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Shiozaki A.,University of Toyama | Matsuda Y.,Tokyo Womens Medical University | Satoh S.,Maternal and Perinatal Care Center | Saito S.,University of Toyama
Journal of Obstetrics and Gynaecology Research | Year: 2013

Aim: To demonstrate the difference between risk factors for gestational hypertension (GH) and preeclampsia (PE). Material and Methods: Using data from women with no essential hypertension and with singleton births between 2001 and 2005 delivering after 22 weeks of gestation at 125 centers in Japan (Japan Perinatal Registry Network) (n = 241 292), we compared risk factors for GH and PE. Odds ratios were calculated using multivariate logistic regression analyses. Results: Of 241 292 women, 2808 (1.2%) developed GH and 6423 (2.7%) developed PE. Thirty-five years or older, primiparity, diabetes mellitus, and renal disease increased the risk of both hypertensive conditions. Forty years or older was a risk factor only for GH, while primiparity, female baby, and renal disease were risk factors only for PE. Early-onsetwas a common risk factor for small-for-gestational-age (SGA) in GH and PE, but in late-onset only PE was a risk factor for SGA. The main population of SGA infants was composed of PE cases because PE accounted for 83.3% of early-onset type before 32 weeks. Girl preponderance in the PE women was observed (sex ratio: boys/girls = 0.904), while slight boy preponderance was seen in normotensive women (1.06) and GH (1.02). Conclusion: Preeclampsia is associated with lower fetal sex ratio (girl preponderance) compared to GH or normotensive. Presence of hypertension is a risk factor for SGA in early-onset GH and PE, and hypertension and proteinuria are risk factors for SGA in late-onset group. © 2012 Japan Society of Obstetrics and Gynecology.


Morikawa M.,Hokkaido University | Cho K.,Hokkaido University | Yamada T.,Hokkaido University | Sato S.,Maternal and Perinatal Care Center | Minakami H.,Hokkaido University
Journal of Obstetrics and Gynaecology Research | Year: 2013

Aim: It is unknown how to reduce the number of macrosomic neonates among women without hyperglycemia. The aim of this study was to determine clinically useful risk factors for macrosomic neonates among women without hyperglycemia. Material and Methods: A retrospective observational study was conducted in 117 680 Japanese women without hyperglycemia who gave birth to singleton infants at 37 weeks of gestation or later. Maternal age, parity, fetal sex, pregnancy length, and maternal body composition were studied as possible candidates for risk factors of macrosomic neonates using multivariate logistic regression analyses. Outcome measures were clinically available independent risk factors for macrosomic neonates weighing 4000 g or more. Results: A total of 1037 (0.9%) women gave birth to macrosomic neonates. A male fetus (odds ratio [95% confidence interval]: 1.99 [1.75-2.27]), multiparity (1.75 [1.53-1.99]), pregnancy length of 41 weeks or more (4.28 [3.73-4.91]) and six characteristics at or above the 90th percentile values consisting of body height (1.65 m: 1.70 [1.45-1.99]), pre-pregnancy body weight (65 kg: 1.47 [1.12-1.93]), pre-pregnancy body mass index (BMI) (25 kg/m2: 1.49 [1.16-1.91]), weight gain during pregnancy (15 kg: 2.32 [1.78-3.03]), BMI gain during pregnancy (6.0 kg/m2: 1.52 [1.16-2.00]), and body weight at delivery (75 kg: 2.57 [2.08-3.17]) were identified as independent risk factors for macrosomia. Conclusion: Intervention, such as a counseling on dietary habits leading to a lesser net weight gain may be considered among women suspected of having fetal overgrowth. © 2012 The Authors.


Matsuda Y.,Tokyo Womens Medical University | Hayashi K.,Gunma University | Shiozaki A.,University of Toyama | Kawamichi Y.,Tokyo Womens Medical University | And 2 more authors.
Journal of Obstetrics and Gynaecology Research | Year: 2011

Aim: A case-cohort study was performed to clarify and compare the risk factors for placental abruption and placenta previa. Material & Methods: This study reviewed 242 715 births at 125 centers of the perinatal network in Japan from 2001 through to 2005 as a base-cohort. Women with singleton pregnancies delivered after 22 weeks of gestation were included. The evaluation determined the risk factors for placental abruption and placenta previa. Five thousand and thirty-six births (2.1%) were determined as the subcohort by random selection. Acute- inflammation-associated clinical conditions (premature rupture of membranes and clinical chorioamnionitis) and chronic processes associated with vascular dysfunction or chronic inflammation (chronic and pregnancy- induced hypertension, pre-existing or gestational diabetes and maternal smoking) was examined between the two groups. Results: Placental abruption and placenta previa were recorded in 10.1 per 1000 and 13.9 per 1000 singleton births. Risk factors for abruption and previa, respectively, included maternal age over 35 years (adjusted risk ratios [RRs] = 1.20 and 1.78), IVF-ET (RRs = 1.38 and 2.94), preterm labor (RRs = 1.63 and 3.09). Smoking (RRs = 1.37), hypertension (RRs = 2.48), and pregnancy-induced hypertension (RR = 4.45) were risk factors for abruption but not for previa. On the other hand, multiparity (RR = 1.18) was a risk factor for previa but not for abruption. The rates of acute-inflammation-associated conditions and chronic processes were higher among women with abruption than with previa. (RR 2.0 and 4.08, respectively). Conclusion: The case-cohort study technique elucidated the difference in the risk factors for placental abruption and placenta previa. © 2011 The Authors.


Hayashi M.,Nippon Medical School | Nakai A.,Nippon Medical School | Satoh S.,Maternal and Perinatal Care Center | Matsuda Y.,Tokyo Womens Medical University
Fertility and Sterility | Year: 2012

Objective: To compare obstetric and perinatal outcomes of singleton pregnancies conceived with different types of assisted reproductive technology (ART) procedures with those of naturally conceived pregnancies. Design: Retrospective cohort study. Setting: The perinatal database of the Japanese Society of Obstetrics and Gynecology. Patient(s): A total of 242,715 women with singleton pregnancies were examined as a base cohort. Three study groups were created according to the type of ART procedure used, namely ovulation stimulation medications (n = 4,111), IUI (n = 2,351), and IVF-ET (n = 4,570). Controls adjusted for multiple maternal characteristics were selected randomly for each study group. Intervention(s): None. Main Outcome Measure(s): Obstetric and perinatal outcomes. Result(s): Patients who conceived through the ART procedures were associated with an increased incidence of placenta previa, preterm delivery, and low birth weight infant and a decreased incidence of spontaneous cephalic delivery, regardless of the type of ART procedure. Conclusion(s): Among singleton pregnancies, patients conceived with ART procedures were at increased risk for several adverse obstetric and perinatal outcomes, regardless of the type of ART procedure used. These results suggest that maternal factors associated with infertility may contribute to the adverse outcomes rather than the ART procedures themselves. © 2012 American Society for Reproductive Medicine, Published by Elsevier Inc.


Morikawa M.,Hokkaido University | Yamada T.,Hokkaido University | Sato S.,Maternal and Perinatal Care Center | Minakami H.,Hokkaido University
Twin Research and Human Genetics | Year: 2012

This study was conducted to review the overall short-term outcome of monoamniotic twins in Japan and to determine the prospective risk of fetal death so as to adequately counsel parents with monoamniotic twins. Study subjects were 101 women with monoamniotic twins who were registered with the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System and who had given birth at ≥22 weeks of gestation during 2002-2009. The gestational week at delivery (mean ± SD) was 31.8 ± 3.7. Fourteen women experienced intrauterine fetal death (IUFD). Short-term outcomes of co-twins born to the 14 women included 8 IUFDs, one early neonatal death within 7 days of life (END), and 5 survivors. Four other women experienced 5 ENDs. Thus, 13.9% (28/202) of infants died perinatally (22 IUFDs and 6 ENDs), 13.9% (14/101) of women experienced IUFD, and 82.2% (83/101) of women experienced neither IUFD nor END. Structural anomalies and twin-to-twin transfusion syndrome explained 17.9% (five infants) and 10.7% (three infants) of the 28 perinatal deaths, respectively. The prospective risk of IUFD was 13.9% (14/101) for women who reached gestational week 22-0/7, gradually decreasing thereafter but remaining at between 4.5% and 8.0% between gestational week 30 -0/7 and 36-0/7. Copyright © The Authors 2012.

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