Objective: To evaluate the association between maternal pre-pregnancy body mass index and fetal acidosis while accounting for the mode of delivery. Design: Prospective cohort study Setting: Japan Population: Participants from the Japan Environment and Children’s Study with singleton pregnancies after 22 weeks of gestation who gave birth during 2011–2014 Methods: Participants were categorized into five groups according to pre-pregnancy body mass index (BMI) (kg/m2): G1 (BMI<18.5), G2 (18.5 to <20.0), G3 (20.0 to <23.0), G4 (23.0 to <25.0), and G5 (≥25.0). Multiple logistic regression analysis evaluated the effect of maternal pre-pregnancy BMI on fetal acidosis while accounting for the mode of delivery. Main outcome measures: Fetal acidosis was defined as umbilical artery pH (UmA-pH) <7.2 or <7.1. Results: We analyzed 71,799 participants. Adjusted odds ratios (aORs) of UmA-pH <7.2 using G3 as the reference group were 1.17 (95% confidence interval [CI], 1.06–1.30) in G5 and 0.89 (95% CI, 0.82–0.97) in G2. After stratification, aORs of UmA-pH <7.2 were 1.12 (95% CI, 1.08–1.35) in G5 and 0.90 (95% CI, 0.83–0.98) in G2, and the aOR of UmA-pH <7.1 was 0.80 (95% CI, 0.65–0.98) in G2 using G3 as the reference group for vaginal delivery. No association existed between pre-pregnancy BMI and fetal acidosis for delivery via cesarean section. Conclusions: In Japanese women, pre-pregnancy BMI ≥25.0 kg/m2 significantly increased the likelihood of fetal acidosis in newborns delivered vaginally.

Objective: To evaluate the incidence of adverse pregnancy outcomes (APOs) in women with uterine myomas and clarify the effect of uterine myomas on pregnancy outcomes. Design: Prospective cohort study Setting: The Japan Environment and Children’s Study (between 2011–2014) Population: Women (86,370) with singleton births after 22 weeks of gestation. Methods: Using logistic regression, the adjusted odds ratios (aORs) for APOs were calculated considering women without uterine myomas as the reference. Additionally, we used logistic regression to evaluate the effect of intrauterine infection (II) on the incidence of preterm births (PTB) and preterm premature rupture of membranes (pPROM). Main Outcome Measures: PTB (before 37 and 34 weeks), pPROM, II, and gestational hypertension (GH). Results: In women with uterine myomas, the aORs for PTB before 37 and 34 weeks, pPROM, II, and GH were 1.37 (95% confidence interval [CI], 1.22–1.54), 1.61 (95% CI, 1.27–2.05), 1.65 (95% CI, 1.33–2.04), 1.05 (95% CI, 0.75–1.46), and 1.20 (95% CI, 1.05–1.38), respectively. In women with both uterine myomas and intrauterine infection, the aORs for PTB before 37 weeks and pPROM were not significantly increased. Conclusions: Intra-pregnancy uterine myomas were associated with an increased risk of APOs. II in women with uterine myomas was not associated with PTB or pPROM. These data suggest a potential mechanical disadvantage in pregnant women with uterine myomas. Funding: Ministry of the Environment, Japan Key words: uterine myoma, preterm birth, preterm premature rupture of membrane, intrauterine infection

Background: The effects of maternal ritodrine hydrochloride administration (MRA) during pregnancy on fetuses and offspring are not entirely clear. The present study aimed to evaluate the association between MRA and childhood wheezing using data from a nationwide Japanese birth cohort study. Methods: This study retrospectively analyzed data from the Japan Environment and Children’s Study, a nationwide birth cohort study, conducted between 2011 and 2014. Data of women with singleton births after 22 weeks of gestation were analyzed. The participants were divided according to MRA status. Considering childhood factors affecting the incidence of wheezing, a logistic regression model was used to calculate adjusted odds ratios for “wheezing ever,” diagnosis of asthma in the last 12 months, and “asthma ever” in women with MRA, with women who did not receive MRA as the reference. Participants were stratified by term births, and adjusted odds ratios for outcomes were calculated using a logistic regression model. Results: A total of 68,123 participants were analyzed. The adjusted odds ratio for wheezing ever was 1.17 (95% confidence interval, 1.12–1.22). The adjusted odds ratios for the other outcomes did not significantly increase after adjusting for childhood factors. The same tendency was confirmed after excluding women with preterm births. Conclusion: MRA was associated with an increased incidence of childhood wheezing up to three years, irrespective of term births or preterm births. It is important that perinatal physicians consider both the adverse maternal side effects of MRA and its potential effects on the offspring’s childhood.

Background: This study aimed to evaluate differences in maternal characteristics and obstetric and childhood outcomes between term births according to the use of tocolytic treatment. Methods: This study analyzed the data of the participants enrolled in the Japan Environment and Children’s Study between 2011 and 2014. Data of 63,409 women with singleton births after 37 weeks of gestation were analyzed. We compared maternal characteristics, obstetric outcomes, and childhood outcomes between term births with tocolytic treatment and those without tocolytic treatment. Multiple logistic regression was used to calculate adjusted odds ratios for childhood outcomes with significant between-group differences in the univariable analysis for term births with tocolytic agents, with term births without tocolytic agents as the reference group. Results: In term births with tocolytic agents, participants had significantly younger age, leaner body mass index, higher oxidative stress during pregnancy, shorter pregnancy period, lighter neonatal birth weight, lower incidence of gestational diabetes mellitus, higher incidence of preterm premature rupture of membrane, higher rates of cesarean section, lower incidence of meconium-stained amniotic fluid during pregnancy, and higher incidence of childhood allergic disorders. The incidence of childhood developmental disorders showed no significant between-group differences. The adjusted odds ratio for childhood allergic disorders in term births with tocolytic agents was 1.09 (95% confidence interval, 1.04-1.14). Conclusions: This study found no significant association between tocolytic treatment and the incidence of childhood developmental disorders in children with term births. However, tocolytic treatment showed an association with a slightly increased incidence of childhood allergic disorders.

Maternal diabetes insipidus does not usually adversely affect the course of pregnancy. We present a rare case of central diabetes insipidus diagnosed at 31 weeks of gestation with fetal oligohydramnios successfully treated with intranasal desmopressin. To date, only three cases of diabetes insipidus with oligohydramnios have been reported.

Background: Globally, the incidence of allergic diseases is increasing along with cesarean delivery rates. Data regarding the association between cesarean delivery and allergic diseases are inconsistent. Here, we aimed to clarify the association between cesarean delivery and the development of asthma, atopic dermatitis, wheezing, and eczema. Methods: We used data from the Japan Environment and Children’s Study. The data included were those of 104,065 fetal records and their children. Information about the mode of delivery, asthma, atopic dermatitis, wheezing, and eczema was obtained from questionnaires and medical record transcripts. Multiple logistic regression analysis was used to assess the association between cesarean delivery and asthma, atopic dermatitis, wheezing, and eczema risk among infants at 1 year of age. Results: We included 74,639 subjects in this study, wherein 18.4% underwent cesarean deliveries. After adjusting for the perinatal, socioeconomic, and postnatal confounding factors, children born by cesarean delivery had no increased risk of developing asthma [95% confidence interval (CI) 0.84–1.08], atopic dermatitis (95% CI, 0.92–1.13), wheezing (95% CI, 0.94–1.04), or eczema (95% CI, 0.94–1.05). Conclusions: This nationwide cohort study found no association between cesarean delivery and asthma, atopic dermatitis, wheezing, and eczema among infants at 1 year of age. However, further studies are needed to evaluate whether cesarean delivery plays a role in the development of allergic diseases.

Objective: To evaluate the effect of maternal sleep duration (MSD) on low birth weight infants (LBW), small for gestational age infants (SGA), and macrosomia. Design: Prospective cohort study Setting: The Japan Environment and Children’s Study (JECS) Population: Participants enrolled in JECS, with singleton pregnancies after 22 weeks, who gave birth between 2011 and 2014. Methods: Participants were categorized into five groups according to MSD during pregnancy: G1 (MSD <6.0 h), G2 (6.0–7.9 h), G3 (8.0–8.9 h), G4 (9.0–9.9 h), and G5 (10.0–12.0 h). Main outcome measures: The effect of MSD on the risk of LBW (<2,500 g and <1,500 g), SGA, and macrosomia (>4,000 g) with G2 as the reference, while adjusting for gestational excessive body weight gain (BWG). Analysis was also performed after stratification by gestational BWG. Results: We analyzed 82,171 participants. The adjusted odds ratios (aORs) of LBW <2,500 g in G4 and G5 and of SGA in G4 were 0.90 (95% confidence interval [CI], 0.83-0.99), 0.86 (95% CI, 0.76-0.99), and 0.91 (95% CI, 0.82-0.99), respectively, before adjusting for excessive gestational BWG. No significant association was observed between MSD and these outcomes after adjusting for excessive gestational BWG. Among women with appropriate gestational BWG, the aORs of LBW <2,500 g and SGA in G4 were 0.88 (95% CI, 0.80-0.97) and 0.87 (95% CI, 0.78-0.97), respectively. Conclusion: This study revealed that 9.0–9.9 h of MSD significantly decreased LBW <2,500 g and SGA in pregnant women with appropriate gestational BWG, relative to 6.0–7.9 h of MSD.