosing two out of the 14 cases of vasa previa using routine transvaginal ultrasonography (TVUS). In these cases, the aberrant fetal vessel of vasa previa was only one vein with a thin wall that was not clearly visualized by gray-scale TVUS as well as slow flow that was easily misread by color-Doppler. These cases were ultimately diagnosed as vasa previa based on non-pulsatile flow detected by color and pulsed Doppler. CONCLUSIONS The present results suggest that Type 3 may account for a large proportion of vasa previa cases. Most Type 3 cases may present with only one fetal aberrant vessel of vasa previa and fewer risk factors, suggesting that the diagnosis of vasa previa may be more challenging in Type 3 cases than in the other types. Vasa previa with a venous vasa previa needs to be considered because of the difficulties associated with an antenatal diagnosis due to unclear imaging of the vasculature or the lack of specific color Doppler flow patterns. Pulsed Doppler imaging may be helpful for the diagnosis of these cases.
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Affiliation(s)
- Kyosuke Kamijo
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Obstetrics and Gynecology, Iida Municipal Hospital, Iida, Japan
| | - Tsutomu Miyamoto
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hirofumi Ando
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasuhiro Tanaka
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Norihiko Kikuchi
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Manaka Shinagawa
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Yamada
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Obstetrics, Center for Perinatal Medicine, Nagano Children's Hospital, Azumino, Japan
| | - Ryoichi Asaka
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Chiho Fuseya
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Ohira
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Obstetrics and Gynecology, Iida Municipal Hospital, Iida, Japan
| | - Tanri Shiozawa
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
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118
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Morisaki N, Piedvache A, Nagata C, Michikawa T, Morokuma S, Kato K, Sanefuji M, Shibata E, Tsuji M, Shimono M, Ohga S, Kusuhara K. Maternal blood count parameters of chronic inflammation by gestational age and their associations with risk of preterm delivery in the Japan Environment and Children's Study. Sci Rep 2021; 11:15522. [PMID: 34330940 PMCID: PMC8324902 DOI: 10.1038/s41598-021-93101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/21/2021] [Indexed: 11/09/2022] Open
Abstract
Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR), are three reportedly predictive biomarkers that reflect subclinical chronic inflammatory burden. However, how these biomarkers change during pregnancy and its clinical utility among pregnant women have been rarely studied. Among 76,853 singleton pregnancies delivered at 28–41 weeks of gestation that were enrolled in the Japan Environment and Children’s Study, we observed the distribution of maternal NLR, PLR, and LMR values from week 0 to week 36 using spline curves, as well as their predictive values for preterm delivery with and without hypertensive disorders in pregnancy, placental abruption and intrauterine growth restriction (collectively termed ischemic placental disease due to their shared pathological and pathophysiological features) for measurements at 8–11 weeks, 12–17 weeks, and 18–21 weeks. NLR and PLR increased, whereas LMR decreased, with increasing gestation. High LMR and low NLR observed at 18–21 weeks, but not at earlier gestations, were associated with higher risk of preterm delivery with IPD (odds ratio 1.80 [95% CI 1.02, 3.19] per log[LMR]; odds ratio 0.49 [95% CI 0.29, 0.82] per log[NLR]). All parameters were not predictive of preterm delivery without IPD. We provide a robust reference curve for maternal blood count parameters NLR, PLR, and LMR by gestational week.
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Affiliation(s)
- Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Aurélie Piedvache
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Chie Nagata
- Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Seiichi Morokuma
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Sanefuji
- Research Center for Environmental and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiji Shibata
- Regional Center for Japan Environment and Children's Study (JECS), University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Mayumi Tsuji
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Masayuki Shimono
- Regional Center for Japan Environment and Children's Study (JECS), University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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119
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Koizumi M, Ida S, Shoji Y, Etani Y, Kawai M. Renal function in short-statured children born small for gestational age and treated with growth hormone. Pediatr Int 2021; 63:775-781. [PMID: 33073439 DOI: 10.1111/ped.14514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children born small for gestational age (SGA), particularly when associated with an extremely low birthweight (ELBW), have a higher risk of renal dysfunction. Growth hormone (GH) treatment is used to treat short-statured children born SGA; however, its effects on renal function remain elusive, especially in those born SGA with ELBW. METHODS Short-statured children born SGA (N = 42) were included. Subjects were subdivided into two groups based on their birthweight: the ELBW group (N = 15) with a birthweight of <1,000 g, and the non-ELBW group (N = 27) with birthweights ranging between 1,000 and 2,500 g. The creatinine-based estimated glomerular filtration rates (eGFR) before (pre-eGFR) and 5 years after GH treatment (post-eGFR) were compared. Correlations between eGFR, anthropometric, or birth parameters, and cumulative GH dose were evaluated using Spearman's rank correlation coefficient. RESULTS The ELBW group had a lower pre- and post-eGFR than the non-ELBW group. Five-year GH treatment did not significantly reduce eGFR in either group. Post-eGFR was positively associated with gestational week and birthweight. However, the cumulative GH dose was not correlated with pre-eGFR, post-eGFR, or percentage change in eGFR (%ΔeGFR). The change in bodyweight standard deviation score during GH treatment was positively correlated with %ΔeGFR in the ELBW group. CONCLUSIONS The current results indicated that GH treatment was unlikely a risk for the reduction in eGFR in short-statured children born SGA. However, eGFR should be carefully monitored, especially in those born SGA with ELBW because these subjects had lower eGFR than non-ELBW subjects.
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Affiliation(s)
- Mikiko Koizumi
- Departments of, Department of, Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.,Department of, Pediatrics, Yodogawa Christian Hospital, Osaka City, Osaka, Japan
| | - Shinobu Ida
- Departments of, Department of, Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Yasuko Shoji
- Departments of, Department of, Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Yuri Etani
- Departments of, Department of, Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Masanobu Kawai
- Departments of, Department of, Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.,Department of, Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
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What are the causes for low birthweight in Japan? A single hospital-based study. PLoS One 2021; 16:e0253719. [PMID: 34161392 PMCID: PMC8221519 DOI: 10.1371/journal.pone.0253719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/10/2021] [Indexed: 12/29/2022] Open
Abstract
Low-birthweight (LBW; <2,500 g) babies are at a higher risk of poor educational achievement, disability, and metabolic diseases than normal-birthweight babies in the future. However, reliable data on factors that contribute to LBW have not been considered previously. Therefore, we aimed to examine the distribution of the causes for LBW. A retrospective review of cases involving 4,224 babies whose mothers underwent perinatal care at Keio University Hospital between 2013 and 2019 was conducted. The LBW incidence was 24% (1,028 babies). Of the 1,028 LBW babies, 231 babies were from multiple pregnancies. Of the 797 singleton LBW babies, 518 (65%) were born preterm. Obstetric complications in women with preterm LBW babies included premature rupture of membrane or labor onset (31%), hypertensive disorders of pregnancy (HDP, 64%), fetal growth restriction (24%), non-reassuring fetal status (14%), and placental previa/vasa previa (8%). Of the 279 term LBW babies, 109 (39%) were small for gestational age. Multiple logistic regression analyses revealed the following factors as LBW risk factors in term neonates: low pre-pregnancy maternal weight, inadequate gestational weight gain, birth at 37 gestational weeks, HDP, anemia during pregnancy, female sex, and neonatal congenital anomalies. HDP was an LBW risk factor not only in preterm births but also in term births. Our results suggest that both modifiable and non-modifiable factors are causes for LBW. It may be appropriate to consider a heterogeneous rather than a simple classification of LBW and to evaluate future health risks based on contributing factors.
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Ichihara Y, Suga K, Fukui M, Yonetani N, Shono M, Nakagawa R, Kagami S. Serum biotin level during pregnancy is associated with fetal growth and preterm delivery. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 67:170-173. [PMID: 32378602 DOI: 10.2152/jmi.67.170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background : Biotin is a water-soluble vitamin that plays various biological roles through histone modification, such as immune functions and fetal growth. Mammalian maternal biotin deficiency during gestation induces fetal growth restriction. Preterm infants are known to be marginal biotin deficiency. However, studies on the biotin status of pregnant women under various conditions are lacking. Method : This was a retrospective case control study to analyze serum biotin concentration during pregnancy and cord blood in normal pregnancy, preterm delivery and small-for-gestational-age (SGA). Results : Twenty pregnant women with normal term delivery, 35 with preterm delivery, 24 with SGA, and 10 non-pregnant adult women were enrolled. Serum biotin concentrations of pregnant women remained low from first to third trimester. The levels of serum biotin in cord blood showed a significant positive correlation with gestational age, and that of pregnant women showed a weak positive correlation with gestational age. The maternal serum biotin levels during second and third trimester of SGA group were significantly lower than those of normal term delivery. Conclusion : This study suggests that maternal biotin deficiency during pregnancy might be the risk of preterm labor or fetal growth restriction. Further studies are required to clarify the roles of biotin in perinatal medicine. J. Med. Invest. 67 : 170-173, February, 2020.
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Affiliation(s)
- Yuko Ichihara
- Department of Pediatrics, Tokushima University Hospital, Kuramotocho, Tokushima, Tokushima, Japan.,Department of Pediatrics, Tokushima Municipal Hospital, Kitajyosanjimacho, Tokushima, Tokushima, Japan
| | - Kenichi Suga
- Department of Pediatrics, Tokushima University Hospital, Kuramotocho, Tokushima, Tokushima, Japan
| | - Maika Fukui
- Department of Pediatrics, Tokushima University Hospital, Kuramotocho, Tokushima, Tokushima, Japan
| | - Naoto Yonetani
- Department of Obstetrics and Gynecology, Tokushima University Hospital, Kuramotocho, Tokushima, Tokushima, Japan
| | - Miki Shono
- Department of Pediatrics, Tokushima University Hospital, Kuramotocho, Tokushima, Tokushima, Japan
| | - Ryuji Nakagawa
- Department of Pediatrics, Tokushima University Hospital, Kuramotocho, Tokushima, Tokushima, Japan
| | - Shoji Kagami
- Department of Pediatrics, Tokushima University Hospital, Kuramotocho, Tokushima, Tokushima, Japan
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Ushida T, Kidokoro H, Nakamura N, Katsuki S, Imai K, Nakano-Kobayashi T, Moriyama Y, Sato Y, Hayakawa M, Natsume J, Kajiyama H, Kotani T. Impact of maternal hypertensive disorders of pregnancy on brain volumes at term-equivalent age in preterm infants: A voxel-based morphometry study. Pregnancy Hypertens 2021; 25:143-149. [PMID: 34139669 DOI: 10.1016/j.preghy.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Infants born to mothers with hypertensive disorders of pregnancy (HDP) reportedly have negative behavioral and neurodevelopmental outcomes. However, the effects of maternal HDP on infant brain growth have not been fully evaluated. We aimed to evaluate brain volumes and brain injury in preterm infants born to mothers with HDP using magnetic resonance (MR) imaging at term-equivalent age. STUDY DESIGN In this cohort study, MR imaging was performed for 94 preterm infants born before 34 weeks of gestation at Nagoya University Hospital between 2010 and 2018. Twenty infants were born to mothers with HDP and 74 to mothers without HDP. MAIN OUTCOME MEASURES Total brain volumes and regional volumetric alterations were assessed by voxel-based morphometry, and brain injury was evaluated using the Kidokoro global brain abnormality score. Developmental quotient was assessed at a corrected age of 1.5 years in 59 infants (HDP, n = 11; non-HDP, n = 48). RESULTS No significant differences were observed in the gray and white matter volumes of the two groups (HDP: 175 ± 24 mL, 137 ± 13 mL, respectively; non-HDP: 172 ± 24 mL, 142 ± 13 mL, respectively). Additionally, no regional volumetric alterations were observed between the two groups after covariate adjustment (gestational age and infant sex). The total Kidokoro score and developmental quotient were similar in both groups. CONCLUSIONS No significant differences in the global and regional brain volumes were observed. Further research is needed to confirm our findings at different time points of MR imaging and in different populations.
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Affiliation(s)
- Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriyuki Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoru Katsuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakano-Kobayashi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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Goto Y, Mandai M, Nakayama T, Yamazaki S, Nakayama SF, Isobe T, Sato T, Nitta H. Association of prenatal maternal blood lead levels with birth outcomes in the Japan Environment and Children's Study (JECS): a nationwide birth cohort study. Int J Epidemiol 2021; 50:156-164. [PMID: 33141187 DOI: 10.1093/ije/dyaa162] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite dramatic declines in prenatal maternal blood lead levels (BLLs) in most developed countries, little is known about the effects of extremely low-level (<1.0 µg/dL) lead exposure on fetal growth. METHODS We measured maternal BLL during the second or third trimester of pregnancy and assessed birth outcomes, including birthweight, preterm birth (<37 gestational weeks) risk, small for gestational age births (SGA; birthweight <10th percentile) and low birthweight (LBW; <2500 g). The association between birthweight and maternal BLL was estimated using linear and quadratic spline models. Multivariable logistic models were used to examine the risk of binary responses. RESULTS From 103 099 pregnant women, 20 000 blood samples were randomly selected for analysis. The maternal BLL range was 0.16-7.4 µg/dL, and the median was 0.63 µg/dL. After adjusting for covariates, the linear model showed that each 0.1 μg/dL increase in maternal BLL was associated with a 5.4 g decrease in mean birthweight [95% confidence interval (CI), 3.4 to 7.5 g]. The risk of SGA [adjusted odds ratio (aOR), 1.03; 95% CI, 1.02 to 1.05) and LBW (aOR, 1.03; 95% CI, 1.02 to 1.05) increased, whereas the risk of preterm delivery did not (aOR, 0.99; 95% CI, 0.97 to 1.02). CONCLUSIONS Even at a maternal BLL below 1.0 µg/dL, prenatal lead exposure was associated with decreased birthweight and increased risk of SGA and LBW, but not preterm delivery. The adverse effect estimates of prenatal lead exposure on birth outcomes were quantitatively small and clinically limited at this low level.
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Affiliation(s)
| | - Marie Mandai
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Shin Yamazaki
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
| | - Shoji F Nakayama
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
| | - Tomohiko Isobe
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
| | - Tosiya Sato
- Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Hiroshi Nitta
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
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Takasawa K, Miyakawa Y, Saito Y, Adachi E, Shidei T, Sutani A, Gau M, Nakagawa R, Taki A, Kashimada K, Morio T. Marked clinical heterogeneity in congenital hyperinsulinism due to a novel homozygous ABCC8 mutation. Clin Endocrinol (Oxf) 2021; 94:940-948. [PMID: 33595839 DOI: 10.1111/cen.14443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The most severe forms of congenital hyperinsulinism (CHI) are caused by inactivating mutations of two KATP channel genes, KCNJ11 and ABCC8. Unresponsiveness to diazoxide and need for subtotal pancreatectomy can usually be predicted by genetic form, particularly biallelic mutations in KATP channel genes. A few reports indicated marked clinical heterogeneity in siblings with identical biallelic mutations in ABCC8. The clinical heterogeneity in biallelic KATP CHI was speculated to be caused by epigenetic and environmental factors or related to differences in splicing factor machinery. OBJECTIVE To elucidate the clinical pathophysiology, especially heterogeneity, among three cases with CHI caused by a homogenous novel mutation. PATIENTS AND METHODS We report a case series that includes two siblings and one unrelated individual with CHI caused by a homogenous 1-bp deletion around the splice acceptor site at the exon 35 mutation of ABCC8, which exhibited markedly distinct phenotypes. To assess the effect of the mutation on splicing, we performed digital droplet polymerase chain reaction (ddPCR) on normal pancreas tissue and a patient's lymphocytes. RESULTS ddPCR of ABCC8 cDNA revealed that expression of exon 35 and its upstream and downstream regions did not differ. These data suggested that clinical heterogeneity may not be caused by differences in splicing factor machinery. CONCLUSION The phenotypic variation in homozygotes could not be explained by splicing abnormalities. Though early genetic diagnosis of KATP CHI could contribute to selecting appropriate therapeutic options, more deliberate selection of therapeutic options in diffuse CHI due to biallelic ABCC8 mutations may be required.
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Affiliation(s)
- Kei Takasawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuichi Miyakawa
- Department of Pediatrics, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Yoko Saito
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eriko Adachi
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunanori Shidei
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akito Sutani
- Department of Pediatrics, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Maki Gau
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuichi Nakagawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsuko Taki
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
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Imai K, Wada M, Ogawa M, Tsuchiya K, Kusuda S. Neonatal Outcomes of Infants Born to Women on Hemodialysis: A Single-Center, Case-Control Study. Am J Perinatol 2021; 40:741-747. [PMID: 34058762 DOI: 10.1055/s-0041-1730436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The study aimed to investigate the neonatal outcomes of infants born to mothers on hemodialysis. STUDY DESIGN This retrospective, case-control, and observational study included 17 infants born to 16 mothers on dialysis in 2003 to 2016. We compared their clinical characteristics to those of 51 gestational age- and sex-matched control infants. Statistical comparisons were made between the two groups by using the Wilcoxon-Mann-Whitney test for continuous variables and the Chi-square test or Fisher's exact test for categorical variables. RESULTS Of the 16 pregnancies of mothers on dialysis, 15 (94%) deliveries were premature (<37 weeks), and 16/17 (94%) infants survived to discharge. The incidences of neonatal complications, such as intraventricular hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus, and periventricular leukomalacia, were not significantly different between the groups. However, 5/17 (29%) of the infants had congenital anomalies. CONCLUSION Although infants born to mothers on dialysis have a high risk of prematurity, they do not have any additional risk of neonatal complications, except for congenital anomalies. The potential risk of congenital anomalies should be investigated further. KEY POINTS · Preterm birth rate among mothers on hemodialysis was 94%.. · Complications in these infants were similar to controls.. · Twenty-nine percent of infants had congenital anomalies..
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Affiliation(s)
- Ken Imai
- Neonatal Division, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Masaki Wada
- Neonatal Division, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Masaki Ogawa
- Maternal-Fetal Division, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Tsuchiya
- Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University, Tokyo, Japan
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J-P NA, Minami M, Eitoku M, Maeda N, Fujieda M, Suganuma N. Lack of concern about body image and health during pregnancy linked to excessive gestational weight gain and small-for-gestational-age deliveries: the Japan Environment and Children's Study. BMC Pregnancy Childbirth 2021; 21:396. [PMID: 34020606 PMCID: PMC8139142 DOI: 10.1186/s12884-021-03827-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Pregnant women in Japan express various reasons for limiting gestational weight gain (GWG). We aimed to identify and characterise groups where the women share common reasons to limit GWG and to examine how these groups are associated with inappropriate GWG and abnormal foetal size. Methods We prospectively studied information from the Japan Environment and Childrens Study (JECS) on 92,539 women who gave birth to live singletons from 2011 through 2014. Pregnant women were recruited during early pregnancy. Their reasons for limiting GWG and other information were collected through self-reported questionnaires and medical records. We applied latent class analysis to group the women based on their reported reasons. We used multinomial logistic regression to compare the risks of inappropriate (inadequate and excessive) GWG and abnormal foetal size (determined by new-born weight for gestational age) between the identified groups. Results We identified three groups: Group 1 (76.7%), concerned about delivery and new-born health (health-conscious women); Group 2 (14.5%), concerned about body shape, delivery, and new-born health (body-shape- and health-conscious women); and Group 3 (8.8%), women without strong reasons to limit GWG (women lacking body-shape and health consciousness). Compared with Group 1 members, Group 2 members tended to be younger, have lower pre-pregnancy weight, be unmarried, be nulliparous, have practiced weight loss before pregnancy, and not have chronic medical conditions. Group 3 members tended to be less educated, unmarried, multiparous, smokers, and have a higher prevalence of pre-pregnancy underweight and previous caesarean delivery. Relative to Group 1, Group 2 had a lower unadjusted risk for inadequate GWG (relative risk ratio [RRR]=0.86, 95% CI: 0.810.90) and large-for-gestational-age birth (RRR=0.91, 95% CI 0.860.97), whereas Group 3 had a higher unadjusted risk for excessive GWG (RRR=1.36, 95% CI: 1.291.43) and small-for-gestational-age (SGA) births (RRR=1.15, 95% CI: 1.051.25). Conclusions In this Japanese nationwide birth cohort study, pregnant women who were less conscious about body shape and health had complex risks for excessive GWG and SGA birth. Health care providers should consider a womans perception of GWG when addressing factors affecting GWG and foetal growth. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03827-0.
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Affiliation(s)
- Naw Awn J-P
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Marina Minami
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
| | - Masamitsu Eitoku
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan.
| | - Nagamasa Maeda
- Department of Obstetrics and Gynecology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Mikiya Fujieda
- Department of Pediatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Narufumi Suganuma
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, 783-8505, Japan
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Novel Physique Index for the Screening of Skeletal Dysplasia at Birth. CHILDREN-BASEL 2021; 8:children8050331. [PMID: 33922881 PMCID: PMC8146428 DOI: 10.3390/children8050331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/18/2021] [Accepted: 04/23/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to devise a novel physique index and investigate its accuracy in identifying newborns with skeletal dysplasia in comparison with head circumference (HC)/height (HT) ratio. The birth weight (W), HT, and HC at birth of 1500 newborns were retrospectively collected. The linear regression equations and coefficients of determination (R2) were determined. The formulated equation was corrected by the mean weight for gestational age at birth (Wcorr) as a novel physique index for screening skeletal dysplasia. The index accuracy was assessed using receiver operating characteristic (ROC) curves in 11 newborns by fetal ultrasound and compared with that of the HC/HT ratio. The R2 values between W and HT, (HT)2, and (HT) 3 were 0.978, 0.990, and 0.993, respectively. Those between W and HC, (HC)2, and (HC)3 were 0.974, 0.984, and 0.988, respectively. W/Wcorr × (HC/HT)3 was used as a novel physique index. Seven newborns had skeletal dysplasia. Our novel physique index had a higher area under the curve (AUC), sensitivity, and specificity than the HC/HT ratio (AUC: 1.00 vs. 0.86, sensitivity: 1.00 vs. 0.86, and specificity: 1.00 vs. 0.75, respectively). Our novel physique index was more accurate than HC/HT ratio and has the potential to accurately identify newborns with skeletal dysplasia.
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Kyozuka H, Murata T, Fukuda T, Endo Y, Yamaguchi A, Yasuda S, Kanno A, Sato A, Ogata Y, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Immunoglobulin E levels and pregnancy-induced hypertension: Japan Environment and Children's Study. Sci Rep 2021; 11:8664. [PMID: 33883660 PMCID: PMC8060415 DOI: 10.1038/s41598-021-88227-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/09/2021] [Indexed: 02/08/2023] Open
Abstract
High serum immunoglobulin E (IgE) levels are associated with cardiovascular events. We aimed to evaluate the association between total IgE levels during the first trimester of pregnancy and pregnancy-induced hypertension (PIH) development in a large Japanese cohort. We analysed data pertaining to singleton primipara pregnancies recorded in the Japan Environment and Children's Study involving births from 2011 to 2014. Serum IgE levels were determined using the immunonephelometric technique. High serum IgE was defined as level ≥ 170 IU/ml. Hypertensive disorders in pregnancy (HDP) were categorized into early onset (Eo) PIH (developed < 34 weeks) or late onset (Lo) PIH (developed ≧ 34 weeks). A multiple logistic regression model was used to estimate the risk of high serum IgE levels on PIH, Eo-PIH, and Lo-PIH. Overall, 32,518 participants were enrolled. The prevalence of total, Eo-, and Lo-PIH was 3.2%, 0.6%, and 2.3%, respectively. Patients with high serum IgE levels had an increased risk of Lo-HDP (adjusted odds ratio [aOR]:1.19, 95% confidence interval 1.01-1.40). No correlation was found with either PIH (total) or Eo-PIH. High serum IgE levels during the first trimester were associated with the risk of Lo-PIH. Our results could influence and shape further research regarding the pathogenesis of Lo hypertension.
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Affiliation(s)
- Hyo Kyozuka
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Tsuyoshi Murata
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Toma Fukuda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuta Endo
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akiko Yamaguchi
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shun Yasuda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Aya Kanno
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Medical Center for Children and Women, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Huang H, Takai Y, Mikami Y, Samejima K, Gomi Y, Narita T, Ichinose S, Itaya Y, Ono Y, Matsunaga S, Saitoh M, Seki H. Safety of transvaginal aspiration of cysts in pregnancies complicated with ovarian endometrioma. J Gynecol Obstet Hum Reprod 2021; 50:102146. [PMID: 33862263 DOI: 10.1016/j.jogoh.2021.102146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/28/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Pregnancy complicated with ovarian endometrioma is a risk factor for preterm delivery and rupture or infection during pregnancy. This study aimed to clarify the effectiveness and safety of transvaginal aspiration during pregnancy for endometrioma diagnosed in the first trimester. DESIGN This retrospective observational study included 8 pregnant women with endometrioma who underwent transvaginal cyst aspiration at 12-14 weeks (aspiration group) between March 2011-March 2018 and 23 pregnant women with endometrioma who refused aspiration during the same period (observation group). METHODS Characteristics of patients were compared in both groups. Safety, feasability and complications of transvaginal cyst aspiration were reported. Complications and obstetrical outcomes were reported and compared in both groups. RESULTS The maximum cyst diameter was 8.9 ± 1.5 cm (mean ± standard deviation) in the aspiration group, which was significantly larger than that in the observation group (4.7 ± 0.2 cm). Four preterm deliveries (17.3%) occurred in the observation group and none in the aspiration group. The emergency cesarean section rate during delivery was 14.2% in the aspiration group and 43.7% in the observation group. CONCLUSIONS The aspiration group tended to have lower rate of preterm deliveries and emergency cesarean sections, suggesting that cyst aspiration could be an effective, minimally invasive, and safe management option for endometrioma during pregnancy.
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Affiliation(s)
- Haipeng Huang
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yasushi Takai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yukiko Mikami
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Kouki Samejima
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yosuke Gomi
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Tatsuya Narita
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Shunichiro Ichinose
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yukiko Itaya
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yosihisa Ono
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Shigetaka Matsunaga
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Masahiro Saitoh
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hiroyuki Seki
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
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130
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Mizutani Y, Kinoshita M, Lin YC, Fukaya S, Kato S, Hisano T, Hida H, Iwata S, Saitoh S, Iwata O. Temporal inversion of the acid-base equilibrium in newborns: an observational study. PeerJ 2021; 9:e11240. [PMID: 33954050 PMCID: PMC8052977 DOI: 10.7717/peerj.11240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background A considerable fraction of newborn infants experience hypoxia-ischaemia and metabolic acidosis at birth. However, little is known regarding the biological response of newborn infants to the pH drift from the physiological equilibrium. The aim of this study was to investigate the relationship between the pH drift at birth and postnatal acid-base regulation in newborn infants. Methods Clinical information of 200 spontaneously breathing newborn infants hospitalised at a neonatal intensive care centre were reviewed. Clinical variables associated with venous blood pH on days 5-7 were assessed. Results The higher blood pH on days 5-7 were explained by lower cord blood pH (-0.131, -0.210 to -0.052; regression coefficient, 95% confidence interval), greater gestational age (0.004, 0.002 to 0.005) and lower partial pressure of carbon dioxide on days 5-7 (-0.005, -0.006 to -0.004) (adjusted for sex, postnatal age and lactate on days 5-7). Conclusion In relatively stable newborn infants, blood pH drift from the physiological equilibrium at birth might trigger a system, which reverts and over-corrects blood pH within the first week of life. Given that the infants within the study cohort was spontaneously breathing, the observed phenomenon might be a common reaction of newborn infants to pH changes at birth.
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Affiliation(s)
- Yuko Mizutani
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Masahiro Kinoshita
- Department of Paediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng-Kung University, Tainan, Taiwan
| | - Satoko Fukaya
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Shin Kato
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Tadashi Hisano
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Hideki Hida
- Department of Neurophysiology and Brain Science, Nagoya City University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sachiko Iwata
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Osuke Iwata
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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131
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Murata T, Kyozuka H, Fukuda T, Yasuda S, Yamaguchi A, Morokuma S, Sato A, Ogata Y, Shinoki K, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Maternal sleep duration and neonatal birth weight: the Japan Environment and Children's Study. BMC Pregnancy Childbirth 2021; 21:295. [PMID: 33845773 PMCID: PMC8042950 DOI: 10.1186/s12884-021-03670-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The adequate maternal sleep duration required for favorable obstetric outcomes is unknown. We evaluated the association between maternal sleep duration and low birth weight infants, small for gestational age infants, and macrosomia. METHODS Participants enrolled in the Japan Environment and Children's Study, a nationwide birth cohort study, with singleton pregnancies after 22 weeks, who gave birth between 2011 and 2014 were enrolled and categorized into five groups according to maternal sleep duration during pregnancy: < 6.0 h, 6.0-7.9 h, 8.0-8.9 h, 9.0-9.9 h, and 10.0-12.0 h. We evaluated the association between maternal sleep duration and the incidence of low birth weight infants (< 2500 g), very low birth weight infants (< 1500 g), small for gestational age infants, and macrosomia (> 4000 g), with women with maternal sleep duration of 6.0-7.9 h as the reference, using a multiple logistic regression model. RESULTS In total, 82,171 participants were analyzed. The adjusted odds ratios (95% confidence intervals) for low birth weight infants in women with maternal sleep duration of 9.0-9.9 h and 10.0-12.0 h and for small for gestational age infants in women with maternal sleep duration of 9.0-9.9 h were 0.90 (0.83-0.99), 0.86 (0.76-0.99), and 0.91 (0.82-0.99), respectively, before adjusting for excessive gestational weight gain. No significant association was observed between maternal sleep duration and these outcomes after adjusting for excessive gestational weight gain. Among women with appropriate gestational weight gain, the adjusted odds ratios (95% confidence intervals) for low birth weight infants and for small for gestational age infants with sleep duration of 9.0-9.9 h were 0.88 (0.80-0.97) and 0.87 (0.78-0.97), respectively. CONCLUSIONS Maternal sleep duration of 9.0-9.9 h was significantly associated with the decreased incidence of low birth weight infants and small for gestational age infants in pregnant women with appropriate gestational weight gain, compared with that of 6.0-7.9 h. Care providers should provide proper counseling regarding the association between maternal sleep duration and neonatal birth weight and suggest comprehensive maternal lifestyle modifications to prevent low birth weight and small for gestational age infants.
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Affiliation(s)
- Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan. .,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Hyo Kyozuka
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Toma Fukuda
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiichi Morokuma
- Research Center for Environmental and Developmental Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-0054, Japan.,Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kosei Shinoki
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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132
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Itabashi K, Miyazawa T, Kusuda S, Wada K. Changes in mortality rates among extremely preterm infants born before 25 weeks' gestation: Comparison between the 2005 and 2010 nationwide surveys in Japan. Early Hum Dev 2021; 155:105321. [PMID: 33548820 DOI: 10.1016/j.earlhumdev.2021.105321] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is no consensus as to whether the outcomes of extremely preterm infants born <25 weeks' gestation have been constantly improving. AIMS Our study aimed to clarify changes in mortality during hospitalization among extremely preterm infants. STUDY DESIGN Comparison of mortality rates between the 2005 and 2010 retrospective nationwide surveys in Japan. SUBJECTS Extremely preterm infants born <25 weeks' gestation in Japan and registered in the nationwide surveys, 802 infants in 2005 and 797 in 2010, respectively. OUTCOMES Mortality rates stratified by gestational age. RESULTS AND CONCLUSION Mortality rates <25 weeks' gestation decreased from 36.4% to 25.6% (difference - 10.8% [95% confidence interval {CI}: -15.3%, -6.2%]) in 2010 compared to 2005. Gestational age-specific mortality rates were lower in 2010 compared to 2005, except for 24 weeks' gestation: 66.0% vs. 50.0% (difference: -16% [95% CI: -29.8%, -21.2%]) and 45.7% vs. 25.5% (difference: -20.2%, [95% CI: -28.1, -12.3%]) at 22, and 23 weeks' gestation, respectively. After adjusting for explanatory variables, the probability of death during hospitalization in 2010 was significantly lower in infants born <25 weeks' gestation (adjusted odds ratio [aOR] 0.597 [95% CI: 0.471, 0.757], but when stratified by gestational age, it was only significant for infants born at 23 weeks' gestation (aOR 0.439 [95% CI: 0.303, 0.636]). In conclusion, the mortality rates among infants born <25 weeks' gestation have been steadily improving from 2005 to 2010 in Japan, but the practice for infants born at 22 weeks' gestation is still challenging.
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Affiliation(s)
- Kazuo Itabashi
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan.
| | - Tokuo Miyazawa
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Satoshi Kusuda
- Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazuko Wada
- Department of Pediatrics, Osaka Women's and Children's Hospital, Osaka, Japan
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133
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Go H, Ohto H, Nollet KE, Sato K, Ichikawa H, Kume Y, Kanai Y, Maeda H, Kashiwabara N, Ogasawara K, Sato M, Hashimoto K, Hosoya M. Red cell distribution width as a predictor for bronchopulmonary dysplasia in premature infants. Sci Rep 2021; 11:7221. [PMID: 33790386 PMCID: PMC8012706 DOI: 10.1038/s41598-021-86752-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/19/2021] [Indexed: 01/21/2023] Open
Abstract
Bronchopulmonary dysplasia (BPD) is the most common morbidity complicating preterm birth. Red blood cell distribution width (RDW), a measure of the variation of red blood cell size, could reflect oxidative stress and chronic inflammation in many diseases such as cardiovascular, pulmonary, and other diseases. The objectives of the present study were to evaluate perinatal factors affecting RDW and to validate whether RDW could be a potential biomarker for BPD. A total of 176 preterm infants born at < 30 weeks were included in this study. They were categorized into BPD (n = 85) and non-BPD (n = 91) infants. RDW at birth and 14 days and 28 days of life (DOL 14, DOL 28) were measured. Clinical data were obtained from all subjects at Fukushima Medical University (Fukushima, Japan). The mean RDW at birth, DOL 14 and DOL 28 were 16.1%, 18.6%, 20.1%, respectively. Small for gestational age (SGA), chorioamnionitis (CAM), hypertensive disorders of pregnancy (HDP), gestational age and birth weight were significantly associated with RDW at birth. SGA, BPD and red blood cell (RBC) transfusion before DOL 14 were associated with RDW at DOL 14. BPD and RBC transfusion before DOL 14 were associated with RDW at DOL 28. Compared with non-BPD infants, mean RDW at DOL 14 (21.1% vs. 17.6%, P < 0.001) and DOL 28 (22.2% vs. 18.2%, P < 0.001) were significantly higher in BPD infants. Multivariate analysis revealed that RDW at DOL 28 was significantly higher in BPD infants (P = 0.001, odds ratio 1.63; 95% CI 1.22–2.19). Receiver operating characteristic analysis for RDW at DOL 28 in infants with and without BPD yielded an area under the curve of 0.87 (95% CI 0.78–0.91, P < 0.001). RDW at DOL 28 with mild BPD (18.1% vs. 21.3%, P < 0.001), moderate BPD (18.1% vs. 21.2%, P < 0.001), and severe BPD (18.1% vs. 24.0%, P < 0.001) were significantly higher than those with non-BPD, respectively. Furthermore, there are significant differences of RDW at DOL 28 among mild, moderate, and severe BPD. In summary, we conclude that RDW at DOL 28 could serve as a biomarker for predicting BPD and its severity. The mechanism by which RDW at DOL 28 is associated with the pathogenesis of BPD needs further elucidation.
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Affiliation(s)
- Hayato Go
- Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Japan.
| | | | - Kenneth E Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenichi Sato
- Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Japan
| | - Hirotaka Ichikawa
- Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Japan
| | - Yohei Kume
- Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Japan
| | - Yuji Kanai
- Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Japan
| | - Hajime Maeda
- Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Japan
| | - Nozomi Kashiwabara
- Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Japan
| | - Kei Ogasawara
- Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Japan
| | - Maki Sato
- Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Japan
| | - Koichi Hashimoto
- Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Japan
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134
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Ushida T, Kotani T, Moriyama Y, Imai K, Nakano-Kobayashi T, Kinoshita F, Nakamura N, Iitani Y, Yoshida S, Yamashita M, Kajiyama H. Platelet counts during normal pregnancies and pregnancies complicated with hypertensive disorders. Pregnancy Hypertens 2021; 24:73-78. [PMID: 33714072 DOI: 10.1016/j.preghy.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/20/2021] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine the trajectories of platelet counts and the prevalence of gestational thrombocytopenia (<150 × 109/L) during normal pregnancies and pregnancies with complications, such as hypertensive disorders of pregnancy (HDP), preeclampsia, and fetal growth restriction (FGR). STUDY DESIGN A multicenter retrospective study was conducted using laboratory data on women who delivered term singletons at 11 primary maternity care units between 2011 and 2018 (n = 35,045), and non-pregnant women who underwent a medical check-up between 2016 and 2019 (n = 61,189). After 1:1 matching, 28,073 pregnant women and 28,073 non-pregnant women were selected for analysis. MAIN OUTCOMES MEASURES The trajectories of platelet counts and prevalence of gestational thrombocytopenia were evaluated in normal pregnant women, pregnant women with complications, and non-pregnant women. RESULTS The platelet counts declined throughout pregnancy, with the nadir occurring on postpartum day 1. The platelet counts recovered to the level of the non-pregnant state at postpartum 2-7 days. The mean platelet counts at postpartum day 1 decreased by an estimated 19.8% and 9.7% compared to those in the non-pregnant state and first trimester, respectively. The prevalence of gestational thrombocytopenia in normal pregnant women at 37-41 gestational weeks and in pregnant women with complications of HDP, preeclampsia, and FGR were 6.1%, 7.3%, 17.5%, and 7.7%, respectively. CONCLUSION Platelet counts declined throughout pregnancy and recovered to the level of the non-pregnant state in the early postpartum period. Gestational thrombocytopenia is common during normal pregnancy, and its prevalence is significantly higher in women with preeclampsia.
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Affiliation(s)
- Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakano-Kobayashi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumie Kinoshita
- Data Science Division, Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Noriyuki Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukako Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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135
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Nakashima T, Inoue H, Sakemi Y, Ochiai M, Yamashita H, Ohga S. Trends in Bronchopulmonary Dysplasia Among Extremely Preterm Infants in Japan, 2003-2016. J Pediatr 2021; 230:119-125.e7. [PMID: 33246013 DOI: 10.1016/j.jpeds.2020.11.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate recent trends in bronchopulmonary dysplasia (BPD) and its risk factors among extremely preterm infants. STUDY DESIGN Demographic and clinical data were reviewed for 19 370 infants born at 22-27 weeks of gestation registered in the affiliated hospitals of the Neonatal Research Network of Japan between 2003 and 2016. We investigated the overall survival and prevalence of bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age and risk factors for developing BPD among the survivors. RESULTS Among 19 370 infants, 2244 (11.6%) died by 36 weeks' postmenstrual age. The mortality rate decreased from 19.0% (99% CI, 15.7%-22.8%) in 2003 to 8.0% (99% CI, 6.2%-10.3%) in 2016. Among 17 126 survivors, BPD developed in 7792 (45.5%) infants, and its proportion significantly increased from 41.4% (99% CI, 36.5%-46.4%) in 2003 to 52.0% (99% CI, 48.2%-55.9%) in 2016. A multivariable analysis of the survivors showed a positive association of BPD with ≥4 weeks' supplemental oxygen or invasive ventilation, birth weight <750 g, small for gestational age, ≥4 weeks' noninvasive positive pressure ventilation, chorioamnionitis, <26 weeks' gestational age, <20 cases per year of center patient volume, or treated patent ductus arteriosus. Although the median duration of invasive ventilation was shortened, the proportions of factors associated adversely with BPD generally showed increasing trends over time. CONCLUSIONS The mortality rate of extremely preterm infants has decreased, but the rate of BPD has increased in survivors between 2003 and 2016. Despite the decreasing duration of invasive ventilation over time, increasing rates of BPD suggest that differences in the patient population or other management strategies influence the development of BPD.
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Affiliation(s)
- Toshinori Nakashima
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Fukuoka, Japan.
| | - Hirosuke Inoue
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Sakemi
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Fukuoka, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hironori Yamashita
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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136
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Kyozuka H, Fukusda T, Murata T, Yamaguchi A, Kanno A, Yasuda S, Sato A, Ogata Y, Kuse M, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Impact of preconception sodium intake on hypertensive disorders of pregnancy: The Japan Environment and Children’s study. Pregnancy Hypertens 2021; 23:66-72. [DOI: 10.1016/j.preghy.2020.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/12/2020] [Accepted: 11/19/2020] [Indexed: 02/08/2023]
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137
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Murata T, Kyozuka H, Yamaguchi A, Fukuda T, Yasuda S, Sato A, Ogata Y, Shinoki K, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Maternal pre-pregnancy body mass index and foetal acidosis in vaginal and caesarean deliveries: The Japan Environment and Children's Study. Sci Rep 2021; 11:4350. [PMID: 33623113 PMCID: PMC7902605 DOI: 10.1038/s41598-020-79178-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022] Open
Abstract
A high maternal body mass index (BMI) is associated with increased risks of asphyxia-related neonatal morbidity. We evaluated the association between maternal pre-pregnancy BMI and foetal acidosis while accounting for the mode of delivery. Participants from the Japan Environment and Children's Study with singleton pregnancies after 22 weeks of gestation who gave birth during 2011-2014 were included. The participants (n = 71,799) were categorised into five groups according to the pre-pregnancy BMI: G1 (BMI < 18.5 kg/m2), G2 (18.5 to < 20.0 kg/m2), G3 (20.0 to < 23.0 kg/m2), G4 (23.0 to < 25.0 kg/m2), and G5 (≥ 25.0 kg/m2). Foetal acidosis was defined as umbilical artery pH (UmA-pH) < 7.20 or < 7.10. Multiple logistic regression analyses were used to evaluate the effect of pre-pregnancy BMI on foetal acidosis risk, accounting for the mode of delivery. In Japanese women, pre-pregnancy BMI ≥ 25.0 kg/m2 significantly increased the likelihood of foetal acidosis in newborns delivered vaginally. We found no association between pre-pregnancy BMI and foetal acidosis in newborns delivered via caesarean section. Counselling for body weight control before pregnancy and adequate management and selection of the mode of delivery in pregnant women with a high BMI who are in labour may be essential to avoid foetal acidosis.
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Affiliation(s)
- Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Hyo Kyozuka
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Toma Fukuda
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kosei Shinoki
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environmental and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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138
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Arimitsu T, Wakabayashi D, Tamaoka S, Takahashi M, Hida M, Takahashi T. Case Report: Intact Survival of a Marginally Viable Male Infant Born Weighing 268 Grams at 24 Weeks Gestation. Front Pediatr 2021; 8:628362. [PMID: 33614546 PMCID: PMC7888275 DOI: 10.3389/fped.2020.628362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022] Open
Abstract
We report the case of a preterm small for gestational age male infant born at 24 weeks of gestation with a birth weight of 268 g who was discharged from our hospital without the requirement for home oxygen therapy or tube feeding. He did not experience severe intraventricular hemorrhage, periventricular leukomalacia, hearing disability, or any other serious complications. At that time (February 2019), according to the University of Iowa's Tiniest Babies Registry, he was the tiniest male infant in the world to survive without any serious complications other than severe retinopathy of prematurity that required laser therapy. Although the survival rate of infants with extremely low birth weight is improving worldwide, a high mortality rate and incidence of severe complications remain common for infants weighing <300 g at birth, particularly in male infants. In recent years, there have been frequent discussions regarding the ethical and social issues involved in treating extremely preterm infants weighing <400 g. Despite the challenges, reports of such infants surviving are increasing. Neonatal medicine has already achieved great success in treating infants weighing 400 g or more at birth. However, lack of evidence and experience may make physicians reluctant to treat infants weighing less than this. The present case demonstrates that intact survival of a marginally viable male infant with a birth weight of <300 g is possible with minimal handling and family involvement beginning shortly after birth. Our detailed description of the clinical course of this case should provide invaluable information to physicians around the world who treat such infants. This report will aid in the progress of neonatal medicine and help to address many of the social and ethical issues surrounding their care.
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Affiliation(s)
- Takeshi Arimitsu
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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139
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Defining the Normal Growth Curve of Fetal Fractional Limb Volume in a Japanese Population. J Clin Med 2021; 10:jcm10030485. [PMID: 33572882 PMCID: PMC7866269 DOI: 10.3390/jcm10030485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/31/2022] Open
Abstract
Fetal fractional limb volume is a useful measure for predicting birth weight and newborn adiposity; however, a normal growth curve has been reported solely in the United States. As the birth weight of neonates in Japan is significantly lower than that in the US, fetal fractional limb volume is likely to be smaller in the Japanese population. This study aimed to define the normal growth curve of fractional arm volume (AVol) and thigh volume (TVol) in the Japanese population. Ultrasound scans of 453 AVol and TVol pairs were obtained; each AVol and TVol percentile at each gestational age was calculated. The measured AVol and TVol at each gestational week were also converted to z-scores based on a previous report. The growth curves increased linearly until the second trimester and exponentially in the third trimester. Linear regression showed a significant negative correlation between gestational age and AVol and TVol z-scores. The growth pattern of fetal fractional limb volume in the Japanese population is consistent with, but smaller than, that reported in the US; this difference becomes greater as the gestational age progresses.
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140
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Magawa S, Nii M, Ishida M, Takase S, Nakayama R, Enomoto N, Tanaka H, Kondo E, Sakuma H, Ikeda T. Evaluation of placental oxygenation index using blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) during normal late pregnancy. J Matern Fetal Neonatal Med 2021; 35:5274-5281. [PMID: 33491514 DOI: 10.1080/14767058.2021.1878140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM Noninvasive blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) has recently been used to evaluate placental oxygenation. However, this method still has unresolved problems, such as long testing times and lack of normal values set. In the present study, we used a shorter protocol in BOLD-MRI and established normal values for placental oxygenation in late pregnancy. METHODS We recruited 18 healthy singleton pregnant women (>32 weeks of gestation) who had a normal body size before pregnancy and a normal course of pregnancy. They underwent BOLD-MRI with three consecutive 4-min periods of different oxygenation: normoxia (21% O2), hyperoxia (10 L O2/min), and then normoxia. Placental time-activity curves were presented as signal intensity change relative to baseline (ΔR2*). The time from starting maternal oxygen administration to peak ΔR2*. To assess the relationship between peak ΔR2* values and placenta-related parameters and fetal development, the correlation between peak ΔR2*, placental weight, and neonatal birth weight was evaluated using Spearman's rank correlation test. RESULTS In all cases, the BOLD signal was elevated by maternal oxygen administration, with the peak resolving within 4 min after the end of oxygen administration. Peak ΔR2* and time to peak ΔR2* during oxygenation were 7.99 ± 2.58, and 458.1 ± 73.9 s, respectively. There was a significant correlation between peak ΔR2* and neonatal birth weight (percentile) (r = 0.537, p = .022), and between placental weight and neonatal birth weight (r = 0.769, p < .01). CONCLUSIONS In all cases, the BOLD signal increased with maternal hyperoxia using this protocol. So, 4 min observation following maternal oxygen administration is sufficient for peak ΔR2* evaluation. These reference values set in this study may be one of the indicators of BOLD signal changes in normal pregnancies after 32 weeks of gestation.
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Affiliation(s)
- Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Faculty Medicine, Mie, Japan
| | - Shinichi Takase
- Department of Radiology, Mie University Faculty Medicine, Mie, Japan
| | - Ryohei Nakayama
- Department of Electronic and Computer Engineering, Ritsumeikan University, Kyoto, Japan
| | - Naosuke Enomoto
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Faculty Medicine, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
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141
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Narai S, Kawashima-Sonoyama Y, Fujimoto M, Miura M, Adachi K, Nanba E, Namba N. Cord Blood from SGA Preterm Infants Exhibits Increased GLUT4 mRNA Expression. Yonago Acta Med 2021; 64:57-66. [PMID: 33642904 DOI: 10.33160/yam.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 01/02/2023]
Abstract
Background Insulin and insulin-like growth factor (IGF) signaling plays an important role in prenatal and postnatal growth and glucose metabolism. Both small-for-gestational age (SGA) and preterm infants have abnormal growth and glucose metabolism. However, the underlying mechanism remains unknown. Recently, we showed that term SGA infants have abnormal insulin/IGF signaling in cord blood. In this study, we examined whether preterm infants show similar aberrations in cord blood insulin/IGF signaling. Methods A total of 41 preterm cord blood samples were collected. Blood glucose, insulin, IGF-1, and C-peptide concentrations were measured, and mRNA expression of IGF1R, INSR, IRS1, IRS2, and SLC2A4 (i.e., GLUT4) was analyzed by quantitative reverse-transcription PCR. Results This study included 34 appropriate-for-gestational age (AGA) and 7 SGA preterm neonates. No hyperinsulinemia or any differences in IGF1R or INSR mRNA expression were detected between the two groups. However, GLUT4 mRNA levels were increased in preterm SGA. Moreover, the expression level in hypoglycemic preterm SGA was significantly higher than that in hypoglycemic preterm AGA. IRS2 mRNA expression did not show a statistically significant difference between preterm SGA and AGA neonates. Conclusion SGA preterm birth does not induce hyperinsulinemia; however, it modifies insulin/IGF signaling components such as GLUT4 in umbilical cord blood. Our study suggests that prematurity or adaptation to malnutrition alters the insulin/IGF signaling pathway.
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Affiliation(s)
- Satoshi Narai
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Yuki Kawashima-Sonoyama
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Masanobu Fujimoto
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Mazumi Miura
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
| | - Kaori Adachi
- Division of Functional Genomics, Research Center for Bioscience and Technology, Tottori University, Yonago 683-8503, Japan
| | - Eiji Nanba
- Division of Functional Genomics, Research Center for Bioscience and Technology, Tottori University, Yonago 683-8503, Japan
| | - Noriyuki Namba
- Division of Pediatrics and Perinatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan and
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142
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Hirashima C, Ohkuchi A, Sasaki K, Takahashi K, Suzuki H, Matsubara S, Matsuda Y. Low placental growth factor levels and high soluble endoglin levels at 26-31 weeks of gestation precede light placenta with and without relatively heavy infant, respectively: A retrospective cohort study. J Obstet Gynaecol Res 2021; 47:1040-1051. [PMID: 33401341 DOI: 10.1111/jog.14636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/19/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022]
Abstract
AIM Our aim was to examine whether serum levels of placental growth factor (PlGF) and soluble endoglin (sEng) at 19-25 and 26-31 weeks of gestation were associated with the occurrence of the 9-block categorization of placenta weight (PW) and fetal/placenta ratio (F/P ratio). METHODS We performed a retrospective cohort study in 1391 women with singleton pregnancy. Serum levels of PlGF and sEng were measured by enzyme immunosorbent assay. A light placenta was defined as PW ZS < -1.28 SD. Based on the PW (light, normal, and heavy) and F/P ratio (relatively heavy, balanced growth, and relatively small), 9-block categorization were performed. Multivariable logistic regression analyses were performed. RESULTS Low PlGF at 26-31 weeks was an independent risk factor for the birth of infants belonging to Block A (light placenta and relatively heavy infant), after adjusting for prepregnancy body mass index and serum levels of sEng. High sEng at 26-31 weeks was an independent risk factor for the birth of infants belonging to Block D (light placenta and balanced growth of infant), after adjusting for past history of either preeclampsia or gestational hypertension, high pulsatility index of uterine artery flow velocity waveforms in the second trimester, and serum level of PlGF. CONCLUSIONS Low PlGF levels at 26-31 weeks of gestation may precede a light placenta and relatively heavy infant (Block A), and high sEng levels at 26-31 weeks of gestation may precede a light placenta and balanced growth of infant (Block D).
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Affiliation(s)
- Chikako Hirashima
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kemal Sasaki
- Department of Food and Health Sciences, Jissen Women's University, Tokyo, Japan
| | - Kayo Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hirotada Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yoshio Matsuda
- Department of Obstetrics and Gynecology, Japan Community Health Care Organization (JCHO), Mishima General Hospital, Mishima-shi, Japan
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143
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Tamura N, Hanaoka T, Ito K, Araki A, Miyashita C, Ito S, Kobayashi S, Ito Y, Minakami H, Cho K, Endo T, Baba T, Sengoku K, Miyamoto T, Ogasawara K, Kishi R. Mediating Factors Between Parental Socioeconomic Status and Small for Gestational Age in Infants: Results from the Hokkaido Study on Environment and Children's Health. Matern Child Health J 2021; 25:645-655. [PMID: 33392928 DOI: 10.1007/s10995-020-03035-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Previous studies indicated a significant association between small for gestational age (SGA) in infants and their parents' socioeconomic status (SES). Thus, this study aimed to examine if parental factors, such as maternal smoking, and the pre-pregnancy body mass index (BMI) could mediate the associations between parental SES and SGA. METHODS The participants of this study were pregnant women who enrolled in an ongoing birth cohort study, the Hokkaido study, during the first trimester of their pregnancies. A total of 14,593 live singleton births were included in the statistical analysis, of which 1011 (6.9%) were SGA. Two structural equation models were employed to evaluate the associations between parental SES, parental characteristics, and SGA. RESULTS The effect of low SES on SGA was directly mediated by maternal pre-pregnancy BMI, smoking during the third trimester, and alcohol consumption during the first trimester in the first model, which was based the assumption of independent associations between mediating factors. In the second model, which additionally considered the mediating factors from the first model, smoking during pregnancy mediated decline in parental SES, consequently increased SGA. Moreover, an increase in pregnancy smoking status increased the prevalence of lower maternal pre-pregnancy BMI and its effect on SGA. CONCLUSIONS FOR PRACTICE In this study, we observed the independent mediating effect of maternal pre-pregnancy BMI, smoking, and alcohol consumption during pregnancy on low SES and, consequently, SGA, with the additional mediating pathway of SES to smoking to low BMI on SGA.
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Affiliation(s)
- Naomi Tamura
- Hokkaido University Center for Environmental and Health Sciences, Kita 12, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan.,Graduate School of Health Science, Hokkaido University, Sapporo, Japan.,Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Tomoyuki Hanaoka
- Hokkaido University Center for Environmental and Health Sciences, Kita 12, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Kumiko Ito
- Hokkaido University Center for Environmental and Health Sciences, Kita 12, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan.,Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Atsuko Araki
- Hokkaido University Center for Environmental and Health Sciences, Kita 12, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan.,Graduate School of Health Science, Hokkaido University, Sapporo, Japan
| | - Chihiro Miyashita
- Hokkaido University Center for Environmental and Health Sciences, Kita 12, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Sachiko Ito
- Hokkaido University Center for Environmental and Health Sciences, Kita 12, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Sumitaka Kobayashi
- Hokkaido University Center for Environmental and Health Sciences, Kita 12, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Yoichi Ito
- Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Hisanori Minakami
- Departments of Obstetrics and Gynecology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazutoshi Cho
- Departments of Obstetrics and Gynecology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Endo
- Departments of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Tsuyoshi Baba
- Departments of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kazuo Sengoku
- Departments of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
| | - Toshinobu Miyamoto
- Departments of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan
| | | | - Reiko Kishi
- Hokkaido University Center for Environmental and Health Sciences, Kita 12, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan.
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144
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Go H, Ohto H, Nollet KE, Sato K, Miyazaki K, Maeda H, Ichikawa H, Chishiki M, Kashiwabara N, Kume Y, Ogasawara K, Sato M, Hosoya M. Biomarker Potential of the Soluble Receptor for Advanced Glycation End Products to Predict Bronchopulmonary Dysplasia in Premature Newborns. Front Pediatr 2021; 9:649526. [PMID: 33996692 PMCID: PMC8116889 DOI: 10.3389/fped.2021.649526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a common cause of pulmonary disease in preterm infants. The soluble receptor for advanced glycation end products (sRAGE) is implicated in the development of various pulmonary diseases. The objectives of the current study were to investigate perinatal factors associated with serum sRAGE levels at birth and to establish whether serum sRAGE could be a biomarker for BPD. This retrospective single-center study was conducted at Fukushima Medical University Hospital's Department of Pediatrics Neonatal Intensive Care Unit from April 2014 to September 2020. Mechanically ventilated or oxygenated neonates born at <32 weeks gestational age and healthy control neonates were included in this study. Serum sRAGE levels in cord blood were measured using an enzyme-linked immunosorbent assay. Eighty-four preterm infants born at <32 weeks and 40 healthy infants were identified. The 84 born at <32 weeks were categorized as BPD (n = 34) or non-BPD (n = 50) neonates. The median gestational age (GA) and birthweight (BW) were significantly lower in BPD vs. non-BPD neonates (24.4 vs. 27.6 weeks, P < 0.001, 634 vs. 952 g, P < 0.001, respectively). Serum sRAGE at birth in all 124 preterm and term infants significantly correlated with BW (r = 0.417, P < 0.0001) and GA (r = 0.415, P < 0.0001). Among those born at <32 weeks, median serum sRAGE levels at birth were significantly lower in infants with BPD than without (1,726 vs. 2,797 pg/mL, P = 0.0005). Receiver operating characteristic analysis for sRAGE levels at birth in infants with and without BPD revealed that the area under the curve was 0.724 (95% confidence interval 0.714-0.834, P = 0.001). However, serum RAGE levels were not associated with severity of BPD. Serum sRAGE levels at birth were significantly correlated with BW and GA. Furthermore, serum sRAGE levels at birth could serve as a biomarker for predicting BPD, but not its severity.
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Affiliation(s)
- Hayato Go
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | | | - Kenneth E Nollet
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenichi Sato
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kyohei Miyazaki
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hajime Maeda
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hirotaka Ichikawa
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mina Chishiki
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nozomi Kashiwabara
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yohei Kume
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kei Ogasawara
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Maki Sato
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
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145
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Ozawa J, Tanaka K, Kabe K, Namba F. Impact of being large-for-gestational-age on neonatal mortality and morbidities in extremely premature infants. Pediatr Res 2021; 90:910-916. [PMID: 33504968 PMCID: PMC7838861 DOI: 10.1038/s41390-021-01375-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/18/2020] [Accepted: 12/25/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Small for gestational age (SGA) infants have an increased risk for neonatal mortality and morbidities. However, few studies have examined the risk of large for gestational age (LGA) on these factors. We compared the risk of mortality and morbidities in LGA premature infants with those of appropriate for gestational age (AGA) infants. METHODS Premature infants who were born between 2003 and 2012 at <26 weeks of gestational age were included. Relative risks of mortality and morbidities were evaluated between LGA and AGA infants. RESULTS From 6898 extremely premature infants, 357 (5.2%), 5530 (80.2%), and 1011 (14.7%) were LGA, AGA, and SGA, respectively. A total of 5887 infants (5530 AGA and 357 LGA) were examined after excluding infants with congenital anomalies, unknown sex, and deficient data. The risk of mortality in LGA and AGA infants did not differ (relative risk (95% confidence interval) 1.04 (0.83-1.32)). Compared to AGA infants, LGA infants did not increase the risk of morbidities, including intraventricular hemorrhage, cystic periventricular leukomalacia, treated retinopathy of prematurity, necrotizing enterocolitis, and bronchopulmonary dysplasia. CONCLUSIONS This study demonstrates that being born LGA does not correlate with an increased risk of mortality and morbidities in extremely premature infants. IMPACT It is currently unknown if being large for gestational age is a risk for neonatal morbidity. A total of 6898 preterm infants born <26 weeks gestational age were included in the study. It was found that being large for gestational age was not related to increased risk of mortality and morbidities.
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Affiliation(s)
- Junichi Ozawa
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama Japan
| | - Kosuke Tanaka
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama Japan
| | - Kazuhiko Kabe
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
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146
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Onuma S, Ida S, Maeyama T, Shoji Y, Etani Y, Kawai M. Growth hormone treatment for extremely low birthweight children born small for gestational age. Pediatr Int 2021; 63:46-52. [PMID: 32594610 DOI: 10.1111/ped.14363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The effectiveness of growth hormone (GH) treatment for height gain in short-stature children born small for gestational age (SGA) with extremely low birthweight (ELBW; birthweight <1,000 g) remains largely unknown. METHODS In study 1, 35 prepubertal Japanese children born SGA with ELBW were categorized into three groups based on the presence or absence of catch-up growth by age 3 (CU(+) and CU(-), respectively) and GH treatment (GH(+) and GH(-), respectively). Height standard deviation (SD) scores (HT-SDS) in the CU-/GH+ group (n = 19) were compared with those in the age-matched CU+/GH- (n = 9) and CU-/GH- groups (n = 7). In study 2, 66 prepubertal Japanese SGA children treated with GH were divided into three groups by birthweight: <1,000 g (n = 19), 1,000-2,000 g (n = 20), and >2,000 g (n = 27). Changes in HT-SDS during the initial 3 years of GH treatment were compared among the three groups. RESULTS In study 1, the mean HT-SDS in the CU-/GH+ group (-1.15 SD) was similar to that in the CU+/GH- group (-1.39 SD) but higher than that in the CU-/GH- group (-2.24 SD). In study 2, GH achieved a height gain of +1.62 SD in the ELBW group, which was similar to that in the other groups (1,000-2,000 g: +1.46 SD, >2,000 g: +1.53 SD). CONCLUSIONS Growth hormone treatment in short-stature children born SGA with ELBW increased HT-SDS, which was similar to that in SGA children born with a birthweight ≥1,000 g. These results indicate that GH treatment may be an effective approach to promote adequate growth recovery for short-stature children born SGA with ELBW.
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Affiliation(s)
- Shinsuke Onuma
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Shinobu Ida
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Takatoshi Maeyama
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yasuko Shoji
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yuri Etani
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanobu Kawai
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan.,Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Osaka, Japan
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147
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Kasuga Y, Kawai T, Miyakoshi K, Saisho Y, Tamagawa M, Hasegawa K, Ikenoue S, Ochiai D, Hida M, Tanaka M, Hata K. Epigenetic Changes in Neonates Born to Mothers With Gestational Diabetes Mellitus May Be Associated With Neonatal Hypoglycaemia. Front Endocrinol (Lausanne) 2021; 12:690648. [PMID: 34267729 PMCID: PMC8276691 DOI: 10.3389/fendo.2021.690648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/01/2021] [Indexed: 12/28/2022] Open
Abstract
The detection of epigenetic changes associated with neonatal hypoglycaemia may reveal the pathophysiology and predict the onset of future diseases in offspring. We hypothesized that neonatal hypoglycaemia reflects the in utero environment associated with maternal gestational diabetes mellitus. The aim of this study was to identify epigenetic changes associated with neonatal hypoglycaemia. The association between DNA methylation using Infinium HumanMethylation EPIC BeadChip and neonatal plasma glucose (PG) level at 1 h after birth in 128 offspring born at term to mothers with well-controlled gestational diabetes mellitus was investigated by robust linear regression analysis. Cord blood DNA methylation at 12 CpG sites was significantly associated with PG at 1 h after birth after adding infant sex, delivery method, gestational day, and blood cell compositions as covariates to the regression model. DNA methylation at two CpG sites near an alternative transcription start site of ZNF696 was significantly associated with the PG level at 1 h following birth (false discovery rate-adjusted P < 0.05). Methylation levels at these sites increased as neonatal PG levels at 1 h after birth decreased. In conclusion, gestational diabetes mellitus is associated with DNA methylation changes at the alternative transcription start site of ZNF696 in cord blood cells. This is the first report of DNA methylation changes associated with neonatal PG at 1 h after birth.
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Affiliation(s)
- Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Tomoko Kawai
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan
- *Correspondence: Kenichiro Hata, ; Tomoko Kawai,
| | - Kei Miyakoshi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Saisho
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masumi Tamagawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Keita Hasegawa
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Daigo Ochiai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Mariko Hida
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Research Institute for Child Health and Development, Tokyo, Japan
- *Correspondence: Kenichiro Hata, ; Tomoko Kawai,
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148
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Inadera H, Takamori A, Matsumura K, Tsuchida A, Cui ZG, Hamazaki K, Tanaka T, Ito M, Kigawa M, Origasa H, Michikawa T, Nakayama SF, Isobe T, Takeuchi A, Sato T, Nitta H, Yamazaki S. Association of blood cadmium levels in pregnant women with infant birth size and small for gestational age infants: The Japan Environment and Children's study. ENVIRONMENTAL RESEARCH 2020; 191:110007. [PMID: 32768474 DOI: 10.1016/j.envres.2020.110007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is growing evidence of an association between cadmium (Cd) and unfavorable birth outcomes. The effect of Cd exposure on anthropometric measures at birth or small for gestational age (SGA) infants in a large, nationwide Japanese cohort remains to be clarified. OBJECTIVES To analyze the association between maternal blood Cd levels at different sampling times and sex-dependent infant birth size, weight, body length, chest, and head circumferences, in addition to SGA. METHODS Data of 17,584 pregnant women in the Japan Environment and Children's Study were analyzed for anthropometric measurements. For SGA determination, 13,969 cases of vaginal delivery were analyzed after excluding infants born by cesarean section. Maternal blood Cd levels were categorized into quartiles (Q1-Q4), and the Q1 was used as a reference. Multiple linear regression analysis was performed for anthropometric measurements, and multiple logistic regression analysis was used to investigate the association of maternal blood Cd levels with the risk of SGA. RESULTS Birth weight tended to decrease according to the increase in quartiles of blood Cd levels (15.63 g decrease [95% confidence level (CI): -33.26, 2.01] for Q4). The overall analysis revealed no decreases in body length and head and chest circumference, but subgroup analysis revealed that chest circumference tended to decrease according to the increase in quartiles in the female sex/third-trimester stratification (0.16 cm decrease [95% CI: -0.32, 0.00] for Q4). SGA risk was also higher and paralleled the increase in blood Cd levels associated with the female sex/third-trimester group (Odds Ratio 1.90 [95% CI: 1.23, 2.94] for Q4). CONCLUSION Our results provide further evidence of sex-specific health risks associated with Cd exposure in early life in a large Japanese pregnancy cohort.
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Affiliation(s)
- Hidekuni Inadera
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan; Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | - Ayako Takamori
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan; Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Kenta Matsumura
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | - Akiko Tsuchida
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan; Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | - Zheng-Guo Cui
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kei Hamazaki
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan; Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | - Tomomi Tanaka
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan; Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Mika Ito
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Mika Kigawa
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan; Department of Liberal Arts and Human Development, Kanagawa University of Human Services, Yokosuka, Japan
| | - Hideki Origasa
- Department of Biostatistics and Clinical Epidemiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Takehiro Michikawa
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
| | - Shoji F Nakayama
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
| | - Tomohiko Isobe
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
| | - Ayano Takeuchi
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - Tosiya Sato
- Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Hiroshi Nitta
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan
| | - Shin Yamazaki
- Japan Environment and Children's Study Programme Office, National Institute for Environmental Studies, Tsukuba, Japan.
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149
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Maeyama T, Ida S, Onuma S, Shoji Y, Yamamoto T, Etani Y, Kawai M. Fat distribution in short-stature children born small for gestational age. Pediatr Int 2020; 62:1351-1356. [PMID: 32521070 DOI: 10.1111/ped.14337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/08/2020] [Accepted: 06/04/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Children born small for gestational age (SGA) with catch-up growth are at high risk for developing obesity; however, the characteristics of body composition, especially fat distribution, before and after growth hormone (GH) treatment in SGA children without catch-up growth remains largely unknown. METHODS Anthropometric characteristics, body composition by dual-energy X-ray absorption, and fat distribution by computed tomography at the umbilical level were examined in 27 prepubertal short-stature children born SGA before and 1 year after GH treatment. RESULTS Before GH treatment, short-stature SGA children had lean phenotypes, and both visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were significantly lower than the age- and sex-matched Japanese reference values. Growth hormone treatment significantly increased height standard deviation scores (SDS), without affecting body mass index SDS. Percentage fat mass decreased with GH treatment; however, fat mass was not altered. Both VAT and SAT were significantly lower than the reference values after GH treatment. The ratio of VAT over SAT significantly increased by GH treatment. CONCLUSIONS Both VAT and SAT were within or below the age- and sex-matched Japanese reference values in short-stature children born SGA before and after GH treatment, indicating that GH treatment may not have unfavorable effects on adiposity in short-stature children born SGA, although it may alter fat distribution.
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Affiliation(s)
- Takatoshi Maeyama
- Department of Gastroenterology Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Shinobu Ida
- Department of Gastroenterology Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Shinsuke Onuma
- Department of Gastroenterology Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Yasuko Shoji
- Department of Gastroenterology Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Takehisa Yamamoto
- Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Yuri Etani
- Department of Gastroenterology Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Masanobu Kawai
- Department of Gastroenterology Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.,Department of Pediatrics, Minoh City Hospital, Minoh, Osaka, Japan
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150
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Gestational weight gain and foetal acidosis in vaginal and caesarean deliveries: The Japan Environment and Children's Study. Sci Rep 2020; 10:20389. [PMID: 33230184 PMCID: PMC7683683 DOI: 10.1038/s41598-020-77429-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022] Open
Abstract
Inappropriate gestational weight gain (GWG), either above or below the recommended values, has been associated with an increased risk of adverse obstetric outcomes. To evaluate the risks of GWG for foetal acidosis according to pre-pregnancy body mass index (BMI) and mode of delivery, we analysed women with singleton pregnancies between 2011 and 2014 in the Japan Environment and Children’s Study. Participants (n = 71,799) were categorised according to pre-pregnancy BMI. GWG was categorised into insufficient, appropriate, or excessive. Foetal acidosis was defined as umbilical artery pH (UmA-pH) < 7.20 or < 7.10. Multiple logistic regressions were performed for each BMI category to identify the risks of GWG for foetal acidosis, accounting for the mode of delivery. Excessive GWG was significantly associated with increased foetal acidosis in overweight women and in women whose pre-pregnancy BMI was 23.0–25.0 kg/m2 especially in those with vaginal deliveries. Conversely, excessive GWG was not significantly associated with increased foetal acidosis in obese women and in women whose pre-pregnancy BMI was ≥ 25.0 kg/m2.
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