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Abstract Aims/Introduction In Japan, the increasing frequency of underweight among women of reproductive age and the accompanying increase in the rate of low birth weight (LBW) are social issues. The study aimed to establish a prospective registry system for gestational diabetes mellitus (GDM) in Japan and to clarify the actual status of GDM according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Materials and Methods Pregnant women with gestational diabetes mellitus and those in the normal glucose tolerance (NGT) group were enrolled in the Diabetes and Pregnancy Outcome for Mother and Baby study from October 2015. Pregnant women with positive glucose screening in early and mid‐to‐late pregnancy underwent a 75 g oral glucose tolerance test by gestational week 32. Gestational diabetes mellitus was diagnosed according to IADPSG criteria. Women with a positive glucose screening test at mid‐to‐late pregnancy but NGT were enrolled as references (NGT group). Treatment for gestational diabetes mellitus and maternal and neonatal pregnancy data were prospectively collected on outcomes. Results In total 1,795 singleton pregnancies (878 women with GDM and 824 NGT women) were analyzed. The risk of LBW and small‐for‐gestational age in the GDM group was significantly higher than in the NGT group. A similar relationship was found for LBW risk in the non‐overweight/obese group but not in the overweight/obese group. Conclusions We established a prospective GDM registry system in Japan. In the management of GDM in Japan, suppression of maternal weight gain may be associated with reduced fetal growth, especially in non‐overweight/obese women with GDM; however, further investigation is required.

There is little evidence concerning the need to treat gestational diabetes (GDM) in the same way as pregestational diabetes. We evaluated the efficacy of the simple insulin injection (SII) regimen for achieving the target glucose goal without increasing adverse perinatal outcomes in singleton pregnant women with GDM. All subjects underwent self-monitoring of blood glucose (SMBG), and insulin therapy was indicated according to the SMBG profile. Insulin was initially started with the SII regimen, in which one daily injection of NPH insulin before breakfast was used, and another NPH injection was added at bedtime, if necessary. We used the target glucose as the SII>the diet group. The rate of achieving target glucose levels before delivery in the SII group at fasting, postprandial

Abstract Background Recent studies have suggested that fetal sex influences maternal glucose and insulin metabolism during pregnancy. We examined whether fetal sex is associated with maternal insulin resistance and the β-cell function during mid-pregnancy. Methods This retrospective study included singleton pregnant women who underwent a 75-g oral glucose tolerance test (OGTT) at 24–34 weeks of gestation due to positive diabetic screening. In addition to plasma glucose (PG), we measured plasma insulin during the OGTT to obtain surrogate indices associated with insulin resistance (IR), including homeostasis assessment model (HOMA) -IR and insulin sensitivity index (IsOGTT), and β-cell function, including insulinogenic index (II), HOMA-β, and area under the curve of insulin response. We compared these indices between women carrying male fetuses to those carrying female fetuses. Results The study population included 617 women (mean age, 32.4 ± 4.9 years) with a mean pre-pregnancy body mass index (BMI) of 22.6±4.5. They underwent the 75g-OGTT at 29.0 ± 2.5 weeks. Two hundred fifty-eight (42%) women were diagnosed with gestational diabetes (GDM). There was no significant difference in maternal age, pre-pregnancy BMI, gestational age at OGTT, PG at OGTT, or the prevalence of GDM between women with a male fetus (n=338) (male group) and those with a female fetus (n=279) (female group). Regarding the indices of IR, IR was significantly higher and insulin sensitivity was lower in the female group than in the male group (HOMA-IR: 7.0 [5-9.6] vs. 6.2 [4.6-8.8], p< 0.05; IsOGTT: 5.86 [4.29-7.83] vs. 6.29 [4.59-8.84], p< 0.01) (median [quartile range]). These differences remained significant after adjustment for maternal age, pre-pregnancy BMI, gestational age and fasting PG at OGTT, and the diagnosis of GDM. In contrast, the β-cell function did not differ between the two groups. Conclusion Maternal IR during mid-pregnancy was significantly higher in women carrying a female fetus than in those with a male fetus. The sex of the fetus may affect maternal insulin sensitivity during mid-pregnancy.

Abstract Background Although the onset of gestational diabetes (GDM) is known to be a significant risk factor for the future development of type 2 diabetes, this risk specifically in women with GDM diagnosed by the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria has not yet been thoroughly investigated. This study was performed to investigate the risk factors associated with the development of postpartum diabetes in Japanese women with a history of GDM, and the effects of the differences in the previous Japanese criteria and the IADPSG criteria. Methods This retrospective cohort study included Japanese women with GDM who underwent at least one postpartum oral glucose tolerance test (OGTT) between 2003 and 2014. Cases with overt diabetes in pregnancy were excluded. We investigated the risk factors including maternal baseline and pregnancy characteristics associated with the development of postpartum diabetes. Results Among 354 women diagnosed with GDM during the study period, 306 (86%) (116/136 [85.3%] and 190/218 [87.2%] under the previous criteria and the IADPSG criteria, respectively) who underwent at least 1 follow-up OGTT were included in the study. Thirty-two women (10.1%) developed diabetes within a median follow-up period of 57 weeks (range, 6–292 weeks). Eleven (9.5%) and 21 (11.1%) were diagnosed as GDM during pregnancy based on the previous Japanese criteria and the IADPSG criteria, respectively, which did not significantly differ between those criteria. A multivariate logistic regression analysis revealed that HbA1c and 2-h plasma glucose (PG) at the time of the diagnostic OGTT during pregnancy were independent predictors of the development of diabetes after adjusting for confounders. The adjusted relative risk of HbA1c ≥5.6% for the development of diabetes was 4.67 (95% confidence interval, 1.53-16.73), while that of 2-h PG ≥183 mg/dl was 7.02 (2.51-20.72). Conclusions A modest elevation of the HbA1c and 2-h PG values at the time of the diagnosis of GDM during pregnancy are independent predictors of the development of diabetes during the postpartum period in Japanese women with a history of GDM. The diagnostic criteria did not affect the incidence of postpartum diabetes.

Abstract Background Although breastfeeding is expected to reduce the incidence of diabetes in women with gestational diabetes, the effect has not been clearly confirmed. We examined whether or not high-intensity breastfeeding reduces the incidence of abnormal glucose tolerance and investigated the effect of high-intensity breastfeeding on insulin resistance during the first year postpartum in Japanese women with current gestational diabetes. Methods In this retrospective study, we included women with gestational diabetes who underwent postpartum 75 g oral glucose tolerance test during the first year (12-14 months) postpartum from 2009 to 2011 at a single tertiary perinatal care center in Japan. High-intensity breastfeeding was defined as the condition in which infants were fed by breastfeeding alone or 80% or more of the volume. We investigated the effect of high-intensity breastfeeding on the prevalence of postpartum abnormal glucose tolerance and the postpartum homeostasis model of assessment of insulin resistance (HOMA-IR), after controlling for confounders, including prepregnancy obesity and weight changes during pregnancy and postpartum. Results Among 88 women with gestational diabetes, 46 (52%) had abnormal glucose tolerance during the postpartum period. High-intensity breastfeeding women (n = 70) were significantly less likely to have abnormal glucose tolerance than non-high-intensity breastfeeding women (n = 18) (46% vs. 78%, p = 0.015). High-intensity breastfeeding was also associated with a lower HOMA-IR at 12-14 months postpartum than non-high-intensity breastfeeding (1.41 ± 1.02 vs. 2.28 ± 1.05, p = 0.035). Those associations remained significant after controlling for confounders. At least six months of high-intensity breastfeeding had a significant effect on lowering both the abnormal glucose tolerance prevalence and HOMA-IR compared with non-high-intensity breastfeeding. Conclusions In Japanese women with gestational diabetes, high-intensity breastfeeding ≥6 months had a protective effect against the development of abnormal glucose tolerance during the first year postpartum through improving insulin resistance, independent of obesity and postpartum weight change.

Objective. To demonstrate whether or not the routine use of prophylactic oxytocin (RUPO) reduces the blood loss and incidence of postpartum hemorrhaging (PPH). Methods. We used a prospective cohort and a historical control in a tertiary perinatal care center in Japan. In the prospective cohort, we introduced RUPO in April 2012 by infusing 10 units of oxytocin per 500 mL of normal saline into a venous line after anterior shoulder delivery (RUPO group). In the historical control, oxytocin was administered via a case-selective approach (historical control group). We included completed singleton vaginal deliveries and compared the volume of blood loss and the incidence of PPH between the groups. Results. We found a significantly lower volume of blood loss (520±327 versus 641±375 mL, p

Objectives. We evaluated the efficacy of magnesium sulfate as a second-line tocolysis for 48 hours. Materials and Methods. A multi-institutional, simple 2-arm randomized controlled trial was performed. Forty-five women at 22 to 34 weeks of gestation were eligible, whose ritodrine did not sufficiently inhibit uterine contractions. After excluding 12 women, 33 were randomly assigned to either magnesium alone or combination (ritodrine and magnesium). The treatment was determined as effective if the frequency of uterine contraction was reduced by 30% at 48 hours of the treatment. Results. After magnesium sulfate infusion, 90% prolonged their pregnancy for >48 hours. Combination therapy was effective in 95% (18/19), which was significantly higher than 50% (7/14) for magnesium alone. Conclusion. This randomized trial revealed that combination therapy significantly reduced uterine contractions, suggesting that adjuvant magnesium with ritodrine is recommended, rather than changing into magnesium alone, when uterine contractions are intractable with ritodrine infusion.

Objective: In some cases with light-for-date (LFD) infants born at late preterm and term, we cannot find any causes associated with fetal growth restriction (FGR). The management protocol is still unclear in such idiopathic FGR cases. We aimed to demonstrate risk factors associated with adverse neonatal outcomes in cases with idiopathic LFD infants born at late preterm and term. Methods: This is a retrospective multicenter study in Japan, we included cases with a LFD infant born at 34 weeks' gestation or later whose cause of growth restriction was not clinically identified in either maternal, fetal, or placental conditions in singleton pregnancies. We defined combined neonatal complications including respiratory disorders, clinical hypoglycemia, and hyperbilirubinemia as adverse neonatal outcomes. We investigated maternal and perinatal factors associated with adverse neonatal outcomes. Results: We included 686 singleton pregnancy cases of a LFD infant born at late preterm and term in 2011-2013. Among them, we identified 404 (59%) cases of idiopathic FGR. The diagnosis of FGR during pregnancy was made in 67% of the cases. In multivariate analysis, GA at delivery (adjusted- OR 0.64 [95%CI 0.54-0.76]) and BW z-score (a-OR 0.40 [95%CI 0.22-0.71]) were independently associated with the adverse neonatal outcomes. Regarding cases with a late preterm LFD infant, only the diagnosis of FGR during pregnancy was a significant predictor of the adverse neonatal outcomes (a-OR 7.56 [95%CI 1.84-33.5]). Conclusions: In singleton idiopathic LFD infants born at late preterm and term, GA at delivery and severity of growth restriction were associated with the adverse neonatal outcomes. In terms of late preterm LFD infants, the diagnosis of FGR during pregnancy was an only predictor of adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: Gestational diabetes (GDM) is one of the most common complications during pregnancy, up to 12% or more of all pregnant women. It is well established evidence that women affected by GDM during pregnancy are high risk of the development of diabetes after delivery. Several studies showed that breastfeeding has a protective effect against the development of diabetes in general population and in women with GDM during pregnancy. However, underlying mechanism regarding the protective effect has not been clearly understood. Therefore, in this study, we investigated the effect of breastfeeding on insulin resistance during the first year postpartum in Japanese women with current gestational diabetes. Methods: In this retrospective study, we included women who were diagnosed as having GDM after 24 weeks' gestation during pregnancy and underwent postpartum 75g oral glucose tolerance test (OGTT) during the first year postpartum at a single tertiary perinatal care center in Japan. We used IADPSG criteria and WHO criteria to make a diagnosis of GDM during pregnancy and abnormal glucose tolerance (AGT) after delivery, respectively. We defined AGT as impaired glucose intolerance and diabetes by WHO criteria. Regarding breastfeeding conditions, we defined highintensity breastfeeding (HIB) as the condition in which infants were fed by breastfeeding alone or 80% or more of the volume, and other statuses, including partial and non-breastfeeding, as non-HIB. We investigated the effect of HIB on the prevalence of postpartum abnormal glucose tolerance and the postpartum homeostasis model of assessment of insulin resistance (HOMA-IR), after controlling for confounders, including prepregnancy obesity and weight changes during pregnancy and postpartum. Results: We included 88 women affected by GDM during pregnancy, and among them, 46 (52%) women had AGT during the postpartum period. Among the all participants, 70 (79.5%) women fed their infants by HIB at least 6 weeks or more during postpartum period (HIB group), and the other 18 (20.5%) women were in the non-HIB group. HIB women were significantly less likely to have AGT than non-HIB women (46% vs. 78%, p<0.02). Women in the HIB group were also associated with a lower HOMA-IR at one year postpartum than those in the non-HIB group (1.41±1.02 vs. 2.28±1.05, p=0.035). Regarding the duration of breastfeeding, we found that at least six months of HIB had a significant effect of both reducing the prevalence of the AGT and improving HOMA-IR during one year postpartum, in comparison with non-HIB. Conclusions: In Japanese women with GDM, HIB at least 6 months or more had a protective effect against the development of AGT during the first year postpartum through improving insulin resistance, independent of obesity and postpartum weight change. [ABSTRACT FROM AUTHOR]

Objective: Gestational diabetes (GDM) is considered as mild maternal hyperglycemia during late pregnancy. However, the significance of mild hyperglycemia during early pregnancy (before 20 weeks' gestation) is still controversial. We investigated to identify the characteristics and significance of Japanese women with GDM who were diagnosed before 20 weeks' gestation. Methods: This retrospective study included Japanese women who were diagnosed with GDM before 20 weeks' gestation (the early GDM [e-GDM] group) and those who were diagnosed at 24 weeks' gestation or later (the late GDM [l-GDM] group). We used IADPSG criteria to diagnose GDM. We compared the maternal characteristics and perinatal outcomes between the groups. Results: We included 117 and 351 women in the e- and l-GDM groups, and the mean gestational age (GA) at diagnosis was 13.7±4.3 and 28.0±3.1 weeks, respectively. Maternal prepregnancy body mass index (BMI) in the e-GDM group was significantly higher than that in the l-GDM group (24.7±4.9 vs. 23.0±4.6, p=0.002). Although fasting plasma glucose (PG) levels were also significantly higher in the e-GDM group (88.7±8.9 vs. 84.3±10.8 mg/dl, p<0.0001), there were no significant differences in the 1- and 2-hour PG values between the groups. The mean GA at the beginning of insulin therapy was 21.1±7.3 and 30.0±4.6 weeks in the e- and l-GDM groups, respectively. The rate of insulin therapy was higher in the l-GDM group (41.9% vs. 52.3%, p<0.05). The perinatal outcomes did not differ between the groups. When we compared in the obese subgroups (prepregnancy BMI ≥2 ), we found the prepregnancy BMI was significantly higher in the e-GDM group (31.6±4.7 vs. 29.3±3.4, p=0.0016). However, there were no significant differences in the rate of insulin administration (52.4% vs. 65.6%, ns) or in the perinatal outcomes between the groups. Conclusion: The Japanese women with GDM who were diagnosed before 20 weeks were more frequently obese than those who were diagnosed at 24 weeks or later. The findings suggest that early diagnosis and treatment intervention seemed to be beneficial in obese women with GDM. [ABSTRACT FROM AUTHOR]