Center for Maternal Fetal and Neonatal Medicine

Tokyo, Japan

Center for Maternal Fetal and Neonatal Medicine

Tokyo, Japan

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Jwa S.C.,National Health Research Institute | Jwa S.C.,Chiba University | Fujiwara T.,National Health Research Institute | Hata A.,Chiba University | And 2 more authors.
BMC Public Health | Year: 2013

Background: Research investigating the association between socioeconomic status (SES) and blood pressure (BP) during pregnancy is limited and its underlying pathway is unknown. The aim of this study was to investigate the mediators of the association between educational level as an indicator of the SES and BP in early and mid-pregnancy among Japanese women. Methods. Nine hundred and twenty-three pregnant women in whom BP was measured before 16 weeks and at 20 weeks of gestation were enrolled in this study. Maternal educational levels were categorized into three groups: high (university or higher), mid (junior college), and low (junior high school, high school, or vocational training school). Results: The low educational group had higher systolic (low vs. high, difference = 2.39 mmHg, 95% confidence interval [CI]: 0.59 to 4.19) and diastolic BP levels (low vs. high, difference = 0.74 mmHg, 95% CI: -0.52 to 1.99) in early pregnancy. However, the same associations were not found after adjustment for pre-pregnancy body mass index (BMI). BP reduction was observed in mid-pregnancy in all three educational groups and there was no association between educational level and pregnancy-induced hypertension. Conclusion: In Japanese women, the low educational group showed higher BP during pregnancy than the mid or high educational groups. Pre-pregnancy BMI mediates the association between educational level and BP. © 2013 Jwa et al.; licensee BioMed Central Ltd.


Egawa M.,Center for Maternal Fetal and Neonatal Medicine | Hayashi S.,Center for Maternal Fetal and Neonatal Medicine | Yang L.,National Childrens Medical Research Center | Sakamoto N.,National Childrens Medical Research Center | Sago H.,Center for Maternal Fetal and Neonatal Medicine
Prenatal Diagnosis | Year: 2013

Objective: The purpose of our study was to investigate the incidence of chorioamniotic membrane separation (CMS) after fetoscopic laser surgery and the association between CMS and preterm premature rupture of membranes (pPROM). We also analyzed the risk factors associated with the occurrence of CMS. Method: Retrospective cohort study of 148 patients with twin-twin transfusion syndrome who underwent laser surgery at our institution from March 2003 to December 2009. Results: Chorioamniotic membrane separation occurred in 29 of 148 (19.6%) patients. The presence of CMS strongly correlated with pPROM prior to 28weeks' gestation. Multivariate analysis of the risk factors of pPROM <28w showed for CMS an odds ratio (OR) of 7.01 (95% confidence interval (CI): [1.46; 33.60], p=0.015). Posterior placentation correlated with the occurrence of CMS (OR: 4.17, 95% CI: [1.39; 12.49], p=0.01) and the recipient's deepest vertical pocket (OR: 1.38, 95% CI: [1.03; 1.86], p=0.03). There was however no measurable impact of CMS on gestational age at delivery, neither on survival. Conclusion: Chorioamniotic membrane separation occurs in approximately 20% of patients following fetoscopic laser surgery for twin-twin transfusion syndrome and is associated with pPROM <28w. Posterior location of the placenta coincided with an elevated risk for CMS. © 2012 John Wiley & Sons, Ltd. What's already known about this topic? Chorioamniotic membrane separation (CMS) after fetoscopic laser surgery (FLS) occurs in 20% of patients and is related to preterm premature rupture of membranes and preterm labor. It is not established that three-dimensional ultrasound has stronger impact on maternal-fetal bonding than two-dimensional ultrasound. What does this study add? We confirmed that the incidence of CMS is 20% after FLS. Chorioamniotic membrane separation is associated with pPROM prior to 28weeks' gestation. The risk factors related to the incidence of CMS are the location of the placenta and recipient deepest vertical pocket after FLS. © 2012 John Wiley & Sons, Ltd.


PubMed | Center for Maternal Fetal and Neonatal Medicine, The Interdisciplinary Center and University of Tokyo
Type: Journal Article | Journal: American journal of medical genetics. Part A | Year: 2016

Tetraploidy is characterized by the presence of four complete sets of chromosomes in an individual. Full tetraploidy is usually considered lethal. To date, only ten live-births with the condition have been reported. Trisomy 18 without neonatal intensive treatment is also known to be fatal. We report a female newborn who had mosaicism with near-tetraploidy and trisomy 18 (94,XXXX,+18,+18/47,XX,+18). She had features of conditions. The most plausible mechanism of the formation was a failure of cytoplasmic cleavage at the first division of the zygote. The longer survival of the patient compared with the 10 previously reported live-births with non-mosaic tetraploidy may be due to the dominance of the trisomy cells. We suggest that non-tetraploid cells, even when trisomic for chromosome 18, might contribute to longer survival in comparison to non-mosaic tetrapolid patients.


PubMed | Center for Maternal Fetal and Neonatal Medicine, Kyoto Pharmaceutical University and RIKEN
Type: | Journal: Neuroscience | Year: 2016

To identify molecular candidates involved in brain disabilities of Ts1Cje, a mouse model of Down syndrome (DS), we performed comparative proteomic analyses. Proteins extracted from the brains of postnatal wild-type (WT) and Ts1Cje mice were analyzed by two-dimensional gel electrophoresis (2-DE). No differences were detected in the proteins expressed in the whole brain between WT and Ts1Cje mice at postnatal day 0 and 3months of age. Five spots with differential expression in the brains of Ts1Cje mice were detected by 2-DE of brain proteins from WT and Ts1Cje embryos at embryonic day 14.5 (E14.5). These differentially expressed proteins in Ts1Cje embryos were identified as calcyclin-binding protein (CACYBP), nucleoside diphosphate kinase-B (NDPK-B), transketolase (TK), pyruvate kinase (PK), and 60S acidic ribosomal protein P0 (RPLP0) by peptide mass fingerprinting. CACYBP and NDPK-B were involved in cell proliferation, whereas TK and PK were associated with energy metabolism. Experiments on cell proliferation, an in vivo bromodeoxyuridine (BrdU)-labeling experiment, and immunohistochemical analysis for phospho-histone H3 (an M-phase marker) demonstrated increased numbers of BrdU-positive and M-phase cells in the ganglionic eminence. Our findings suggest that the dysregulated expression of proteins demonstrated by comparative proteomic analysis could be a factor in increased cell proliferation, which may be associated with abnormalities in DS brain during embryonic life.


PubMed | Red Cross, Kanagawa Childrens Medical Center, Nihon University, Shizuoka Childrens Hospital and 8 more.
Type: Journal Article | Journal: Pediatrics international : official journal of the Japan Pediatric Society | Year: 2015

Surgical intestinal disorders, such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in very low-birthweight infants (VLBWI). The aim of this study was to compare the composite outcomes of death or neurodevelopmental impairment (NDI) in VLBWI with surgical intestinal disorders and assess independent risk factors for death and NDI at 18 months of corrected age.A retrospective matched-cohort study was conducted at 11 institutes. We included VLBWI who had undergone laparotomy for NEC, FIP, and MRI. Two control subjects were chosen for every surgical patient and matched for gestational age and birthweight to form the comparison group. Death and neurodevelopmental outcome at 18 months of corrected age were evaluated.The number of infants in the NEC, FIP, MRI, and control groups was 44, 47, 42, and 261, respectively. In-hospital mortality was higher in infants with NEC and MRI relative to those in the control group (P < 0.001). The incidence rate for NDI at 18 months of corrected age was higher in infants with MRI relative to those in the control group (P = 0.021). On logistic regression analysis, low gestational age, male sex, small for gestational age, intraventricular hemorrhage, and MRI were associated with increased risk of death or NDI at 18 months of corrected age.NEC and MRI were associated with in-hospital mortality, and MRI was associated with NDI or death at 18 months of corrected age.


PubMed | Center for Maternal Fetal and Neonatal Medicine and Sanno Birth Center
Type: Journal Article | Journal: The journal of obstetrics and gynaecology research | Year: 2016

The aim of this study was to investigate the practicability and efficiency of lectin-based isolation of fetal erythroblasts for clinical use in non-invasive prenatal testing.Peripheral blood samples were collected from 39 pregnant women. Leukocytes were removed with an anti-CD45 antibody after density gradient centrifugation. After blood cells were attached to slides by binding to a galactose-specific lectin and galactose-bound vinyl polymer, the slides were stained with May-Grnwald-Giemsa stain and cells were classified by automated image analysis based on their size and the nuclear area/cytoplasmic area ratio. In 14 samples from the women with male fetuses, fetal origin of the isolated erythroblasts was confirmed by detecting the Y chromosome using fluorescence in situ hybridization. In eight samples, single erythroblasts were collected by the laser capture microdissection technique for amplification of the sex-determining region Y gene to confirm fetal origin.Panning with an anti-CD45 antibody achieved stable removal of leukocytes without aggregation. In all samples, erythroblasts were successfully identified by automated image analysis (18-6000/10 mL of blood). The number of slides required to examine 10 mL of blood ranged from one to six, which was reasonable for clinical use. The Y chromosome was detected in 7.5-43.6% of erythroblasts by fluorescence in situ hybridization, and the sex-determining region Y gene was amplified in seven of eight samples.The combination of lectin-based erythroblast isolation and automated image analysis is a practical and efficient method for isolating fetal erythroblasts as a source of fetal genomes.


Inoue T.,Center for Maternal Fetal and Neonatal Medicine | Ito Y.,Center for Maternal Fetal and Neonatal Medicine | Nakamura T.,Center for Maternal Fetal and Neonatal Medicine | Matsuoka K.,National Center for Child Health and Development | Sago H.,Center for Maternal Fetal and Neonatal Medicine
Journal of Perinatology | Year: 2014

A case of fetal neuroblastoma of the right adrenal gland, with rapid development of hydrops fetalis due to catecholamine-induced cardiomyopathy, is reported. A fetus with a right suprarenal mass detected during ultrasonography at 32 weeks gestation progressively developed into hydrops fetalis by 35.2 weeks gestation. An emergent cesarean section was performed. At birth, the female neonate was hypertensive, with markedly elevated catecholamine levels; echocardiography showed poor contractility. Morphine, human atrial natriuretic peptide, milrinone, nitroprusside and dobutamine were initiated and her blood pressure was maintained within the normal range and her cardiac contractility improved 2 weeks after birth. Neuroblastoma cells were detected in the placenta, resulting in the right adrenal mass being diagnosed as a neuroblastoma. She was well, and the mass diminished in size within 4 months, without surgery. A fetus with suspected neuroblastoma, indicated by a suprarenal mass, should be managed with appropriate consideration of hydrops. © 2014 Nature America, Inc. All rights reserved.


PubMed | National Center for Child Health and Development and Center for Maternal Fetal and Neonatal Medicine
Type: Journal Article | Journal: Pediatrics international : official journal of the Japan Pediatric Society | Year: 2015

Many neonatal intensive care and maternal units still use self-monitoring of blood glucose (SMBG) devices as a tool to aid diagnosis despite the introduction of point-of-care testing (POCT) devices, which are known to have higher accuracy. We evaluated the performance of two glucose meters, the StatStrip (Nova Biomedical), a POCT device, and the Medisafe Mini (Terumo), an SMBG device, to detect hypoglycemia in neonates. In addition, we evaluated the interference of hematocrit, acetaminophen and ascorbic acid.Whole blood samples were drawn from neonates who were at risk of hypoglycemia and analyzed with the StatStrip and Medisafe Mini. The results were further confirmed with blood gas analyzers ABL825 and BM6050. To evaluate the interference of hematocrit, acetaminophen and ascorbic acid, concentrated solutions of glucose and interfering substances were gravimetrically prepared and analyzed.Among the 222 blood samples analyzed, results from the StatStrip were more closely aligned to those of the ABL825 at all levels of glucose than the Medisafe Mini.StatStrip appears to be unaffected by hematocrit, ascorbic acid or acetaminophen. We recommend its use in neonates in hospital. Further studies are required to identify other interference effects.


PubMed | Center for Maternal Fetal and Neonatal Medicine, National Institute for Child Health and Development and Tokyo Medical University
Type: Journal Article | Journal: American journal of physiology. Lung cellular and molecular physiology | Year: 2016

Vascular growth is necessary for normal lung development. Although endothelial progenitor cells (EPCs) play an important role in vascularization, little is known about EPC function in congenital diaphragmatic hernia (CDH), a severe neonatal condition that is associated with pulmonary hypoplasia. We hypothesized that the function of endothelial colony-forming cells (ECFCs), a type of EPC, is impaired in CDH. Cord blood (CB) was collected from full-term CDH patients and healthy controls. We assessed CB progenitor cell populations as well as plasma vascular endothelial growth factor (VEGF) and stromal cell-derived factor 1 (SDF1) levels. CB ECFC clonogenicity; growth kinetics; migration; production of VEGF, SDF1, and nitric oxide (NO); vasculogenic capacity; and mRNA expression of VEGF-A, fms-related tyrosine kinase 1 (FLT1), kinase insert domain receptor (KDR), nitric oxide synthase (NOS) 1-3, SDF1, and chemokine (C-X-C motif) receptor 4 (CXCR4) were also assessed. Compared with controls, CB ECFCs were decreased in CDH. CDH ECFCs had reduced potential for self-renewal, clonogenicity, proliferation, and migration. Their capacity for NO production was enhanced but their response to VEGF was blunted in CDH ECFCs. In vivo potential for de novo vasculogenesis was reduced in CDH ECFCs. There was no difference in CB plasma VEGF and SDF1 concentrations, VEGF and SDF1 production by ECFCs, and ECFC mRNA expression of VEGF-A, FLT1, KDR, NOS1-3, SDF1, and CXCR4 between CDH and control subjects. In conclusion, CB ECFC function is disrupted in CDH, but these changes may be caused by mechanisms other than alteration of VEGF-NO and SDF1-CXCR4 signaling.


PubMed | Center for Maternal Fetal and Neonatal Medicine and Kyushu University
Type: | Journal: BMC research notes | Year: 2015

Correlations among Chiari type II malformation (CMII) morphological findings, the proportion of fetal heart rate patterns corresponding to the quiet phase (QP), and neurological outcomes have yet to be investigated.The correlations among the morphological findings (i.e., the degree of ventriculomegaly, myelomeningocele levels, and degree of cerebellar herniation), proportion of time spent in QP, and developmental quotients (DQs) were analyzed in 22 children. The proportion of time spent in QP was compared between children with poor neurological outcomes (n=9) and those with good outcomes (n=13). Pearsons correlations and the Mann-Whitney U-test were used to assess for statistical significance; P<0.05 was considered statistically significant. No significant differences were observed between the DQs and morphological findings, but the DQs and the proportion of time spent in QP were significantly correlated (r=0.287, P=0.01). The proportion of time spent in QP was significantly different between children with poor outcomes and those with good outcomes (median, 11% [range, 0-32%] vs. 28% [range, 2-55%]; P=0.006).The proportion of fetal heart rate patterns corresponding to the QP might be a useful predictor of neurological outcomes in 2-year-old children with CMII.

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