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Association between pesticide usage during pregnancy and neonatal hyperbilirubinemia requiring treatment: the Japan Environment and Children’s Study



Maternal exposure to pesticides during pregnancy may cause oxidative hemolysis leading to neonatal hyperbilirubinemia. This investigation examined for associations between maternal use of pesticides or repellents during pregnancy and neonatal hyperbilirubinemia requiring phototherapy.


We used the dataset from the Japan Environment and Children’s Study, a large national birth cohort study registered from January 31, 2011 to March 31, 2014. The fixed data of 61,751 live births were used to evaluate the presence of neonatal hyperbilirubinemia and potential confounding factors. We employed multiple logistic regression analysis to identify correlations between the frequency of maternal pesticide or repellent use during pregnancy and clinically relevant neonatal hyperbilirubinemia.


After controlling for confounding factors, there were significant associations between neonatal hyperbilirubinemia necessitating phototherapy and the frequent use of indoor insecticide spray (OR 1.21, 95% CI 1.05–1.38). For spray- or lotion-type insect repellents, an opposite relationship was observed (more than a few times a week: OR 0.70, 95% CI 0.61–0.81, up to a few times a month: OR 0.84, 95% CI 0.78–0.91).


The frequent use of indoor insecticide spray during pregnancy showed an increased risk of neonatal hyperbilirubinemia requiring phototherapy, which was absent for spray- or lotion-type insect repellents.


  • The frequent use of indoor insecticide spray during pregnancy showed an increased risk of neonatal hyperbilirubinemia requiring phototherapy, which was absent for spray- or lotion-type insect repellents.

  • This is the first study examining the effects of maternal exposure to pesticides or repellents on clinically relevant neonatal hyperbilirubinemia using a dataset from a nationwide birth cohort study.

  • This large-scale Japanese cohort study revealed that the frequent use of indoor insecticide spray during pregnancy may increase the risk of neonatal hyperbilirubinemia requiring treatment.

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This research was supported by The Japan Environment and Children’s Study (JECS) Group. We sincerely thank all the participants in this study and all individuals involved in data collection. The Japan Environment and Children’s Study was funded by the Ministry of the Environment of the Government of Japan. The finding and conclusions of this study are solely the response of the authors and do not represent the official views of the above government.

the Japan Environment & Children’s Study (JECS) Group

Toshihiro Kawamoto6, Hirohisa Saito7, Reiko Kishi8, Nobuo Yaegashi9, Koichi Hashimoto10, Chisato Mori11, Shuichi Ito12, Zentaro Yamagata13, Hidekuni Inadera14, Michihiro Kamijima15, Takeo Nakayama16, Hiroyasu Iso17, Masayuki Shima18, Yasuaki Hirooka19, Narufumi Suganuma20, Koichi Kusuhara6 and Takahiko Katoh21

Author information





T.S., N.M., and T.N. designed the study. Y.M. and S.O. contributed to data collection. T.S. and T.N. performed statistical analysis and interpretation of data. T.S. drafted the article. N.M., Y.I., M.K., H.K., Y.N., T.T, T.N. and members of the Japan Environment & Children’s Study (JECS) Group revised the manuscript critically for important intellectual content. All members reviewed and approved the manuscript.

Corresponding author

Correspondence to Tetsuo Nomiyama.

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Written informed consent was obtained from each participant.

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Shibazaki, T., Motoki, N., Misawa, Y. et al. Association between pesticide usage during pregnancy and neonatal hyperbilirubinemia requiring treatment: the Japan Environment and Children’s Study. Pediatr Res 89, 1565–1570 (2021).

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