論文

Background and Objectives: Preterm birth (PTB) imposes a substantial medical and economic burden on perinatal care. Recent advances in 16S rRNA gene sequencing help detailed microbiota analysis. Understanding microbiota’s contribution may help in understanding PTB pathogenesis. We aim to investigate the microbiota profiles of the oral, vaginal, and placental microbiota in pregnant Japanese women hospitalized for care of preterm labor and examine the association between them and perinatal outcomes. Materials and Methods: This cross-sectional study included 20 pregnant Japanese women admitted to a single perinatal center for preterm labor between 2022 and 2023. Oral, vaginal, and placental samples were collected aseptically during hospitalization. The patients were retrospectively categorized into: term birth (TB, n = 10), chronic abruption-oligohydramnios sequence (CAOS, n = 3), and PTB without CAOS (PTB, n = 7) perinatal outcomes. Microbiota profiles were analyzed using 16S rRNA gene sequencing, and group comparisons were performed using univariate statistical methods. Results: Alpha or beta diversity of the oral and vaginal microbiota among the three groups did not differ significantly. CAOS and PTB groups showed a trend toward altered vaginal microbial composition, but not the TB group. In the placental microbiota, beta diversity differed significantly among the TB, PTB, and CAOS groups. Ureaplasma urealyticum was more abundant in the PTB group, whereas Ureaplasma parvum was more abundant in the CAOS group. Conclusions: A potential shift in the vaginal microbiota and alterations in the placental microbiota, observed in PTB, including CAOS, suggested a possible microbial contribution.

Purpose: While meso/dextrocardia, a cardiac axis abnormality, is associated with various complications and a poor prognosis, few studies have been reported. We aimed to identify and review patients at our hospital who had been diagnosed with fetal meso/dextrocardia. Methods: The medical records of 29 patients diagnosed with fetal meso/dextrocardia between April 1, 2014 and March 31, 2024 were reviewed. Results: We identified eight cases of mesocardia and 21 cases of dextrocardia (17 dextropositions and four dextroversions). Right lung hypoplasia (including 3q trisomy, esophageal bronchopleural fistula, and left pulmonary artery sling) was identified in three cases. Five cases of persistent left superior vena cava (PLSVC) were identified [isolated PLSVC (n = 2), VACTERL association (n = 1), trisomy 13 (n = 2)]. Dextroposition was linked to congenital pulmonary airway malformation (eight cases), left pulmonary sequestration (one case), congenital diaphragmatic hernia (six cases), right lung hypoplasia (one case), and VACTERL association with right lung aplasia and esophageal atresia (one case). Dextroversion was associated with asplenia syndrome (two cases), single-ventricle (one case), and Temple syndrome with PLSVC and bilateral hypoplastic pulmonary arteries (one case). Among 29 newborns, six (20.7%) died during the early neonatal period and seven (24.1%) required postnatal multidisciplinary treatment, highlighting a poor prognosis in many cases. Conclusion: While some patients, such as those with isolated PLSVC, had favorable outcomes, several cases involved severe complications requiring intensive perinatal management. When fetal meso/dextrocardia is detected, it is critical to evaluate fetal anomalies comprehensively and not limit assessment to the heart and lungs.

＜文献概要＞はじめに　Developmental origins of health and disease(DOHaD)研究と聞くと「基礎研究や公衆衛生的な難しい話」や「痩せ妊婦の話」などといわれてしまうことがある。実際,実験動物を使用した基礎研究は不可欠であり,わが国においては痩せ妊婦が次世代に与える影響を議論することが多いのは事実である。一方で,DOHaD研究はすべての医療従事者にとって決して馴染みのないものではなく,むしろ日常臨床で行っている日々の診療はDOHaDに直結していると筆者は考えている。

＜文献概要＞妊娠中体重増加量(GWG)は不足でも過剰でも周産期予後や出生体重に影響を与え,児の将来の健康に影響を与える可能性がある.GWG管理は周産期予後改善のみならず,将来の医療経済にも影響を与える可能性があるため,啓発活動も含めた管理が重要であることを認識する.

＜文献概要＞Point　細菌性腟症(BV)とは特定の微生物によらない腟炎とされ,女性の1/4～1/3が罹患している頻度の高い疾患である.BVは流早産のリスク因子であることから,症状のある妊婦に対しては治療を要する.

「B型肝炎母子感染防止事業」により、B型肝炎(hepatitis B virus:HBV)の母子感染は減少傾向にある。しかしながら、胎内感染やワクチン不応は重要課題であり、諸外国では妊娠後期における核酸アナログ投与による感染予防策も試みられている。一方、C型肝炎(hepatitis C virus:HCV)は肝硬変や肝癌への移行率が高いことから感染予防が重要であるが、母子感染メカニズム・予防策についてはいまだ検討中である。B型肝炎・C型肝炎キャリア妊婦に対しては、母子感染に関する正確な情報を提供することが重要である。(著者抄録)

近年、遺伝子解析技術の進歩により糖尿病をはじめとした生活習慣病において、様々な遺伝子の関与が報告されてきた。われわれも日本人妊娠糖尿病における関連候補遺伝子の抽出をわが国ではじめて行い、報告した。しかし、周産期合併症をターゲットとした遺伝子解析については多くの困難があり、解析では工夫が必要となる。本稿ではわれわれが行った研究方法や結果を示すとともに、その課題について概説する。(著者抄録)