1
|
Dermitzakis I, Theotokis P, Axarloglou E, Delilampou E, Manthou ME, Meditskou S. Effects of hazardous chemicals on secondary sex ratio: A comprehensive review. CHEMOSPHERE 2024; 361:142467. [PMID: 38810798 DOI: 10.1016/j.chemosphere.2024.142467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/15/2024] [Accepted: 05/26/2024] [Indexed: 05/31/2024]
Abstract
The secondary sex ratio (SSR), defined as the ratio of male to female offspring at birth, has garnered significant scientific interest due to its potential impact on population dynamics and evolution. In recent years, there has been a growing concern regarding the potential consequences of environmental chemicals on the SSR, given their widespread exposure and potential enduring ramifications on the reproductive system. While SSR serves as an indicator of health, ongoing research and scientific inquiry are being conducted to explore the potential relationship between chemicals and offspring ratio. Although some studies have suggested a possible correlation, others have yielded inconclusive results, indicating that the topic is intricate and still needs to be elucidated. The precise mechanism by which chemical agents exert their influence on the SSR remains ambiguous, with disruption of the endocrine system being a prominent justification. In light of the complex interplay between chemical exposure and SSR, the present review aims to comprehensively examine and synthesize existing scientific literature to gain a deeper understanding of how specific chemical exposures may impact SSR. Insights into chemical hazards that shift SSR patterns or trends could guide prevention strategies, including legislative bans of certain chemicals, to minimize environmental and public health risks.
Collapse
Affiliation(s)
- Iasonas Dermitzakis
- Department of Histology-Embryology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Paschalis Theotokis
- Department of Histology-Embryology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Evangelos Axarloglou
- Department of Histology-Embryology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Efthymia Delilampou
- Department of Histology-Embryology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Maria Eleni Manthou
- Department of Histology-Embryology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Soultana Meditskou
- Department of Histology-Embryology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| |
Collapse
|
2
|
Schrenk D, Bignami M, Bodin L, Chipman JK, del Mazo J, Grasl‐Kraupp B, Hogstrand C, (Ron) Hoogenboom L, Leblanc J, Nebbia CS, Nielsen E, Ntzani E, Petersen A, Sand S, Schwerdtle T, Wallace H, Benford D, Fürst P, Hart A, Rose M, Schroeder H, Vrijheid M, Ioannidou S, Nikolič M, Bordajandi LR, Vleminckx C. Update of the risk assessment of polybrominated diphenyl ethers (PBDEs) in food. EFSA J 2024; 22:e8497. [PMID: 38269035 PMCID: PMC10807361 DOI: 10.2903/j.efsa.2024.8497] [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] [Indexed: 01/26/2024] Open
Abstract
The European Commission asked EFSA to update its 2011 risk assessment on polybrominated diphenyl ethers (PBDEs) in food, focusing on 10 congeners: BDE-28, -47, -49, -99, -100, -138, -153, -154, -183 and ‑209. The CONTAM Panel concluded that the neurodevelopmental effects on behaviour and reproductive/developmental effects are the critical effects in rodent studies. For four congeners (BDE-47, -99, -153, -209) the Panel derived Reference Points, i.e. benchmark doses and corresponding lower 95% confidence limits (BMDLs), for endpoint-specific benchmark responses. Since repeated exposure to PBDEs results in accumulation of these chemicals in the body, the Panel estimated the body burden at the BMDL in rodents, and the chronic intake that would lead to the same body burden in humans. For the remaining six congeners no studies were available to identify Reference Points. The Panel concluded that there is scientific basis for inclusion of all 10 congeners in a common assessment group and performed a combined risk assessment. The Panel concluded that the combined margin of exposure (MOET) approach was the most appropriate risk metric and applied a tiered approach to the risk characterisation. Over 84,000 analytical results for the 10 congeners in food were used to estimate the exposure across dietary surveys and age groups of the European population. The most important contributors to the chronic dietary Lower Bound exposure to PBDEs were meat and meat products and fish and seafood. Taking into account the uncertainties affecting the assessment, the Panel concluded that it is likely that current dietary exposure to PBDEs in the European population raises a health concern.
Collapse
|
3
|
Barr KJ, Johnson CL, Cohen J, D’Souza P, Gallegos EI, Tsai CC, Dunlop AL, Corwin EJ, Barr DB, Ryan PB, Panuwet P. Legacy Chemical Pollutants in House Dust of Homes of Pregnant African Americans in Atlanta. TOXICS 2022; 10:toxics10120755. [PMID: 36548588 PMCID: PMC9784423 DOI: 10.3390/toxics10120755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/19/2022] [Accepted: 11/25/2022] [Indexed: 05/09/2023]
Abstract
We developed and applied a method for measuring selected persistent organic pollutants (POPs) (i.e., polybrominated diphenyl ethers (PBDEs), organochlorine pesticides, and polychlorinated biphenyls (PCBs)) in dust collected from pregnant African Americans (AAs) in Atlanta using isotope dilution gas chromatography-tandem mass spectrometry. Limits of quantification were ranged from 0.10 to 2.50 ng/g dust. NIST standard reference material measurements demonstrated the robustness of our method. Our accuracies ranged from 82 to 108%, relative standard deviations ranged from 2 to 16%, and extraction recoveries ranged from 76 to 102%. We measured POPs in dust collected from 34 homes of pregnant AAs participating in the Atlanta AA birth cohort study who were enrolled from 2016 to 2019. Concentrations of POPs were detected in all samples with the frequencies of detection ranging from 8 to 100%. Concentrations of PBDE congeners 99 and 47, p,p'-DDT, and PCB153 were detected at some of the highest concentrations with geometric means of 1270, 730, 63.4 and 240 ng/g, respectively. The ratio of DDT/DDE was quite large (~2.7) indicating that p,p'-DDT remains intact in homes for long periods of time. These data demonstrate that care should be taken to remediate POPs in indoor dust, especially in vulnerable, disparate segments of the population.
Collapse
Affiliation(s)
- Kathryn J. Barr
- Department of Environmental Sciences, College of Arts and Sciences, Emory University, Atlanta, GA 30322, USA
| | - Cierra L. Johnson
- Laboratory of Exposure Assessment and Development for Environmental Research, Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Jordan Cohen
- Laboratory of Exposure Assessment and Development for Environmental Research, Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Priya D’Souza
- Laboratory of Exposure Assessment and Development for Environmental Research, Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | | | - Chia-Chen Tsai
- Laboratory of Exposure Assessment and Development for Environmental Research, Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Anne L. Dunlop
- Division of Preventive Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | | | - Dana Boyd Barr
- Laboratory of Exposure Assessment and Development for Environmental Research, Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - P. Barry Ryan
- Laboratory of Exposure Assessment and Development for Environmental Research, Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Parinya Panuwet
- Laboratory of Exposure Assessment and Development for Environmental Research, Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- Correspondence:
| |
Collapse
|
4
|
Fucic A, Duca RC, Galea KS, Maric T, Garcia K, Bloom MS, Andersen HR, Vena JE. Reproductive Health Risks Associated with Occupational and Environmental Exposure to Pesticides. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126576. [PMID: 34207279 PMCID: PMC8296378 DOI: 10.3390/ijerph18126576] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/07/2021] [Accepted: 06/14/2021] [Indexed: 02/07/2023]
Abstract
A marked reduction in fertility and an increase in adverse reproductive outcomes during the last few decades have been associated with occupational and environmental chemical exposures. Exposure to different types of pesticides may increase the risks of chronic diseases, such as diabetes, cancer, and neurodegenerative disease, but also of reduced fertility and birth defects. Both occupational and environmental exposures to pesticides are important, as many are endocrine disruptors, which means that even very low-dose exposure levels may have measurable biological effects. The aim of this review was to summarize the knowledge collected between 2000 and 2020, to highlight new findings, and to further interpret the mechanisms that may associate pesticides with infertility, abnormal sexual maturation, and pregnancy complications associated with occupational, environmental and transplacental exposures. A summary of current pesticide production and usage legislation is also included in order to elucidate the potential impact on exposure profile differences between countries, which may inform prevention measures. Recommendations for the medical surveillance of occupationally exposed populations, which should be facilitated by the biomonitoring of reduced fertility, is also discussed.
Collapse
Affiliation(s)
- Aleksandra Fucic
- Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia
- Correspondence: ; Tel.: +385-15682500; Fax: +3814673303
| | - Radu C. Duca
- Unit Environmental Hygiene and Human Biological Monitoring, Department of Health Protection, National Health Laboratory, L-3555 Dudelange, Luxembourg;
- Centre for Environment and Health, KU Leuven, 3001 Leuven, Belgium
| | - Karen S. Galea
- Institute of Occupational Medicine, Edinburgh EH14 4AP, UK;
| | - Tihana Maric
- Medical School, University of Zagreb, 10000 Zagreb, Croatia;
| | - Kelly Garcia
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA; (K.G.); (M.S.B.)
| | - Michael S. Bloom
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA; (K.G.); (M.S.B.)
| | - Helle R. Andersen
- Department of Public Health, University of Southern Denmark, DK-5000 Odense C, Denmark;
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA;
| |
Collapse
|
5
|
Varakina Y, Lahmanov D, Aksenov A, Trofimova A, Korobitsyna R, Belova N, Sobolev N, Kotsur D, Sorokina T, Grjibovski AM, Chashchin V, Thomassen Y. Concentrations of Persistent Organic Pollutants in Women's Serum in the European Arctic Russia. TOXICS 2021; 9:6. [PMID: 33430444 PMCID: PMC7828080 DOI: 10.3390/toxics9010006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 12/30/2022]
Abstract
Persistent organic pollutants (POPs) are heterogeneous carbon-based compounds that can seriously affect human health. The aim of this study was to measure serum concentrations of POPs in women residing in the Euro-Arctic Region of Russia. A total of 204 women from seven rural settlements of the Nenets Autonomous Okrug (NAO) took part in the study. We measured serum concentrations of 11 polychlorinated biphenyls (PCBs) and 17 organochlorine pesticides (OCPs) across the study sites and among Nenets and non-Nenets residents. Measurement of POPs was performed using an Agilent 7890A gas chromatograph equipped with an Agilent 7000 series MS/MS triple quadrupole system. The concentrations of all POPs were low and similar to findings from other Arctic countries. However, significant geographic differences between the settlements were observed with exceptionally high concentrations of PCBs in Varnek located on Vaygach Island. Both ΣDDT (p = 0.011) and ΣPCB (p = 0.038) concentrations were significantly lower in Nenets. Our main findings suggest that the serum concentrations of the legacy POPs in women in the Euro-Arctic Region of Russia are low and similar to those in other Arctic countries. Significant variations between settlements, and between Nenets and non-Nenets residents, were found. Arctic biomonitoring research in Russia should include studies on the associations between nutrition and concentrations of POPs.
Collapse
Affiliation(s)
- Yulia Varakina
- Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named after M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia; (D.L.); (A.A.); (A.T.); (R.K.); (N.B.); (N.S.); (D.K.); (T.S.); (V.C.); (Y.T.)
| | - Dmitry Lahmanov
- Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named after M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia; (D.L.); (A.A.); (A.T.); (R.K.); (N.B.); (N.S.); (D.K.); (T.S.); (V.C.); (Y.T.)
| | - Andrey Aksenov
- Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named after M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia; (D.L.); (A.A.); (A.T.); (R.K.); (N.B.); (N.S.); (D.K.); (T.S.); (V.C.); (Y.T.)
| | - Anna Trofimova
- Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named after M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia; (D.L.); (A.A.); (A.T.); (R.K.); (N.B.); (N.S.); (D.K.); (T.S.); (V.C.); (Y.T.)
| | - Rimma Korobitsyna
- Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named after M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia; (D.L.); (A.A.); (A.T.); (R.K.); (N.B.); (N.S.); (D.K.); (T.S.); (V.C.); (Y.T.)
| | - Natalia Belova
- Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named after M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia; (D.L.); (A.A.); (A.T.); (R.K.); (N.B.); (N.S.); (D.K.); (T.S.); (V.C.); (Y.T.)
- Central Scientific Research Laboratory, Northern State Medical University of the Ministry of Healthcare of the Russian Federation, Troitskiy Ave. 51, 163000 Arkhangelsk, Russia;
| | - Nikita Sobolev
- Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named after M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia; (D.L.); (A.A.); (A.T.); (R.K.); (N.B.); (N.S.); (D.K.); (T.S.); (V.C.); (Y.T.)
| | - Dmitry Kotsur
- Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named after M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia; (D.L.); (A.A.); (A.T.); (R.K.); (N.B.); (N.S.); (D.K.); (T.S.); (V.C.); (Y.T.)
- N. Laverov Federal Center for Integrated Arctic Research, Ural Branch of the Russian Academy of Sciences, Naberezhnaya Severnoy Dvini 23, 163000 Arkhangelsk, Russia
| | - Tatiana Sorokina
- Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named after M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia; (D.L.); (A.A.); (A.T.); (R.K.); (N.B.); (N.S.); (D.K.); (T.S.); (V.C.); (Y.T.)
| | - Andrej M. Grjibovski
- Central Scientific Research Laboratory, Northern State Medical University of the Ministry of Healthcare of the Russian Federation, Troitskiy Ave. 51, 163000 Arkhangelsk, Russia;
- Department of Health Policy and Management, Al-Farabi Kazakh National University, Almay 050040, Kazakhstan
- Department of Epidemiology and Modern Vaccination Technologies, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- West Kazakhstan Marat Ospanov Medical University, Aktobe 0300190, Kazakhstan
| | - Valery Chashchin
- Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named after M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia; (D.L.); (A.A.); (A.T.); (R.K.); (N.B.); (N.S.); (D.K.); (T.S.); (V.C.); (Y.T.)
- North-Western State Medical University Named after I.I. Mechnikov, Kirochnaya ul. 41, 191015 Saint-Petersburg, Russia
- Institute of Ecology, National Research University Higher School of Economics, Myasnitskaya Str. 20, 101000 Moscow, Russia
| | - Yngvar Thomassen
- Arctic Biomonitoring Laboratory, Northern (Arctic) Federal University Named after M. V. Lomonosov, Naberezhnaya Severnoy Dvini 17, 163002 Arkhangelsk, Russia; (D.L.); (A.A.); (A.T.); (R.K.); (N.B.); (N.S.); (D.K.); (T.S.); (V.C.); (Y.T.)
- Institute of Ecology, National Research University Higher School of Economics, Myasnitskaya Str. 20, 101000 Moscow, Russia
- National Institute of Occupational Health, Gydas vei 8, N-0304 Oslo, Norway
| |
Collapse
|
6
|
Bae J. Effects of Socio-demographic Factors on the Decreasing Trend in the Sex Ratio at Birth in Korea, 1997-2017. J Prev Med Public Health 2020; 53:371-380. [PMID: 33070509 PMCID: PMC7569017 DOI: 10.3961/jpmph.20.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/21/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study investigated the effects of socio-demographic factors on the decreasing trend in the sex ratio at birth from 1997 to 2017 in Korea. METHODS Data from 10 349 602 live births registered with Statistics Korea from 1997 to 2017 were analyzed. The secondary sex ratio (SSR), defined as the ratio of male to female live births, during the study period (1997-1999 [phase I], 2000-2002 [phase II], 2003-2005 [phase III], 2006-2008 [phase IV], 2009-2011 [phase V], 2012-2014 [phase VI], and 2015-2017 [phase VII]) was calculated according to selected socio-demographic factors, such as parental age, education, occupation, and birth order. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals for a male birth after adjusting for potential confounders. RESULTS The SSR gradually decreased from 1.10 (in 1998-2000 and 2002) to 1.05 (in 2013-2016). While a decreasing trend in the SSR was not noted among first births, male-biased sex ratios were prominent among third and higher-order births, for which the highest SSR was 1.46 in 1998. Higher birth order was significantly associated with an excess of male births in phases I-VI (≥third vs. first, OR range, 1.03 to 1.35). Advanced maternal age was significantly associated with an excess of female births in phases II, III, and V (≥40 vs. 20-24 years, OR range, 0.92 to 0.95). CONCLUSIONS This study demonstrated that advanced maternal age and reduction of the artificially-biased SSR among third and higher-order births may partially explain the decreasing trend in the SSR from 1997 to 2017 in Korea.
Collapse
Affiliation(s)
- Jisuk Bae
- Department of Preventive Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| |
Collapse
|
7
|
Adachi S, Sawaki J, Tokuda N, Tanaka H, Sawai H, Takeshima Y, Shibahara H, Shima M. Paternal occupational exposure to chemicals and secondary sex ratio: results from the Japan Environment and Children's Study. Lancet Planet Health 2019; 3:e529-e538. [PMID: 31868601 DOI: 10.1016/s2542-5196(19)30239-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Declining proportions of male births have been reported in several industrialised countries. Previous reports have shown that exposure to certain chemical substances might influence the secondary sex ratio (SSR). We assessed the associations between paternal occupational exposure to chemicals and the SSR of their children using the Japan Environment and Children's Study (JECS), a large-scale birth cohort study. METHODS Data on paternal occupational exposure to various agents and other covariates were collected using a self-administered questionnaire to partners of pregnant female participants enrolled in the JECS. After adjusting for potential confounders, multivariable modified Poisson regression models were used to evaluate associations between paternal occupational exposures and the SSR of their children. This study was registered in the UMIN Clinical Trials Registry, number UMIN000030786. FINDINGS The JECS study gathered data on 103 062 pregnancies, 104 065 fetuses, and 51 898 partners of pregnant women. Among 50 283 children with data on paternal occupational exposures, 25 657 were male and 24 626 were female. The proportion of boys whose fathers were regularly occupationally exposed to insecticides was 0·445 (males, n=293; females, n=366; 95% CI 0·406-0·483), which was lower than the proportion of boys whose fathers were not exposed to insecticides. After adjusting for confounding factors, regular paternal occupational exposure to insecticides (adjusted relative risk 0·86, 95% CI 0·78-0·96) and medical disinfectants (0·95, 0·90-1·00) were significantly associated with lower SSRs among their offspring compared with the offspring of fathers not exposed to these substances. INTERPRETATION A declining proportion of boys could potentially be due to fathers working in environments in which they are exposed to chemicals. The associations between poorer semen quality and levels of reproductive and thyroid hormones require investigation. FUNDING Ministry of the Environment of Japan.
Collapse
Affiliation(s)
- Sho Adachi
- Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan; Department of Public Health, Hyogo College of Medicine, Nishinomiya, Japan
| | - Junko Sawaki
- Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan
| | - Narumi Tokuda
- Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroyuki Tanaka
- Department of General Medicine and Community Health Science, Sasayama Medical Center, Sasayama, Japan
| | - Hideaki Sawai
- Department of Clinical Genetics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yasuhiro Takeshima
- Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan; Department of Pediatrics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroaki Shibahara
- Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan; Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masayuki Shima
- Hyogo Regional Center for the Japan Environment and Children's Study, Hyogo College of Medicine, Nishinomiya, Japan; Department of Public Health, Hyogo College of Medicine, Nishinomiya, Japan.
| |
Collapse
|