• Journal of Preventive Medicine and Public Health
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• v.37 no.4
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• pp.300-305
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• 2004

Objectives : The exposure to particulate air pollution during the pregnancy has reported to result in adverse pregnancy outcome such as low birth weight, preterm birth, still birth, and intrauterine growth retardation (IUGR). We aim to assess whether prenatal exposure of particulate matter less than 10 (m in diameter ($PM_{10}$) is associated with preterm birth in Seoul, South Korea. Methods : We included 382,100 women who delivered a singleton at 25-42 weeks of gestation between 1998 and 2000. We calculated the average PM10 exposures for each trimester period and month of pregnancy, from the first to the ninth months, based on the birth date and gestational age. We used three different models to evaluate the effect of air pollution on preterm birth; the logistic regression model, the generalized additive logistic regression model, and the proportional hazard model. Results : The monthly analysis using logistic regression model suggested that the risks of preterm birth increase with PM10 exposure between the sixth and ninth months of pregnancy and the highest risk was observed in the seventh month (adjusted odds ratio=1.07, 95% CI=1.01-1.14). We also found the similar results using generalized additive model. In the proportional hazard model, the adjusted odds ratio for preterm births due to PM10 exposure of third trimester was 1.04 (95% CI=0.96-1.13) and PM10 exposure between the seventh month and ninth months of pregnancy was associated with the preterm births. Conclusions : We found that there were consistent results when we applied the three different models. These findings suggest that air pollution exposure during the third trimester pregnancy has an adverse effect on preterm birth in South Korea.

• Clinical and Experimental Pediatrics
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• v.64 no.5
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• pp.239-246
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• 2021

Background: The consequences of severe acute respiratory syndrome corona virus 2 on mother and fetus remain unknown due to a lack of robust evidence from prospective studies. Purpose: This study evaluated the effect of coronavirus disease 2019 (COVID-19) on neonatal outcomes and the scope of vertical transmission. Methods: This ambispective observational study enrolled pregnant women with COVID-19 in North India from April 1 to August 31, 2020 to evaluate neonatal outcomes and the risk of vertical transmission. Results: A total of 44 neonates born to 41 COVID-19-positive mothers were evaluated. Among them, 28 patients (68.3%) (2 sets of twins) were delivered within 7 days of testing positive for COVID-19, 23 patients (56%) (2 sets of twins) were delivered by cesarean section; 13 newborns (29.5%) had low birth weight; 7 (15.9%) were preterm; and 6 (13.6%) required neonatal intensive care unit admission, reflecting an increased incidence of cesarean delivery and low birth weight but zero neonatal mortality. Samples of cord blood, placental membrane, vaginal fluid, amniotic fluid, peritoneal fluid (in case of cesarean section), and breast milk for COVID-19 reverse transcription-polymerase chain reaction tested negative in 22 prospective delivery cases. Nasopharyngeal swabs of 2 newborns tested positive for COVID-19: one at 24 hours and the other on day 4 of life. In the former case, biological samples were not collected as the mother was asymptomatic and her COVID-19 report was available postdelivery; hence, the source of infection remained inconclusive. In the latter case, all samples tested negative, ruling out the possibility of vertical transmission. All neonates remained asymptomatic on follow-up. Conclusion: COVID-19 does not have direct adverse effects on the fetus per se. The possibility of vertical transmission is almost negligible, although results from larger trials are required to confirm our findings.

• Environmental Analysis Health and Toxicology
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• v.30
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• pp.11.1-11.19
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• 2015

Objectives The objective of this study was to conduct a systematic review to provide summarized evidence on the association between maternal exposure to particulate air pollution and birth weight (BW) and preterm birth (PTB) after taking into consideration the potential confounding effect of maternal smoking. Methods We systematically searched all published cohort and case-control studies examining BW and PTB association with particulate matter (PM, less than or equal to $2.5{\mu}m$ and $10.0{\mu}m$ in diameter, $PM_{2.5}$ and $PM_{10}$, respectively) from PubMed and Web of Science, from January 1980 to April 2015. We extracted coefficients for continuous BW and odds ratio (OR) for PTB from each individual study, and meta-analysis was used to combine the coefficient and OR of individual studies. The methodological quality of individual study was assessed using a standard protocol proposed by Downs and Black. Forty-four studies met the inclusion criteria. Results In random effects meta-analyses, BW as a continuous outcome was negatively associated with $10{\mu}g/m^3$ increase in $PM_{10}$ (-10.31 g; 95% confidence interval [CI], -13.57 to -3.13 g; I-squared=0%, p=0.947) and $PM_{2.5}$ (-22.17 g; 95% CI, -37.93 to -6.41 g; Isquared=92.3%, p<0.001) exposure during entire pregnancy, adjusted for maternal smoking. A significantly increased risk of PTB per $10{\mu}g/m^3$ increase in $PM_{10}$ (OR, 1.23; 95% CI, 1.04 to 1.41; I-squared=0%, p=0.977) and $PM_{2.5}$ (OR, 1.14; 95% CI, 1.06 to 1.22; I-squared=92.5%, p<0.001) exposure during entire pregnancy was observed. Effect size of change in BW per $10{\mu}g/m^3$ increase in PM tended to report stronger associations after adjustment for maternal smoking. Conclusions While this systematic review supports an adverse impact of maternal exposure to particulate air pollution on birth outcomes, variation in effects by exposure period and sources of heterogeneity between studies should be further explored.

• Clinical and Experimental Pediatrics
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• v.62 no.7
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• pp.245-251
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• 2019

Hemodynamically significant preterm patent ductus arteriosus (PDA) affects mortality; comorbidities such as necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia; and adverse long-term neurodevelopmental outcomes in preterm infants, particularly in very low birth weight infants. However, recent studies have indicated that there is no consensus on the causal relationship between PDA and neonatal outcomes, the benefit of PDA treatment, the factors guiding the need for treatment, and optimal treatment strategies. Such uncertainty has resulted in wide variations in practice for treating preterm PDA between units, regions, and nations. Nowadays, there has been a paradigm shift to more conservative treatment for preterm PDA, and suggestions regarding selective management of preterm PDA considering risk factors and hemodynamic significance are increasing. Neonatologist-performed echocardiography and advances in modalities to assess hemodynamic significance such as biologic markers and near-infrared spectroscopy also help improve the efficacy of selective treatment of preterm PDA.

• Investigative Magnetic Resonance Imaging
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• v.24 no.1
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• pp.30-37
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• 2020

Purpose: Preterm infants are at high risk for adverse neurodevelopmental outcomes. Magnetic resonance imaging (MRI) has been proposed as a means of predicting neurodevelopmental outcomes in this population. It is controversial whether diffuse excessive high signal intensity (DEHSI) represents damage to the white matter or delayed myelination in preterm infants. This study investigated MRI findings for predicting the severity of neurodevelopmental outcomes and assessing whether preterm infants with DEHSI near term-equivalent age have abnormal neurodevelopmental outcomes. Materials and Methods: Preterm infants (n = 64, gestational age at birth < 35 weeks) undergoing brain MRI near term-equivalent age and subsequent neurodevelopmental outcomes were evaluated between 18 and 24 months of age. The associations of MRI findings and the risk of severe cognitive delay, severe psychomotor delay, cerebral palsy (CP), and neurosensory impairment were analyzed. The associations of DEHSI with risks of severe cognitive delay, severe psychomotor delay, CP, and neurosensory impairment (hearing or visual impairment) were analyzed. Outcome data were evaluated by logistic regression and the Fisher's exact test. Results: There were significant associations between abnormal white matter findings and delayed mental development, delayed psychomotor development, neurosensory impairment, and presence of CP. The presence of DEHSI was not correlated with delayed neurodevelopmental outcomes or presence of CP. In multivariate logistic regression analyses, cystic encephalomalacia, punctate lesion, loss of white matter volume and ventricular dilation were significantly associated with CP. Conclusion: Abnormal MRI findings near term-equivalent age in preterm infants predict adverse neurodevelopmental outcomes. No significant association between DEHSI and adverse neurodevelopmental outcomes was demonstrated.

• Clinical and Experimental Reproductive Medicine
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• v.38 no.2
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• pp.103-108
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• 2011

Objective: To investigate adverse pregnancy outcomes in non-obese women with polycystic ovary syndrome (PCOS) compared with obese-PCOS and control groups. Methods: Women with PCOS who underwent assisted reproductive technology (ART) from August, 2003 to December, 2007, were considered. A total of 336 women with PCOS were included in the study group and 1,003 infertile women who had tubal factor as an indication for ART were collected as controls. They were divided into four groups: a non-obese PCOS group, obese-PCOS group, non-obese tubal factor group, and obese tubal factor group, with obesity defined by a body mass index over 25 kg/$m^2$, and reviewed focusing on the basal characteristics, ART outcomes, and adverse pregnancy outcomes. Results: There was no difference among the groups' the clinical pregnancy rate or live birth rate. Regarding adverse pregnancy outcomes, the miscarriage rate, multiple pregnancy rate, and prevalence of preterm delivery and pregnancy induced hypertension were not different among the four groups. The incidence of small for gestational age infant was higher in the PCOS groups than the tubal factor groups ($p$ <0.02). On the other hand, the morbidity of gestational diabetes mellitus (GDM) was not high in the non-obese PCOS group but was in the obese groups. And in the obese PCOS group, the newborns were heavier than in the other groups ($p$ <0.02). Conclusion: Non-obese PCOS presents many differences compared with obese PCOS, not only in the IVF-parameters but also in the morbidity of adverse pregnancy outcomes, especially in GDM and fetal macrosomia.

• The Journal of Korean Medicine
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• v.36 no.2
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• pp.1-7
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• 2015

Objectives: To report on the result of infertility treatment with Korean medicine in clinical settings. Methods: This study was single arm, retrospective observational study. Analysis of the medical records on thirty four infertile women who were treated by acupuncture, moxibustion, herbal medicine(Jokyungjongoktang-gagambang, Sutaehwan-gagambang). Pregnancy rate(PR) and Live birth rate(LBR) were analyzed as the primary outcomes. Changes of AMH, FSH, LH, $E_2$, $P_4$, endometrial thickness, fat mass, and BMI were also analyzed as the secondary outcomes. Results: A total of 34 patients were treated in the traditional Korean medical clinic. Nine patients were dropped, and 25 subjects completed the final examination at the end of this treatment schedule. Five of 25 subjects conceived during treatment, reaching 20% PR and LBR was also 20%. Except for FSH level, the results of the remaining outcome measures, including LFT, showed no significant changes. No serious adverse event has been reported. Conclusion: Although no significant changes in bio-markers were observed, complex treatment using Korean medicine has shown effectiveness on women's infertility. In addition, the safety of the treatment has been verified.

• Clinical and Experimental Reproductive Medicine
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• v.48 no.1
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• pp.80-84
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• 2021

Objective: The aim of the study was to investigate pregnancy, obstetric, and neonatal outcomes in women with small (<4 cm) unilateral endometriomas. Methods: This retrospective study included 177 patients: 91 patients with small endometriomas and 86 controls with unexplained or tubal factor infertility who were treated at the Süleymaniye Gynecology and Maternity Training and Research Hospital Infertility Unit between January 2010 and July 2015. The groups were matched with regards to demographic characteristics such as age, body mass index, and infertility duration. All of the women in this study conceived via intracytoplasmic sperm injection. We compared pregnancy, obstetric, and neonatal outcomes between these groups. Results: Women with endometriomas had a higher biochemical pregnancy rate, but lower clinical pregnancy and live birth rates than women with unexplained and tubal factor infertility (p<0.05 for all). However no significant differences were found in terms of obstetric and neonatal complications between the two groups (p>0.05 for all). Conclusion: In this study, we found that women with endometriomas less than 4 cm were more prone to early pregnancy complications. We also showed that this group did not have any increased risks of late pregnancy, obstetric, and neonatal complications.

• The Journal of Pediatrics of Korean Medicine
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• v.30 no.4
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• pp.99-110
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• 2016

Introduction Jaundice is one of the most common conditions found in neonatal period. Phototherapy is one of the main treatments for neonatal jaundice. However, several adverse effects of the phototherapy have been reported, including DNA damage recently. Therefore, a variety of treatments have been conducted to shorten the duration of phototherapy. Meanwhile, it has been hardly tried to prevent neonatal jaundice, but diverse approaches have been tried in traditional Chinese medicine (TCM) for many years. Therefore, this study aims to analyze the studies for the treatments to prevent neonatal jaundice based on TCM. Materials and Methods Various literatures have been searched via CNKI, and PubMed using the terms "neonatal jaundice" (新生儿黄疸, 胎黃, 胎疸) in category of 'Traditional Chinese Medicine', 'Traditional Chinese Medicinal Herbs' and 'Combination of Traditional Chinese Medicine With Western Medicine'. The search range included randomized controlled trials (RCTs), controlled clinical trials (CCTs), case reports, reviews and animal experiments published from 2013 to 2015. Results A total of 104 studies were found. 93 articles were excluded by reviewing the titles and abstracts. Out of the remaining 11 studies, 9 articles were RCTs, 2 articles were CCTs. The treatment used in neonatal babies in the studies were, using herbal remedies (meditation 5, bath 3 and retention enema 1) and the acupressure. All treatments were initiated within the first 24-48 hours after their birth. Then, there was a study that the subjects taken the herbal medicine were women during pregnancy. The outcome assessments used were the serum total bilirubin (TB), transcutaneous bilirubin measurement (TCB), the incidence of the hyperbilirubinemia, the duration time of the jaundice. Especially, TB, TCB and the incidence of the hyperbilirubinemia have decreased significantly more than that of the control group in the most of the results. No severe adverse events were reported in all articles reviewed. Conclusions Conventional treatment such as, herbal medicine in TCM, seems to be the effective way to prevent neonatal jaundice or hyperbilirubinemia. Therefore, the conventional treatment may be favorable choice for preventive treatment for neonatal jaundice.

• Korean Journal of Clinical Pharmacy
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• v.23 no.2
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• pp.167-174
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• 2013

Objective: The study evaluated the impact of pharmacist inventions with the implementation of pharmacistinvolved nutritional support service at neonate intensive care unit in a tertiary teaching hospital. Method: A retrospective and observational study was carried out. The total of 58 infants in neonate intensive care unit was enrolled between January 2011 and October 2012. The pharmacist-involved total parenteral nutritional program was initiated in June of 2012. During the program, pharmacist actively participated in the multidisciplinary round with performing the interventions from reviewing the amount of combined total parenteral nutrition and enteral fluid intakes, the amount of total calories, the glucose infusion rate, and the amounts of proteins per weight in kilogram. The outcome was compared with the results from the control group which reflected the prior period of the program initiation. Result: The number of days of regaining birth weight was significantly shorter (14.5 vs. 19 days, p=0.049) and the percentage of total calorie days with >90 kcal/kg/day was increased significantly (40 vs. 13%, p=0.008) in intervention group compared to the values in control group. In addition, the total mean daily caloric intakes ($84.78{\pm}13.8$ vs. $74.86{\pm}15.36$ kcal/kg/day, p=0.018) was significantly higher in intervention group than those results in control group. There were no significant differences in safety parameters between two groups related to nutritional services of necrotizing enterocolitis, intraventricular hemorrhage, proven sepsis, and also parenteral nutrition-induced hepatotoxicity. Conclusion: Pharmacist-involved total parenteral nutrition managed program was successfully implemented. The outcome showed the improved effectiveness of total parenteral nutrition with pharmacist interventions and no differences in adverse reactions. This could prove the positive effects of pharmacist involvement on nutritional therapy for neonate population.