- 著者
- Masayuki Shima Narumi Tokuda Hideki Hasunuma Yoshiko Kobayashi Hiroyuki Tanaka Hideaki Sawai Hiroaki Shibahara Yasuhiro Takeshima Munetaka Hirose the Japan Environment and Children’s Study (JECS) Group
- 出版者
- The Japanese Society for Hygiene
- 雑誌
- Environmental Health and Preventive Medicine (ISSN:1342078X)
- 巻号頁・発行日
- vol.27, pp.37, 2022 (Released:2022-09-28)
- 参考文献数
- 47
- 被引用文献数
- 3
Background: Epidural analgesia relives pain during labor. However, the long-term effects on neurodevelopment in children remain unclear. We explored associations between exposure to epidural analgesia during labor and childhood neurodevelopment during the first 3 years of life, in the Japan Environment and Children’s Study (JECS), a large-scale birth cohort study.Methods: Pregnant women were recruited between January 2011 and March 2014, and 100,304 live births of singleton children born at full-term by vaginal delivery, and without congenital diseases were analyzed. Data on mothers and children were collected using a self-administered questionnaires and medical record transcripts. The children’s neurodevelopment was repeatedly assessed for five domains (communication, gross motor, fine motor, problem solving, and personal-social), using the Ages and Stages Questionnaires, Third Edition, at six time points from age 6 to 36 months. After adjusting for potential confounders, the associations between exposure to epidural analgesia during labor and children’s neurodevelopment at each time point were assessed.Results: Of the 42,172 children with valid data at all six time points, 938 (2.4%) were born to mothers who received epidural analgesia during labor. Maternal exposure to epidural analgesia was associated with neurodevelopmental delays during the first 3 years after birth. Delay risks in gross and fine motor domains were the greatest at 18 months (adjusted odds ratio (aOR) [95% confidence interval (CI)]: 1.40 [1.06, 1.84] and 1.54 [1.17, 2.03], respectively), subsequently decreasing. Delay risks in communication and problem-solving domains were significantly high at 6 and 24 months, and remained significant at 36 months (aOR [95% CI]: 1.40 [1.04, 1.90] and 1.28 [1.01, 1.61], respectively). Exposure to epidural analgesia was also associated with the incidence of problem solving and personal-social delays from 18 to 24 months old. Neurodevelopmental delay risks, except for communication, were dominant in children born to mothers aged ≥30 years at delivery.Conclusions: This study showed that maternal exposure to epidural analgesia during labor was associated with neurodevelopmental delays in children during the first 3 years after birth.
- 著者
- Toshimi Michigami Yasuhisa Ohata Makoto Fujiwara Hiroshi Mochizuki Masanori Adachi Taichi Kitaoka Takuo Kubota Hideaki Sawai Noriyuki Namba Kosei Hasegawa Ikuma Fujiwara Keiichi Ozono
- 出版者
- The Japanese Society for Pediatric Endocrinology
- 雑誌
- Clinical Pediatric Endocrinology (ISSN:09185739)
- 巻号頁・発行日
- vol.29, no.1, pp.9-24, 2020 (Released:2020-01-09)
- 参考文献数
- 48
- 被引用文献数
- 28
Hypophosphatasia (HPP) is a rare bone disease caused by inactivating mutations in the ALPL gene, which encodes tissue-nonspecific alkaline phosphatase (TNSALP). Patients with HPP have varied clinical manifestations and are classified based on the age of onset and severity. Recently, enzyme replacement therapy using bone-targeted recombinant alkaline phosphatase (ALP) has been developed, leading to improvement in the prognosis of patients with life-threatening HPP. Considering these recent advances, clinical practice guidelines have been generated to provide physicians with guides for standard medical care for HPP and to support their clinical decisions. A task force was convened for this purpose, and twenty-one clinical questions (CQs) were formulated, addressing the issues of clinical manifestations and diagnosis (7 CQs) and those of management and treatment (14 CQs). A systematic literature search was conducted using PubMed/MEDLINE, and evidence-based recommendations were developed. The guidelines have been modified according to the evaluations and suggestions from the Clinical Guideline Committee of The Japanese Society for Pediatric Endocrinology (JSPE) and public comments obtained from the members of the JSPE and a Japanese HPP patient group, and then approved by the Board of Councils of the JSPE. We anticipate that the guidelines will be revised regularly and updated.