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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]