研究活動情報

• A Pregnant Woman with Primary Hyperparathyroidism Who Underwent Parathyroidectomy in the Second Trimester of Her Third Pregnancy: A Case Report.

  Masayuki Tanaka, Hitomi Imafuku, Iroha Kubota, Keitaro Yamanaka, Sonoko Suda, Naohisa Masuko, Akiko Uchida, Hidenori Fukuoka, Masanori Teshima, Kazumichi Fujioka, Masashi Deguchi, Kenji Tanimura, Yoshito Terai

  Primary hyperparathyroidism (PHPT) during pregnancy is rare, causing severe pregnancy complications. We report a pregnant woman with PHPT and a pregnancy complication history who underwent a single-gland parathyroidectomy during the second trimester and delivered at term. A 28-year-old pregnant woman, gravida 3, para 2, was referred to our hospital at 9 gestational weeks (GWs) because of previous intrauterine fetal death, preterm birth, and fetal growth restriction. She was diagnosed with PHPT during her second pregnancy, and her baby experienced neonatal hypocalcemia. However, she received no PHPT treatment afterward. Laboratory tests and neck ultrasound revealed hyperparathyroidism and an enlarged right superior parathyroid gland. She underwent a right superior parathyroidectomy at 24 GWs. She delivered a 2,136 g (-1.74 SD) healthy female infant at 37 GWs, and her baby demonstrated no neonatal hypocalcemia. Parathyroidectomy, even during pregnancy, should be considered among pregnant women with PHPT having a pregnancy or neonatal complication history.

  2025年05月, The Kobe journal of medical sciences, 71(1) (1), E41-E45, 英語, 国内誌

  研究論文（学術雑誌）


• 治療的頸管縫縮術後の妊娠34週未満早産に関連する因子の検討

  倉智 友香, 谷村 憲司, 栖田 園子, 益子 尚久, 内田 明子, 今福 仁美, 出口 雅士, 寺井 義人

  (一社)日本周産期・新生児医学会, 2025年05月, 日本周産期・新生児医学会雑誌, 61(1) (1), 100 - 106, 日本語


• 妊娠前Body Mass Index 30kg/m2以上の初産婦において経腟分娩成功に関連する因子の検討

  三木 満帆, 谷村 憲司, 栖田 園子, 益子 尚久, 内田 明子, 今福 仁美, 森山 俊武, 出口 雅士, 寺井 義人

  (一社)日本周産期・新生児医学会, 2025年05月, 日本周産期・新生児医学会雑誌, 61(1) (1), 114 - 119, 日本語


• Discrepancies in the Diagnosis of Congenital Toxoplasma gondii Infection Between B1 Gene Semi-Nested Polymerase Chain Reaction and Serological Analyses.

  Akiko Uchida, Kenji Tanimura, Keisuke Shirai, Mariko Ashina, Kazumichi Fujioka, Ichiro Morioka, Miwa Sasai, Masahiro Yamamoto, Hideto Yamada

  Congenital Toxoplasma gondii (T. gondii) infection, which can be caused by a primary T. gondii infection during pregnancy, results in severe neurological sequelae in affected children. We have been conducting a prospective cohort study since January 2019 on pregnant women who were suspected of having primary T. gondii infection based on serological tests. In this study, congenital infection was diagnosed using semi-nested polymerase chain reaction (PCR) to detect the B1 gene in the body fluids of newborns. Up until December 2023, forty-one newborns born to mothers suspected of having primary T. gondii infection during pregnancy underwent B1 gene semi-nested PCR tests and anti-T. gondii immunoglobulin (Ig) G and IgM measurements of their blood samples. Eight newborns showed no clinical symptoms of congenital T. gondii infection; however, they were diagnosed with congenital T. gondii infection according to positive PCR results. However, none of the eight infants eventually exhibited any sign of congenital infection, as their serum samples tested negative for anti-T. gondii IgM and IgG until 12 months of age. Therefore, clinicians should consider discrepancies in the diagnosis of congenital T. gondii infection between PCR tests using body fluids of newborns and serological tests during their infantile period.

  2025年03月, Microorganisms, 13(3) (3), 英語, 国際誌

  研究論文（学術雑誌）


• Discrepancies in the Diagnosis of Congenital Toxoplasma gondii Infection Between B1 Gene Semi-Nested Polymerase Chain Reaction and Serological Analyses

  Akiko Uchida, Kenji Tanimura, Keisuke Shirai, Mariko Ashina, Kazumichi Fujioka, Ichiro Morioka, Miwa Sasai, Masahiro Yamamoto, Hideto Yamada

  2025年03月, Microorganisms, 13(3) (3)

  研究論文（学術雑誌）


• Problems in screening for gestational diabetes mellitus by measurement of casual blood glucose levels at 24-28 gestational weeks.

  Masako Tomimoto, Kenji Tanimura, Naohisa Masuko, Akiko Uchida, Hitomi Imafuku, Masashi Deguchi, Akane Yamamoto, Yushi Hirota, Wataru Ogawa, Yoshito Terai

  AIMS/INTRODUCTION: This study aimed to evaluate the problems in screening for gestational diabetes mellitus (GDM) by casual blood glucose (CBG) measurements at 24-28 gestational weeks. MATERIALS AND METHODS: Overall, 763 pregnant women who underwent the 50-g glucose challenge test (GCT) at 24-28 gestational weeks were enrolled. The preload blood glucose (0-h BG) level of 50-g GCT was considered as CBG. RESULTS: A total of 240 women with BG levels at 1-h after loading (1-h BG) on 50-g GCT ≥140 mg/dL underwent the 75-g oral glucose tolerance test, and 98 (40.8%) were diagnosed with GDM. Of the 99 women with GDM, 71 (71.7%) had 0-h BG on 50-g GCT <100 mg/dL. CONCLUSIONS: This study, where pregnant women underwent both CBG and 50-g GCT simultaneously, showed that when CBG at 24-28 gestational weeks ≥100 mg/dL alone was used for screening GDM, many pregnant women with GDM were overlooked.

  2024年12月, Journal of diabetes investigation, 15(12) (12), 1797 - 1802, 英語, 国内誌

  研究論文（学術雑誌）


• Clinical Practice Guidelines for the Management of Congenital Cytomegalovirus Infection in Japan 2023: Executive Summary.

  Yoshinori Ito, Ichiro Morioka, Naoto Takahashi, Kazumichi Fujioka, Kiyonori Miura, Hiroyuki Moriuchi, Noriko Morimoto, Tetsushi Yoshikawa, Mariko Ashina, Shinya Abe, Hitomi Imafuku, Akiko Uchida, Aya Okahashi, Satsuki Kakiuchi, Yu Kakimoto, Soichiro Kawata, Yoshiki Kawamura, Takumi Kido, Hiroyuki Kidokoro, Kei Kozawa, Tomohiro Samejima, Takako Suzuki, Kenji Tanimura, Chiharu Tomonaga, Yuka Torii, Megumi Nakanishi, Nobuhiko Nagano, Takeshi Nagamatsu, Hajime Narita, Koji Nishimura, Norie Nonobe, Yuri Hasegawa, Koichiro Hara, Midori Hijikata, Takuya Fukuda, Yusuke Funato, Nobuko Mimura, Nobuko Yamamoto, Ai Yoshitomi, Yasumasa Kakei, Tomoyuki Kodama, Akira Oka

  Congenital cytomegalovirus (cCMV) infection is the most common congenital infection in developed countries. Although a standard therapy has not yet been established, evidence for the management of cCMV infection has been accumulating. The first edition of the "Clinical Practice Guidelines for the Management of Congenital Cytomegalovirus Infection" was published in Japan in 2023. This summary outlines the clinical questions (CQs) in the guidelines, with reference to the Japanese Medical Information Distribution Service Manual. Overall, 20 CQs with statements regarding prenatal risk assessment, prevention and management at diagnosis (CQs 1-1-1-3), diagnosis (CQs 2-1-2-6), treatment (CQs 3-1-3-7) and follow-up requirements (CQs 4-1-4-4) have been discussed. For each statement, the levels of recommendation, evidence and consensus rates were determined. These guidelines will assist in the management of patients with cCMV infection.

  2024年07月, The Pediatric infectious disease journal, 英語, 国際誌

  研究論文（学術雑誌）


• Toxoplasma gondii IgG avidity for the diagnosis of primary infection in pregnant women: Comparison between chemiluminescent microparticle immunoassay and enzyme-linked immunosorbent assay.

  Hajime Ota, Hideto Yamada, Shinichiro Wada, Kenji Tanimura, Masashi Deguchi, Akiko Uchida, Akira Nishikawa

  INTRODUCTION: This study evaluated whether IgG avidity measured by chemiluminescent microparticle immunoassay (CMIA) compared with enzyme-linked immunosorbent assay (ELISA) was useful to detect primary T. gondii infection during pregnancy and to estimate the risk for congenital T. gondii infection. METHODS: One hundred six women with positive tests for T. gondii IgG and T. gondii IgM, comprising 21 women (19.8%) with low (<30%), 6 (5.7%) with borderline (30%-35%), and 79 (74.5%) with high (>35%) IgG avidity measured by ELISA were selected. Their stored sera were used for T. gondii IgG avidity measurements by CMIA. RESULTS: In CMIA, 72 (67.9%) women had low (<50%), 12 (11.3%) had borderline (50%-59.9%), and 22 (20.8%) had high (≥60%) IgG avidity. The ratio of low T. gondii IgG avidity index in CMIA was more than three-fold than that in ELISA. Eighteen (85.7%) of 21 women with ELISA low avidity also had CMIA low avidity, and 26 (96.3%) of 27 women with ELISA low or borderline avidity corresponded to CMIA low or borderline avidity, whereas 21 (26.6%) of 79 women with ELISA high avidity were diagnosed with CMIA low avidity. All three cases with congenital T. gondii infection showed coincidentally low IgG avidity in both methods. A positive correlation in IgG avidity indices was found between of ELISA and CMIA. CONCLUSIONS: CMIA for T. gondii avidity measurements compared with ELISA was clinically useful to detect pregnant women at a high risk of developing congenital T. gondii infection.

  2024年05月, Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, 30(5) (5), 434 - 438, 英語, 国際誌

  研究論文（学術雑誌）


• HELLP Syndrome at 20 Gestational Weeks Managed Using the Mississippi Protocol: A Case Report.

  Naohisa Masuko, Kenji Tanimura, Masayuki Tanaka, Akiko Uchida, Ryosuke Takahashi, Hitomi Imafuku, Masashi Deguchi, Yoshito Terai

  Hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome is one of the most severe complications of hypertensive disorders of pregnancy. HELLP syndrome occurring before 22 gestational weeks (GWs) is extremely rare, and patients prevalently exhibit underlying maternal diseases or fetal abnormalities. Here, we report the case of a pregnant woman who had HELLP syndrome at 20 GWs without any obvious underlying maternal diseases or fetal abnormalities. A 38-year-old pregnant woman was referred to Kobe University Hospital from another hospital at 19 + 5/7 GWs for hypertension, proteinuria, generalized edema, and fetal growth restriction. She was diagnosed with partial HELLP syndrome according to the Mississippi classification at 20 + 2/7 GWs. The patient was managed following the Mississippi protocol, including intravenous dexamethasone, magnesium sulfate, and antihypertensive drugs. She received intensive blood pressure and laboratory data monitoring using an arterial line and additional treatments, including platelet transfusion, intravenous haptoglobin infusion, and human atrial natriuretic peptide. The pregnancy ended in an induced delivery at 20 + 3/7 GWs, and she was discharged without complications 10 days postnatal. We performed laboratory tests for diagnosing underlying diseases but identified no obvious underlying diseases. This report indicates that early and intensive treatment of patients with HELLP syndrome occurring before 22 GWs according to the Mississippi protocol may enable clinicians to complete pregnancy termination without maternal complications and provide useful information to clinical practitioners in perinatal medicine.

  2024年04月, The Kobe journal of medical sciences, 70(1) (1), E22-E25, 英語, 国内誌

  研究論文（学術雑誌）


• Advantages of sensor-augmented insulin pump therapy for pregnant women with type 1 diabetes mellitus.

  Hitomi Imafuku, Kenji Tanimura, Naohisa Masuko, Masako Tomimoto, Yutoku Shi, Akiko Uchida, Masashi Deguchi, Kazumichi Fujioka, Akane Yamamoto, Kei Yoshino, Yushi Hirota, Wataru Ogawa, Yoshito Terai

  AIMS/INTRODUCTION: To evaluate the efficacy of sensor-augmented pump (SAP) for improving obstetric and neonatal outcomes among pregnant women with type 1 diabetes mellitus by comparing it with continuous subcutaneous insulin infusion plus self-monitoring of blood glucose (continuous subcutaneous insulin infusion [CSII]/SMBG). MATERIALS AND METHODS: This retrospective cohort study included 40 cases of pregnancy complicated by type 1 diabetes mellitus treated with SAP (SAP group), and 29 cases of pregnancy complicated by type 1 diabetes mellitus treated with CSII/SMBG (CSII/SMBG group). The obstetric and neonatal outcomes were compared between the two groups. RESULTS: The median of the glycoalbumin levels in the first (18.8% vs 20.9%; P < 0.05) and second (15.4% vs 18.0%; P < 0.05) trimesters, the hemoglobin A1c levels in the peripartum period (6.1% vs 6.5%; P < 0.05) and the standard deviation score of birthweights (0.36 vs 1.52; P < 0.05) were significantly lower in the SAP group than in the CSII/SMBG group. The incidence rate of large for gestational age newborns was significantly lower in the SAP group than in the CSII/SMBG group (27.5% vs 65.5%; P < 0.05). No significant differences in the incidence rates of hypertensive disorders of pregnancy, small for gestational age, respiratory distress syndrome, neonatal hypoglycemia, hypervolemia and hyperbilirubinemia were observed between the groups. CONCLUSION: The present study showed that SAP therapy is more effective in preventing large for gestational age newborns in pregnant women with type 1 diabetes mellitus than CSII/SMBG.

  2023年12月, Journal of diabetes investigation, 14(12) (12), 1383 - 1390, 英語, 国内誌

  研究論文（学術雑誌）


• Rapid reduction of adenomyosis coexisting with leiomyoma volume during treatment with Relugolix.

  Keitaro Yamanaka, Keiichi Washio, Akiko Uchida, Yuki Sasagawa, Masashi Nishimoto, Yui Yamasaki, Satoshi Nagamata, Yoshito Terai

  OBJECTIVE: This study elucidated the efficacy of Relugolix (REL) on the reduction of uterine volume and clinical symptoms for the treatment of adenomyosis. METHODS: We conducted a retrospective cohort study of patients who received REL (40 mg for about 20 weeks) and who underwent a hysterectomy for adenomyosis or fibroids. We divided patients into two groups: adenomyosis coexisting with fibroids (Group A) and fibroids only (Group B); the groups were determined by a postoperative pathological examination. The primary end points were the percent reduction in uterine volume, adenomyotic lesion, and the largest fibroid volume at week 16. The secondary end points were the rate of amenorrhea, pelvic pain, and anemia at week 12. RESULTS: A total of 56 patients participated in the current study: 20 in Group A and 36 in Group B. Regarding the largest fibroid volume, there was no significant difference between the two groups. Uterine volume after REL treatment was significantly decreased in Group A (43%), as compared to Group B (27%) (p = .00972), In Group A, adenomyotic lesion was decreased by 61%. Irrespective of the group, adenomyosis showed a significant reduction compared to uterine fibroids (p < .001). There was no statistically significant difference in the mitigation of symptoms (amenorrhea, pelvic pain, and anemia) between the two groups. CONCLUSIONS: REL is more effective in reducing adenomyotic lesion than uterine fibroids and in relieving symptoms (amenorrhea, pelvic pain, and anemia). It can be expected that REL will also be used as a preoperative treatment for adenomyosis.

  2023年12月, Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 39(1) (1), 2237121 - 2237121, 英語, 国際誌

  研究論文（学術雑誌）


• Two pregnant women with immune-mediated thrombotic thrombocytopenic purpura: A case report.

  Akiko Uchida, Kenji Tanimura, Yuki Sasagawa, Hirotaka Yamada, Yoshio Katayama, Masanori Matsumoto

  Thrombotic thrombocytopenic purpura (TTP) during pregnancy is life-threatening. We encountered two pregnant women with immune-mediated TTP (iTTP). A 40-year-old primigravida woman was referred at 19 gestational weeks (GWs) owing to iTTP. She received plasma exchange (PE) and steroid therapies and delivered a live infant at 27 GWs by cesarean delivery. A 29-year-old primigravida woman was referred owing to intrauterine fetal death and thrombocytopenia at 20 GWs. She was diagnosed with iTTP and received PE therapy. She required additional PE and steroid therapies owing to relapse. Before her second pregnancy, she received prednisolone and hydroxychloroquine according to the therapy for systemic lupus erythematosus (SLE). She had induced labor at 37 GWs owing to decrease plasma level of a disintegrin-like and metalloproteinase with thrombospondin type 1 motif 13 (ADAMTS13) activity. Close monitoring of plasma ADAMTS13 activity level and treatments for underlying SLE may prevent iTTP relapse and lead to a good prognosis.

  2023年09月, The journal of obstetrics and gynaecology research, 英語, 国際誌


• 周産期感染症の最前線 先天性サイトメガロウイルス感染

  谷村 憲司, 内田 明子, 今福 仁美, 平久 進也, 藤岡 一路, 森岡 一朗, 峰松 俊夫, 山田 秀人

  日本産婦人科・新生児血液学会, 2023年03月, 日本産婦人科・新生児血液学会誌, 32(2) (2), 27 - 33, 日本語


• Fetal Ultrasound and Magnetic Resonance Imaging Abnormalities in Congenital Cytomegalovirus Infection Associated with and without Fetal Growth Restriction.

  Kenji Tanimura, Akiko Uchida, Mizuki Uenaka, Hitomi Imafuku, Shinya Tairaku, Hiromi Hashimura, Yoshiko Ueno, Takumi Kido, Kazumichi Fujioka

  Congenital cytomegalovirus infection (cCMV) can cause fetal growth restriction (FGR) and severe sequelae in affected infants. Clinicians generally suspect cCMV based on multiple ultrasound (US) findings associated with cCMV. However, no studies have assessed the diagnostic accuracy of fetal US for cCMV-associated abnormalities in FGR. Eight FGR and 10 non-FGR fetuses prenatally diagnosed with cCMV were examined by undergoing periodic detailed US examinations, as well as postnatal physical and imaging examinations. The diagnostic accuracy of prenatal US for cCMV-associated abnormalities was compared between FGR and non-FGR fetuses with cCMV. The diagnostic sensitivity rates of fetal US for cCMV-related abnormalities in FGR vs. non-FGR fetuses were as follows: ventriculomegaly, 66.7% vs. 88.9%; intracranial calcification, 20.0% vs. 20.0%; cysts and pseudocysts in the brain, 0% vs. 0%; ascites, 100.0% vs. 100.0%; hepatomegaly, 40.0% vs. 100.0%; splenomegaly, 0% vs. 0%. The diagnostic sensitivity of fetal US for hepatomegaly and ventriculomegaly in FGR fetuses with cCMV was lower than that in non-FGR fetuses with cCMV. The prevalence of severe long-term sequelae (e.g., bilateral hearing impairment, epilepsy, cerebral palsy, and severe developmental delay) in the CMV-infected fetuses with FGR was higher, albeit non-significantly. Clinicians should keep in mind the possibility of overlooking the symptoms of cCMV in assessing fetuses with FGR.

  2023年01月, Diagnostics (Basel, Switzerland), 13(2) (2), 英語, 国際誌

  研究論文（学術雑誌）

  神戸大学リポジトリ（Kernel）へのリンク


• Uterine rupture in intramural ectopic pregnancy: A case report.

  Keiichi Washio, Masato Komatsu, Masako Tomimoto, Akiko Uchida, Yuki Sasagawa, Masashi Nishimoto, Satoshi Nagamata, Yui Yamasaki, Kenji Tanimura, Yoshito Terai

  Intramural pregnancy is a rare form of ectopic pregnancy. It is defined by a gestation within the uterine wall, completely surrounded by myometrium and separated from the uterine cavity and the fallopian tube. We report a rare case of intramural ectopic pregnancy. If a patient has a history of intrauterine surgery or myomectomy, the possibility of intramural pregnancy, although rare, should not be ruled out.

  2023年01月, Asian journal of endoscopic surgery, 英語, 国内誌

  [査読有り]


• The Current Challenges in Developing Biological and Clinical Predictors of Congenital Cytomegalovirus Infection.

  Kenji Tanimura, Akiko Uchida, Hitomi Imafuku, Shinya Tairaku, Kazumichi Fujioka, Ichiro Morioka, Hideto Yamada

  Congenital cytomegalovirus (CMV) infection may cause severe long-term sequelae. Recent studies have demonstrated that early antiviral therapy for infants with symptomatic congenital CMV (cCMV) infection may improve neurological outcomes; thus, accurate identification of newborns at high risk of cCMV infection may contribute to improved outcomes in affected children. However, maternal serological screening for cCMV infection by diagnosing primary infection during pregnancy, which is a popular screening strategy, is inefficient, because the number of cCMV infections with nonprimary causes, including reactivation of or reinfection with CMV, is larger than that of cCMV infections with primary causes. Low levels of neutralizing antibodies against pentameric complex and potent CMV-specific T cell-mediated immune responses are associated with an increased risk of cCMV infection. Conversely, our prospective cohort studies revealed that the presence of maternal fever/flu-like symptoms, threatened miscarriage/premature delivery, or actual premature delivery are risk factors for cCMV infection among both women with normal pregnancies and those with high-risk ones, regardless of whether the infection is primary or nonprimary. This review focused on host immune responses to human CMV and current knowledge of potential biological and clinical factors that are predictive of cCMV infection.

  2021年12月, International journal of molecular sciences, 22(24) (24), 英語, 国際誌

  研究論文（学術雑誌）

  神戸大学リポジトリ（Kernel）へのリンク


• Clinical factors associated with a placenta accreta spectrum.

  Hitomi Imafuku, Kenji Tanimura, Yutoku Shi, Akiko Uchida, Masashi Deguchi, Yoshito Terai

  INTRODUCTION: Placenta accreta spectrum (PAS) is a life-threating obstetric complication, and prenatal prediction of PAS can decrease maternal morbidity and mortality. The aim of this prospective cohort study was to determine the clinical factors associated with PAS. METHODS: Pregnant women who delivered at a university hospital were enrolled. Clinical data were collected from medical records, and logistic regression analyses were performed to determine which clinical factors were associated with PAS. RESULTS: Eighty-seven (2.1%) of the 4146 pregnant women experienced PAS. Multivariable analyses revealed that a prior history of cesarean section (CS) (OR 3.3; 95% CI 1.9-5.7; p < 0.01), dilation and curettage (D&C) (OR 2.8; 95% CI 1.7-4.6; p < 0.01), hysteroscopic surgery (OR 5.7; 95% CI 2.3-14.4; p < 0.01), uterine artery embolization (UAE) (OR 44.1; 95% CI 13.8-141.0; p < 0.01), current pregnancy via assisted reproductive technology (ART) (OR 4.1; 95% CI 2.4-7.1; p < 0.01), and the presence of placenta previa in the current pregnancy (OR 13.1; 95% CI 7.9-21.8; p < 0.01) were independently associated with the occurrence of PAS. CONCLUSION: Pregnant women who have a prior history of CS, D&C, hysteroscopic surgery, UAE, current pregnancy via ART, and the presence of placenta previa in the current pregnancy are high risk for PAS.

  2021年09月, Placenta, 112, 180 - 184, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）

  神戸大学リポジトリ（Kernel）へのリンク


• 胎児治療と新生児治療の併用は先天性サイトメガロウイルス感染症児の予後を改善する

  谷村 憲司, 施 裕徳, 内田 明子, 今福 仁美, 藤岡 一路, 森岡 一朗, 出口 雅士, 峰松 俊夫, 寺井 義人, 山田 秀人

  (一社)日本周産期・新生児医学会, 2021年06月, 日本周産期・新生児医学会雑誌, 57(Suppl.) (Suppl.), P177 - P177, 日本語


• 非初感染母体から出生した重篤な症候性先天性サイトメガロウイルス感染症児の一例

  今福 仁美, 谷村 憲司, 益子 尚久, 内田 明子, 藤本 将史, 京野 由紀, 藤岡 一路, 出口 雅士, 寺井 義人

  (一社)日本周産期・新生児医学会, 2021年06月, 日本周産期・新生児医学会雑誌, 57(Suppl.) (Suppl.), P163 - P163, 日本語


• トキソプラズマ-IgG avidity index高値母体から発生した先天性トキソプラズマ感染疑いの1例

  谷村 憲司, 内田 明子, 笹川 勇樹, 施 裕徳, 白川 得朗, 今福 仁美, 出口 雅士, 芦名 満理子, 藤岡 一路, 森岡 一朗, 笹井 美和, 山本 雅裕, 山田 秀人

  (一社)日本産婦人科感染症学会, 2021年05月, 日本産婦人科感染症学会学術講演会プログラム・抄録集, 37回, 53 - 53, 日本語


• 症候性先天性サイトメガロウイルス感染症に対する胎児治療と新生児治療の有効性の検討

  谷村 憲司, 施 裕徳, 内田 明子, 上中 美月, 今福 仁美, 藤岡 一路, 森岡 一朗, 出口 雅士, 寺井 義人, 山田 秀人

  「産婦人科の進歩」編集室, 2021年05月, 産婦人科の進歩, 73(2) (2), 152 - 152, 日本語


• Immunoglobulin fetal therapy and neonatal therapy with antiviral drugs improve neurological outcome of infants with symptomatic congenital cytomegalovirus infection.

  Kenji Tanimura, Yutoku Shi, Akiko Uchida, Mizuki Uenaka, Hitomi Imafuku, Toshihiko Ikuta, Kazumichi Fujioka, Ichiro Morioka, Masashi Deguchi, Toshio Minematsu, Hideto Yamada

  Infants with symptomatic congenital cytomegalovirus infection (cCMV) suffer from long-term sequelae. This study aimed at evaluating the efficacy of combining immunoglobulin (Ig) fetal therapy (FT) and neonatal therapy (NT) with antiviral drugs to improve neurological outcomes of affected infants. Women whose fetuses had symptomatic cCMV received Ig injection into the fetal peritoneal cavity and/or maternal blood as FT, while affected newborns received oral valganciclovir or intravenous ganciclovir as NT. We compared the neurological outcomes at ≥18 months old between infants receiving FT with or without NT (FT group) and those receiving NT only (NT group). From 2009-2019, 15 women whose fetuses had symptomatic cCMV received FT, while 19 newborns received NT only. In FT group, two newborns died, and two were <18 months old. Neurological outcomes of the remaining 11 infants in FT group were as follows: normal 45.5 %, mild impairments 36.4 %, and severe impairments 18.2 %. In NT group, one newborn died, one's parents refused the follow-up, one was <18 months old, and two had only chorioretinitis as symptoms. Neurological outcomes of the remaining 14 infants in NT group were as follows: normal 21.4 %, mild impairments 14.3 %, and severe impairments 64.3 %. The proportion of infants with severe impairments in FT group was significantly lower than that in NT group (18.2 % vs 64.3 %, p < 0.05). This is the first trial demonstrating that the combination of Ig FT and NT with antiviral drugs may be more effective in improving neurological outcomes of newborns with symptomatic cCMV as compared to NT only.

  2020年12月, Journal of reproductive immunology, 143, 103263 - 103263, 英語, 国際誌

  研究論文（学術雑誌）

  神戸大学リポジトリ（Kernel）へのリンク


• Clinical and ultrasound features associated with congenital cytomegalovirus infection as potential predictors for targeted newborn screening in high-risk pregnancies.

  Hitomi Imafuku, Hideto Yamada, Akiko Uchida, Masashi Deguchi, Tokuro Shirakawa, Yuki Sasagawa, Yutoku Shi, Kazumichi Fujioka, Ichiro Morioka, Kenji Tanimura

  This prospective cohort study aimed to determine clinical factors associated with congenital cytomegalovirus (CMV) infection in pregnancy. Newborns born at a perinatal medical center received PCR analyses for CMV-DNA in their urine with informed consent. Clinical data, including age, maternal fever or flu-like symptoms, complications, ultrasound fetal abnormality, gestational weeks at delivery, and birth weight, were collected. Logistic regression analyses determined clinical findings associated with congenital CMV infection (cCMV). cCMV was diagnosed in 32 of 4380 pregnancies. Univariate and multivariable analyses revealed that age < 25 years old (OR 2.7, 95% CI 1.1-6.6; p < 0.05), the presence of maternal fever or flu-like symptoms (5.4, 2.6-11.2; p < 0.01), ultrasound fetal abnormalities (12.7, 5.8-27.7; p < 0.01), and preterm delivery at less than 34 gestational weeks (2.6, 1.1-6.0; p < 0.05) were independent clinical findings associated with cCMV. A combination of maternal fever/flu-like symptoms, ultrasound fetal abnormalities, or preterm delivery at less than 34 gestational weeks as optimal predictive factors showed 90.6% sensitivity, 66.4% specificity, and a maximum Youden index of 0.57. CMV-DNA tests in the urine of newborns born to mothers with these clinical manifestations may be an effective method in detecting cCMV as a targeted screening with a high sensitivity.

  2020年11月, Scientific reports, 10(1) (1), 19706 - 19706, 英語, 国際誌

  研究論文（学術雑誌）

  神戸大学リポジトリ（Kernel）へのリンク


• 切迫早産から妊娠29週未満で早産となった児の予後に関連する因子の検討

  澤田 茉美子, 谷村 憲司, 施 裕徳, 内田 明子, 笹川 勇樹, 白川 得朗, 森實 真由美, 藤岡 一路, 山田 秀人

  2005〜2017年に切迫早産のため当院で入院管理を行い妊娠29週未満に分娩となった出生児55例を対象とし、予後不良群と良好群に分け、諸データの比較検討を行った。予後不良の定義は、脳室内出血3度以上、嚢胞性脳室周囲白質軟化症、癲癇、脳性麻痺、在宅酸素療法を要する失明、精神発達遅滞のいずれかを認めたものとし、それ以外の症例を予後良好群とした。比較項目は「破水の有無」「分娩週数」「母体血CRPの最高値」「母体血白血球の最高値」「分娩前母体体温の最高値」「胎児肺成熟を目的とした母体ステロイド投与」「児の性別」「出生体重」「絨毛膜羊膜炎のBlanc分類(度)」とした。検討の結果、予後不良群は良好群に比べて「分娩週数」が有意に早く、他の項目に有意な群間差は認めなかった。予後不良に関連する因子を決定するため単変量ロジスティック回帰分析を行った結果、「分娩週数」と「母体血CRPの最高値」が選択され、これらについて多変量ロジスティック回帰分析を行ったところ「分娩週数」のみが予後不良に関わる独立因子として選択された。

  「産婦人科の進歩」編集室, 2020年10月, 産婦人科の進歩, 72(4) (4), 392 - 394, 日本語


• 先天性サイトメガロウイルス感染発生に関連する臨床因子

  内田 明子, 谷村 憲司, 森實 真由美, 藤岡 一路, 森岡 一朗, 大橋 正伸, 峰松 俊夫, 山田 秀人

  「産婦人科の進歩」編集室, 2020年05月, 産婦人科の進歩, 72(2) (2), 178 - 178, 日本語


• Clinical factors associated with congenital cytomegalovirus infection: A cohort study of pregnant women and newborns.

  Akiko Uchida, Kenji Tanimura, Mayumi Morizane, Kazumichi Fujioka, Ichiro Morioka, Masanobu Oohashi, Toshio Minematsu, Hideto Yamada

  BACKGROUND: The aim of this prospective cohort study was to determine clinical factors associated with the occurrence of congenital cytomegalovirus infection (cCMV) in pregnant women. METHODS: Between March 2009 and November 2017, newborns born at a primary maternity hospital received polymerase chain reaction (PCR) analyses for CMV-DNA in their urine with informed consent of the mothers at a low risk. Clinical data, including age, gravidity, parity, body mass index, occupations, maternal fever/flu-like symptoms, pregnancy complications, gestational weeks at delivery, birth weight, and automated auditory brainstem response (AABR), were collected. Logistic regression analyses were performed to determine clinical factors associated with cCMV. RESULTS: cCMV was diagnosed by positive PCR results of neonatal urine in 9 of 4,125 pregnancies. Univariate and multivariable analyses revealed that the presence of fever/flu-like symptoms (odds ratio [OR], 17.9; 95% confidence interval [CI], 3.7-86.7; p<0.001) and threatened miscarriage/premature labor in the second trimester (OR, 6.0; 95%CI 1.6-22.8; p<0.01) were independent clinical factors associated with cCMV. Maternal fever/flu-like symptoms or threatened miscarriage/premature labor in the second trimester had 100% sensitivity, 53.2% specificity, and a maximum Youden index of 0.85. CONCLUSIONS: This cohort study for the first time demonstrated that these clinical factors of pregnant women and newborns were associated with the occurrence of cCMV. This is useful information for targeted screening to assess risks of cCMV in low-risk mothers, irrespective of primary or non-primary CMV infection.

  2019年12月, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 71(11) (11), 2833 - 2839, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）

  神戸大学リポジトリ（Kernel）へのリンク


• 症候性先天性サイトメガロウイルス感染症に対する胎児治療と新生児治療の有効性

  谷村 憲司, 内田 明子, 今福 仁美, 森實 真由美, 出口 雅士, 藤岡 一路, 森岡 一朗, 峰松 俊夫, 山田 秀人

  (一社)日本産婦人科感染症学会, 2019年09月, 日本産婦人科感染症学会誌, 3(1) (1), 87 - 87, 日本語

• 常位胎盤に対する癒着胎盤予測法確立に向けたリスク因子の抽出

  益子尚久, 今福仁美, 喜多ともみ, 森内航生, 内田明子, 谷村憲司, 出口雅士, 寺井義人

  2025年, 超音波医学 Supplement, 52


• 7日間以上待機的に管理した癒着胎盤7症例の臨床経過

  辻拓弥, 今福仁美, 栖田園子, 益子尚久, 内田明子, 出口雅士, 谷村憲司, 寺井義人

  2025年, 産婦人科の進歩, 77(2) (2)


• Targeted maintenance tocolysisの試み

  喜多ともみ, 谷村憲司, 栖田園子, 益子尚久, 内田明子, 今福仁美, 出口雅士, 寺井義人

  2025年, 産婦人科の進歩, 77(2) (2)


• NIPT判定保留後にステージIVの乳がんが判明した1例

  益子尚久, 今福仁美, 花房宏昭, 田中敬子, 冨本雅子, 高橋良輔, 内田明子, 笹川勇樹, 小野竜輔, 國久智成, 出口雅士, 寺井義人, 谷村憲司

  2024年, 日本遺伝カウンセリング学会誌, 45(2) (2)


• 妊娠中に診断された低異型度漿液性癌の1例

  鷲尾佳一, 山中啓太郎, 栖田園子, 冨本雅子, 施裕徳, 内田明子, 高橋良輔, 長又哲史, 山崎友維, 寺井義人

  2024年, 日本婦人科腫瘍学会学術講演会プログラム・抄録集(Web), 66th


• 慢性胎盤早期剥離12例の妊娠予後および児予後の後方視的検討

  清水香陽子, 今福仁美, 内田明子, 出口雅士, 寺井義人, 谷村憲司

  2024年, 日本周産期・新生児医学会雑誌(Web), 60(3) (3)


• 国産手術支援ロボットhinotoriの臨床導入に向けて

  山崎友維, 岡野史奈, 倉智友香, 三木満帆, 辻麻亜子, 山中啓太郎, 安積麻帆, 豊永絢香, 鷲尾佳一, 内田明子, 笹川勇樹, 長又哲史, 西本昌司, 寺井義人

  2023年, 日本婦人科ロボット手術学会プログラム・抄録集(Web), 11th


• 1型糖尿病合併妊娠管理におけるセンサー機能付きインスリンポンプ療法の有用性の検討

  今福仁美, 谷村憲司, 益子尚久, 冨本雅子, 施裕徳, 内田明子, 出口雅士, 山本あかね, 芳野啓, 廣田勇士, 小川渉, 寺井義人

  2023年, 日本女性栄養・代謝学会誌, 29(1) (1)


• 胎児発育不全児の予後不良に関連する因子の検討

  吉本 梓希子, 谷村 憲司, 久保田 いろは, 栖田 園子, 施 裕徳, 内田 明子, 白川 得朗, 今福 仁美, 出口 雅士, 寺井 義人

  「産婦人科の進歩」編集室, 2021年10月, 産婦人科の進歩, 73(4) (4), 500 - 500, 日本語


• 胎児治療と新生児治療の併用は先天性サイトメガロウイルス感染症児の予後を改善する

  谷村 憲司, 施 裕徳, 内田 明子, 今福 仁美, 藤岡 一路, 森岡 一朗, 出口 雅士, 峰松 俊夫, 寺井 義人, 山田 秀人

  (一社)日本周産期・新生児医学会, 2021年06月, 日本周産期・新生児医学会雑誌, 57(Suppl.) (Suppl.), P177 - P177, 日本語


• 非初感染母体から出生した重篤な症候性先天性サイトメガロウイルス感染症児の一例

  今福 仁美, 谷村 憲司, 益子 尚久, 内田 明子, 藤本 将史, 京野 由紀, 藤岡 一路, 出口 雅士, 寺井 義人

  (一社)日本周産期・新生児医学会, 2021年06月, 日本周産期・新生児医学会雑誌, 57(Suppl.) (Suppl.), P163 - P163, 日本語


• 産科一次施設における先天性サイトメガロウイルス感染症発生の臨床的リスク因子

  内田 明子, 谷村 憲司, 今福 仁美, 笹川 勇樹, 施 裕徳, 白川 得朗, 出口 雅士, 森實 真由美, 大橋 正伸, 山田 秀人

  (一社)日本産婦人科感染症学会, 2021年05月, 日本産婦人科感染症学会学術講演会プログラム・抄録集, 37回, 52 - 52, 日本語


• 梅毒合併妊娠8例の検討

  出口 雅士, 谷村 憲司, 施 裕徳, 内田 明子, 白川 得朗, 今福 仁美, 森實 真由美, 山田 秀人

  (一社)日本産婦人科感染症学会, 2021年05月, 日本産婦人科感染症学会学術講演会プログラム・抄録集, 37回, 43 - 43, 日本語


• 周産期母子医療センターでの先天性サイトメガロウイルス感染に関与する臨床所見

  今福 仁美, 谷村 憲司, 内田 明子, 施 裕徳, 笹川 勇樹, 白川 得朗, 出口 雅士, 山田 秀人

  (一社)日本産婦人科感染症学会, 2021年05月, 日本産婦人科感染症学会学術講演会プログラム・抄録集, 37回, 50 - 50, 日本語


• 不育症と子宮内膜マイクロバイオームとの関連

  施 裕徳, 谷村 憲司, 笹川 勇樹, 内田 明子, 尾崎 可奈, 白川 得朗, 今福 仁美, 出口 雅士, 山田 秀人

  (一社)日本産婦人科感染症学会, 2021年05月, 日本産婦人科感染症学会学術講演会プログラム・抄録集, 37回, 35 - 35, 日本語


• 妊娠中の画像診断で胎児共存奇胎と鑑別困難であった間葉系異形成胎盤の一例

  施裕徳, 谷村憲司, 安積麻帆, 内田明子, 白川得朗, 今福仁美, 出口雅士, 寺井義人

  2021年, Abstracts. Annual Symposium. Japanese Society for the Advancement of Women’s Imaging (CD-ROM), 22nd


• 非初感染母体から出生した重篤な症候性先天性サイトメガロウイルス感染症児の一例

  今福仁美, 谷村憲司, 益子尚久, 内田明子, 藤本将史, 京野由紀, 藤岡一路, 出口雅士, 寺井義人

  2021年, 日本周産期・新生児医学会雑誌(Web), 57(Suppl) (Suppl)


• 精神疾患合併妊娠の妊娠中・産後増悪誘因ならびに児への影響に関する検討

  谷村 憲司, 施 裕徳, 内田 明子, 笹川 勇樹, 白川 得朗, 今福 仁美, 出口 雅士, 山田 秀人

  「産婦人科の進歩」編集室, 2020年10月, 産婦人科の進歩, 72(4) (4), 458 - 458, 日本語


• トキソプラズマIgG avidity index高値母体から発生した先天性トキソプラズマ感染疑いの1例

  谷村 憲司, 笹川 勇樹, 内田 明子, 今福 仁美, 出口 雅士, 藤岡 一路, 森岡 一朗, 笹井 美和, 山本 雅裕, 山田 秀人

  「産婦人科の進歩」編集室, 2020年05月, 産婦人科の進歩, 72(2) (2), 162 - 162, 日本語


• 妊娠糖尿病妊婦におけるHeavy For Date児出生の予測因子

  益子 尚久, 谷村 憲司, 施 裕徳, 内田 明子, 笹川 勇樹, 白川 得郎, 今福 仁美, 出口 雅士, 山田 秀人

  「産婦人科の進歩」編集室, 2020年05月, 産婦人科の進歩, 72(2) (2), 177 - 177, 日本語


• 症候性先天性サイトメガロウイルス感染症に対する胎児治療と新生児治療の有効性

  谷村 憲司, 内田 明子, 今福 仁美, 森實 真由美, 出口 雅士, 藤岡 一路, 森岡 一朗, 峰松 俊夫, 山田 秀人

  (一社)日本産婦人科感染症学会, 2019年09月, 日本産婦人科感染症学会誌, 3(1) (1), 87 - 87, 日本語


• トキソプラズマ抗体妊婦スクリーニングに関する前向きコホート研究

  内田 明子, 谷村 憲司, 西川 鑑, 清水 亜由美, 施 裕徳, 田中 恵里加, 森實 真由美, 出口 雅士, 蝦名 康彦, 森岡 一朗, 山田 秀人

  (一社)日本産婦人科感染症学会, 2019年09月, 日本産婦人科感染症学会誌, 3(1) (1), 88 - 88, 日本語


• A cohort study of maternal screening for congenital Toxoplasma gondii infection: 12 years' experience.

  Hideto Yamada, Kenji Tanimura, Masashi Deguchi, Shinya Tairaku, Mayumi Morizane, Akiko Uchida, Yasuhiko Ebina, Akira Nishikawa

  Primary infection with Toxoplasma gondii (T. gondii) during pregnancy may cause congenital infection of the infant. This study evaluated whether screening using IgG avidity and multiplex-nested polymerase chain reaction (PCR) methods was effective for detecting a high-risk pregnancy for congenital T. gondii infection. In a prospective cohort study serum T. gondii IgG avidity was measured in 469 pregnant women who had a positive test for T. gondii antibody plus a positive or equivocal test for IgM. Multiplex-nested PCR for T. gondii DNA on amniotic fluid, maternal blood, and neonatal blood was performed with informed consent. Low (<30%), borderline (30-35%), and high (>35%) IgG avidity indices were found in 104 (22.2%), 30 (6.4%), and 305 (71.4%), respectively. A total of 12 cases had a positive PCR test for amniotic fluids of the prenatal amniocentesis or at birth, or neonatal blood. Seven of the 12 cases were diagnosed as having congenital T. gondii infection, and they had low IgG avidity indices. Congenital T. gondii infection screening using of IgG avidity and multiplex-nested PCR methods for pregnant women with a positive test for T. gondii antibody plus a positive or equivocal test for T. gondii IgM was useful for detecting a high-risk pregnancy and diagnosing congenital T. gondii infection.

  2019年06月, Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, 25(6) (6), 427 - 430, 英語, 国際誌

  神戸大学リポジトリ（Kernel）へのリンク


• 治療〜難治性疾患へのアプローチ〜 症候性先天性サイトメガロウイルス感染症に対する胎児治療と新生児治療

  谷村 憲司, 内田 明子, 森實 真由美, 西田 浩輔, 藤岡 一路, 森岡 一朗, 峰松 俊夫, 山田 秀人

  (一社)日本周産期・新生児医学会, 2019年01月, 日本周産期・新生児医学会雑誌, 54(別冊) (別冊), 26 - 27, 日本語


• 症候性の先天性サイトメガロウイルス感染症に対する胎児治療と新生児治療

  谷村 憲司, 内田 明子, 今福 仁美, 森實 真由美, 出口 雅士, 藤岡 一路, 森岡 一朗, 峰松 俊夫, 山田 秀人

  (一社)日本周産期・新生児医学会, 2018年06月, 日本周産期・新生児医学会雑誌, 54(2) (2), 638 - 638, 日本語


• トキソプラズマ妊婦スクリーニングの前向きコホート研究

  内田 明子, 谷村 憲司, 西川 鑑, 里吉 雅恵, 清水 亜由美, 施 裕徳, 田中 恵里加, 森實 真由美, 出口 雅士, 蝦名 康彦, 森岡 一朗, 山田 秀人

  (一社)日本周産期・新生児医学会, 2018年06月, 日本周産期・新生児医学会雑誌, 54(2) (2), 689 - 689, 日本語


• A prospective study of maternal toxoplasma screening with use of IgG avidity index and PCR method

  Yutoku Shi, Masashi Deguchi, Kenji Tanimura, Akiko Uchida, Erika Tanaka, Ryosuke Takahashi, Maho Miyaji, Mayumi Morizane, Yasuhiko Ebina, Ichro Morioka, Ayumi Shimizu, Akira Nishikawa, Hideto Yamada

  2017年11月, JOURNAL OF REPRODUCTIVE IMMUNOLOGY, 124, 81 - 81, 英語

  研究発表ペーパー・要旨（国際会議）


• 妊娠中にネフローゼ症候群を発症し,ステロイドおよび血漿交換にて完全寛解に至った一例

  小嶋真理子, 後藤俊介, 泉博子, 内田明子, 出口雅士, 藤井秀毅, 山田秀人, 西慎一

  2017年, 日本腎臓学会誌, 59(6) (6)

• 日本周産期・新生児医学会

  2016年08月 - 現在


• 日本産科婦人科学会

  2013年05月 - 現在


• 日本女性医学会

  2021年11月

• 先天性トキソプラズマ感染症におけるペア型レセプターを介した免疫逃避機構の解明

  内田 明子

  日本学術振興会, 科学研究費助成事業, 若手研究, 神戸大学, 2021年04月01日 - 2025年03月31日

  産婦人科医師として周産期医療に携わっており、日常診療でトキソプラズマIgM抗体陽性妊婦の紹介を引き受けている。1か月あたり5人程度と、その他の疾患に比して紹介数は多くはない。しかし、先天性トキソプラズマ感染症の研究を行っている施設が少なく、またトキソプラズマ抗体検査を行える検査会社との契約がない病院がほとんどであるため、当院へ紹介される、もしくは妊婦本人が希望して来院されることが多い。 妊娠中に実施可能な検査は限られており多くはないが、トキソプラズマIgG抗体（既往感染を示唆する抗体）、IgM抗体（初感染を示唆する抗体）、IgG avidityの測定、multiplex-nested PCR検査を用いた妊婦スクリーニングと、胎児感染予防の治療（スピラマイシンの内服）を行いながら、妊娠期間中は胎児エコーで胎児に異常がないか（胎児発育、肝腫大・脳内石灰化・水頭症の有無など）を超音波でフォローアップし、出生児の精査（血液検査、頭部CT、眼底検査など）、分娩時の胎盤病理検査、羊水PCRを行い最終的に感染が成立しているかどうかを診断していく。 診断と治療、フォローアップによって、天性トキソプラズマ感染の発生を抑制できることをコホート研究で明らかにした。毎年年度末にデーターをさらに追加して解析し、トキソプラズマ感染妊婦に行う検査、フォローアップ方法をまとめ、出生児の精査を行い、先天性感染を予防するためには妊娠中に初感染を行さないように啓蒙を行うことと、スピラマイシンを妊婦に内服させ、先天感染を起こさないようにすることを広く知ってもらえるように努力している。 去年まではCOVID19の影響で、研究室への出入りができなかったが、落ち着いてききたらトキソプラズマの免疫逃避機構を解明し、胎盤を通過してどのように先天性トキソプラズ感染症が発症するのかを解明していきたい。