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Maternal Daily Intake of Polyphenol-Rich Dark Chocolate and Premature Closure of Ductus Arteriosus

Anko, Mayuka, Ikenoue, Satoru, Kawamura, Makoto, Yakubo, Kazumi

Biomed J Sci & Tech Res 21 （ 2 ） 2019年

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Impaired fetal growth in mothers with inadequate gestational weight gain: a retrospective study in Japanese uncomplicated pregnancy.

Ikenoue S, Miyakoshi K, Kasuga Y, Ochiai D, Matsumoto T, Tanaka M

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians （Journal of Maternal-Fetal and Neonatal Medicine） 33 （ 13 ） 1 - 5 2018年12月

ISSN 1476-4954

Introduction: The average birth weight in Japan has gradually decreased and the number of low birth weight infant has increased over the last 30 years. Japanese pregnant women are characterized with lower prevalence of obesity than those in other developed countries, and maternal underweight before pregnancy is independently associated with low birth weight. However, the association between maternal inadequate gestational weight gain (GWG) and the risk of small for gestational age (SGA) in Japanese uncomplicated pregnant women has not been fully understood. This study aimed to examine the effect of maternal inadequate GWG on the risk of SGA in Japanese uncomplicated pregnancies. Methods: We retrospectively analyzed uncomplicated Japanese singleton pregnancies that delivered at term gestation in our institution from 2006 to 2016. The association between GWG and birth weight was analyzed by multiple linear regression. Potential confounding factors included maternal age, parity, prepregnancy BMI, and neonatal sex. The association between inadequate GWG and SGA was also examined by logistic regression. Results: A total of 3837 mother–neonate dyads were analyzed. Maternal GWG was 10.1 ± 3.7 kg (mean ± SD), and 2529 (66%) had inadequate GWG. After adjusting for confounding factors, GWG significantly correlated with birth weight (standardized β = 0.199, p <.001). Inadequate GWG increased the risk of delivering SGA neonate (adjusted odds ratio (aOR) = 1.97 [1.45–2.68], p <.001). This association was particularly pronounced in underweight (aOR = 2.95 [1.38–6.29], p =.005) and normal weight mothers (aOR = 1.79 [1.27–2.52], p =.001), and not in overweight/obese mothers (p =.115). Conclusion: Maternal GWG is associated with birth weight in Japanese women with uncomplicated singleton pregnancies. Inadequate GWG is an important risk factor of SGA, particularly in non-obese women. The present finding would potentially provide further evidence that promoting adequate gestational weight gain in Japanese underweight and normal weight mothers would reduce SGA, as well as metabolic dysfunction in later life.

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妊娠中の母体体重増加不良と出生体重に関する後方視的検討

池ノ上学, 宮越敬, 佐藤佑, 秋葉洋平, 大谷利光, 福武麻里絵, 春日義史, 落合大吾, 松本直, 田中守

糖尿病と妊娠（(一社)日本糖尿病・妊娠学会） 18 （ 2 ） S - 86 2018年08月

ISSN 1347-9172

本邦では近年、やせ妊婦の増加と妊娠中の体重増加不良が指摘されている。今回、当院で単胎正期産分娩に至った3837例について、米国Institute of Medicine基準による母体体重増加不良と、在胎期間別出生時体格標準値(日本小児科学会)によるlight-for-date(LFD:出生体重<10パーセンタイル)との関連を年齢、経産数、非妊時BMI、児の性別を交絡因子として解析した。体重増加不良群では、LFDが有意に高率であり(adjusted odds ratio:1.94)、とくにやせ群(BMI < 18.5)と標準群(18.5 ≦ BMI< 25)でのみ有意差を認めた。やせ群と標準群では母体体重増加不良がLFDのリスク因子であることが示された。(著者抄録)

多胎妊娠と糖代謝異常　より良い管理を目指して　双胎妊娠における妊娠糖尿病の糖代謝異常重症度に関する検討

秋葉洋平, 宮越敬, 税所芳史, 佐藤佑, 池ノ上学, 落合大吾, 松本直, 田中守

糖尿病と妊娠（(一社)日本糖尿病・妊娠学会） 18 （ 2 ） S - 46 2018年08月

ISSN 1347-9172

双胎妊娠における妊娠糖尿病(GDM)の糖代謝異常重症度に関する知見は少ない。本研究の目的は双胎GDMにおける糖代謝異常重症度の解析である。自施設で周産期管理を行ったGDM例を双胎(n=20)と単胎(n=451)に分類し、両群の糖代謝異常重症度を比較検討した(リトドリン使用例は除外)。まず、両群の母体背景(年齢、非妊時BMI、GDM既往、糖尿病家族歴、初期随時血糖)は同等であった。また、インスリン療法導入率および導入週数、投与量について両群間に有意差を認めなかった。したがって、双胎GDMの糖代謝異常重症度は単胎と同等であることが示唆された。(著者抄録)

妊娠関連乳癌の骨転移による脊髄圧迫のため緊急帝王切開術を施行した1例

遠藤豊英, 村上功, 小泉和恵, 白橋真由, 池ノ上学, 横田めぐみ, 天方朋子, 池田俊之, 矢久保和美

埼玉産科婦人科学会雑誌（埼玉産科婦人科学会） 48 （ 1 ） 11 - 14 2018年03月

ISSN 2186-4349

近年、妊娠関連乳癌(Pregnancy Associated Breast Cancer:PABC)は、出産年齢の高齢化に伴い増加傾向である。今回我々は、PABCの骨転移による脊髄圧迫のため緊急帝王切開術を施行した症例を経験した。症例は36歳0経妊0経産の生来健康な女性である。妊娠30週より腰痛及び下肢の痺れを自覚し、妊娠32週1日、歩行困難のため当院へ搬送となった。MRIで多発骨転移による腰椎圧迫骨折および脊髄圧迫を疑う所見を認め、単純CTにて右乳腺腫瘍、右腋窩リンパ節腫大を認めた。PABCの骨転移による脊髄圧迫に対し、緊急放射線照射が必要なOncologic Emergencyであった。妊娠週数を考慮し、ベタメタゾン投与を施行し、妊娠32週4日、緊急帝王切開術及び右乳腺腫瘍針生検を施行した。術後緊急放射線照射を施行したが、下肢麻痺及び膀胱直腸障害は残存した。一方、児は経過良好であった。本症例は転移性脊髄圧迫のため妊娠中にも関わらず緊急放射線照射を要するOncologic Emergencyであった。今後増加が予想されるPABCに対して妊娠前後の乳癌検診の啓蒙が望まれる。(著者抄録)

Discordant fetal phenotype of hypophosphatasia in two siblings

Ikenoue S., Miyakoshi K., Ishii T., Sato Y., Otani T., Akiba Y., Kasuga Y., Ochiai D., Matsumoto T., Ichihashi Y., Matsuzaki Y., Tachikawa K., Michigami T., Nishimura G., Ikeda K., Hasegawa T., Tanaka M.

American Journal of Medical Genetics, Part A （American Journal of Medical Genetics, Part A） 176 （ 1 ） 171 - 174 2018年01月

ISSN 1552-4825

© 2017 Wiley Periodicals, Inc. Hypophosphatasia (HPP) is an autosomal recessive metabolic disorder with impaired bone mineralization due to mutations in the ALPL gene. The genotype-phenotype correlation of this disorder has been widely described. Here, we present two affected siblings, whose fetal phenotypes were discordant. A 31-year-old Japanese woman, G0P0, was referred to our institution because of fetal micromelia. After obstetric counseling, the pregnancy was terminated at 21 weeks’ gestation. Post-mortem radiographs demonstrated severely defective mineralization of the skeleton. The calvarial, spinal, and tubular bones were mostly missing. Only the occipital bones, mandible, clavicles, ribs, one thoracic vertebra, ilia, and tibia were relatively well ossified. The radiological findings suggested lethal HPP. Genetic testing for genomic DNA extracted from the umbilical cord identified compound heterozygous mutations in the ALPL gene (c.532T>C, p.Y178H; c.1559delT, p.Leu520Argfs*86). c.532T>C was a novel variant showing no residual activity of the protein by the functional analysis. The parents were heterozygous carriers. In the next pregnancy, biometric values on fetal ultrasonography at 20 and 26 weeks’ gestation were normal. At 34 weeks, however, a small chest and shortening of distal long bones came to attention. The neonate delivered at 41 weeks showed serum ALP of <5U/L. Radiological examination showed only mild thoracic hypoplasia and metaphyseal mineralization defects of the long bones. ALP replacement therapy was introduced shortly after birth, and the neonate was discharged at day 22 without respiratory distress. Awareness of discordant fetal phenotypes in siblings with HPP precludes a diagnostic error, and enables early medical intervention to mildly affected neonates.

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Clinical and genetic characteristics of abnormal glucose tolerance in Japanese women in the first year after gestational diabetes mellitus

Kasuga Y., Miyakoshi K., Tajima A., Saisho Y., Ikenoue S., Ochiai D., Matsumoto T., Arata N., Hata K., Tanaka M.

Journal of Diabetes Investigation （Journal of Diabetes Investigation） 10 （ 3 ） 817 - 826 2018年01月

ISSN 2040-1116

© 2018 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd Aims/Introduction: Risk factors of type 2 diabetes mellitus in Japanese women with recent gestational diabetes mellitus are unknown. The objective of the present study was to investigate the clinical and genetic characteristics associated with postpartum abnormal glucose tolerance in Japanese women with gestational diabetes mellitus. Materials and Methods: A total of 213 Japanese women with recent gestational diabetes mellitus who underwent a postpartum 2-h oral glucose tolerance test were investigated. The association between antepartum clinical characteristics and postpartum abnormal glucose tolerance (diabetes or prediabetes based on the Japan Diabetes Society criteria) was examined. Frequencies of 45 known type 2 diabetes mellitus-associated genetic variants were also compared between women with and without postpartum abnormal glucose tolerance. Results: A total of 59 women showed postpartum abnormal glucose tolerance (prediabetes, n = 51; diabetes, n = 8). Plasma glucose levels at 1 or 2 h, the insulinogenic index and the insulin secretion-sensitivity index-2 of the antepartum oral glucose tolerance test were independent of postpartum abnormal glucose tolerance risk factors (P = 0.006, P = 0.00002, P = 0.01 and P = 0.006, respectively). Four genetic variants (rs266729 [ADIPOQ], rs6017317 [HNF4A], rs5215 [KCNJ11] and rs7177055 [HMG20A]) showed a nominally significant association with postpartum abnormal glucose tolerance (P < 0.05, respectively). Among these, three were related to insulin secretion. Postpartum abnormal glucose tolerance risk significantly increased with increasing risk-allele number (P = 0.0005; odds ratio 1.91). Conclusions: Clinical features and genetic variants related to impaired insulin secretion are risk factors of postpartum abnormal glucose tolerance in Japanese women with recent gestational diabetes mellitus.

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Cover Image, Volume 176A, Number 1, January 2018

American journal of medical genetics. Part A （American journal of medical genetics. Part A） 176 （ 1 ） i 2018年01月

ISSN 1552-4825

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Association between supraclavicular brown adipose tissue composition at birth and adiposity gain from birth to 6 months of age

Entringer Sonja, Rasmussen Jerod, Cooper Dan M., Ikenoue Satoru, Waffarn Feizal, Wadhwa Pathik D., Buss Claudia

Pediatric Research 82 （ 6 ） 1017 - 1021 2017年12月

ISSN 0031-3998

BackgroundBrown adipose tissue (BAT) is associated with higher energy expenditure and lower adiposity in adults. However, the relationship between BAT composition and adiposity in early life is unknown. The objective of this study was to test the hypothesis that brown fat composition at birth is prospectively associated with adiposity gain during the first 6 months of postnatal life.MethodsN=35 healthy infants were followed up prospectively from intrauterine life and birth through 6 months of age. Dixon magnetic resonance imaging (MRI) scans were conducted during the neonatal period to characterize supraclavicular BAT composition. Dual-energy X-ray absorptiometry to assess total body composition was performed within the first and sixth months of life.ResultsAfter adjusting for potential confounding factors, a more brown-like composition (smaller fat fraction) of the supraclavicular BAT depot was associated with a smaller increase in percent body fat over the first 6 months of postnatal life.ConclusionsA more brown-like BAT composition at birth appears to be protective against excess adiposity gain in early life. Newborn BAT tissue may constitute a target for prevention strategies against the subsequent development of obesity.

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Prospective association of fetal liver blood flow at 30 weeks gestation with newborn adiposity

Ikenoue S., Waffarn F., Ohashi M., Sumiyoshi K., Ikenoue C., Buss C., Gillen D., Simhan H., Entringer S., Wadhwa P.

American Journal of Obstetrics and Gynecology （American Journal of Obstetrics and Gynecology） 217 （ 2 ） 204.e1 - 204.e8 2017年08月

ISSN 0002-9378

© 2017 Elsevier Inc. Background The production of variation in adipose tissue accretion represents a key fetal adaptation to energy substrate availability during gestation. Because umbilical venous blood transports nutrient substrate from the maternal to the fetal compartment and because the fetal liver is the primary organ in which nutrient interconversion occurs, it has been proposed that variations in the relative distribution of umbilical venous blood flow shunting either through ductus venosus or perfusing the fetal liver represents a mechanism underlying this adaptation. Objective The objective of the present study was to determine whether fetal liver blood flow assessed before the period of maximal fetal fat deposition (ie, the third trimester of gestation) is prospectively associated with newborn adiposity. Study Design A prospective study was conducted in a cohort of 62 uncomplicated singleton pregnancies. Fetal ultrasonography was performed at 30 weeks gestation for conventional fetal biometry and characterization of fetal liver blood flow (quantified by subtracting ductus venosus flow from umbilical vein flow). Newborn body fat percentage was quantified by dual energy X-ray absorptiometry imaging at 25.8 ± 3.3 (mean ± standard error of the mean) postnatal days. Multiple regression analysis was used to determine the proportion of variation in newborn body fat percentage explained by fetal liver blood flow. Potential confounding factors included maternal age, parity, prepregnancy body mass index, gestational weight gain, gestational age at birth, infant sex, postnatal age at dual energy X-ray absorptiometry scan, and mode of infant feeding. Results Newborn body fat percentage was 13.5% ± 2.4% (mean ± standard error of the mean). Fetal liver blood flow at 30 weeks gestation was significantly and positively associated with newborn total fat mass (r=0.397; P<.001) and body fat percentage (r=0.369; P=.004), but not with lean mass (r=0.100; P=.441). After accounting for the effects of covariates, fetal liver blood flow explained 13.5% of the variance in newborn fat mass. The magnitude of this association was pronounced particularly in nonoverweight/nonobese mothers (prepregnancy body mass index, <25 kg/m2; n=36) in whom fetal liver blood flow explained 24.4% of the variation in newborn body fat percentage. Conclusion Fetal liver blood flow at the beginning of the third trimester of gestation is associated positively with newborn adiposity, particularly among nonoverweight/nonobese mothers. This finding supports the role of fetal liver blood flow as a putative fetal adaptation underlying variation in adipose tissue accretion.

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Association of ultrasound-based measures of fetal body composition with newborn adiposity

Ikenoue S., Waffarn F., Sumiyoshi K., Ohashi M., Ikenoue C., Buss C., Gillen D., Simhan H., Entringer S., Wadhwa P.

Pediatric Obesity （Pediatric Obesity） 12 86 - 93 2017年08月

ISSN 2047-6302

© 2016 World Obesity Federation Background: Newborns exhibit substantial variation in gestational age-adjusted and sex-adjusted fat mass proportion. The antecedent characteristics of fetal body composition that are associated with newborn fat mass proportion are poorly understood. Objective: The aim of this study was to determine whether a composite measure of fetal fat mass is prospectively associated with newborn adiposity. Methods: In a longitudinal study of 109 low-risk pregnancies, fetal ultrasonography was performed at approximately 12, 20 and 30 weeks gestation. Estimated fetal adiposity (EFA) was derived by integrating cross-sectional arm and thigh per cent fat area and anterior abdominal wall thickness. Newborn per cent body fat was quantified by Dual Energy X-Ray Absorptiometry. The association between EFA and newborn per cent body fat was determined by multiple linear regression. Results: After controlling for confounding factors, EFA at 30 weeks was significantly associated with newborn per cent body fat (standardized β = 0.41, p < 0.001) and explained 24.0% of its variance, which was substantially higher than that explained by estimated fetal weight (8.1%). The observed effect was driven primarily by arm per cent fat area. Conclusions: A composite measure of fetal adiposity at 30 weeks gestation may constitute a better predictor of newborn per cent body fat than estimated fetal weight by conventional fetal biometry. Fetal arm fat deposition may represent an early indicator of newborn adiposity. After replication, these findings may provide a basis for an improved understanding of the ontogeny of fetal fat deposition, thereby contributing to a better understanding of its intrauterine determinants and the development of potential interventions.

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Association between supraclavicular brown adipose tissue composition at birth and adiposity gain from birth to 6 months age

Entringer, S., Rasmussen, J., Cooper, D. M., Ikenoue, S., Waffarn, F., Potkin, S. G., Wadhwa, P. D. and Buss, C.

Pediatr Res 2017年07月

ISSN 0031-3998

BACKGROUND: Brown Adipose Tissue (BAT) is associated with higher energy expenditure and lower adiposity in adults. However, the relationship between BAT composition and adiposity in early life is unknown. The objective of this study was to test the hypothesis that brown fat composition at birth is prospectively associated with adiposity gain during the first six months of postnatal life. METHODS: N=35 healthy infants were followed prospectively from intrauterine life and birth through 6 months age. Dixon MRI scans were conducted during the neonatal period to characterize supraclavicular BAT composition. Dual-energy X-ray absorptiometry to assess total body composition was performed within the first month of life and at 6 months age. RESULTS: After adjusting for potential confounding factors, a more brown-like composition (smaller fat fraction) of the supraclavicular BAT depot was associated with a smaller increase in percent body fat over the first six months of postnatal life. CONCLUSIONS: A more brown-like BAT composition at birth appears to be protective against excess adiposity gain in early life. Newborn BAT tissue may constitute a target for prevention strategies against the subsequent development of obesity.Pediatric Research accepted article preview online, 19 July 2017. doi:10.1038/pr.2017.159.

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Mid-trimester residual cervical length and the risk of preterm birth in pregnancies after abdominal radical trachelectomy: a retrospective analysis

Kasuga Y., Miyakoshi K., Nishio H., Akiba Y., Otani T., Fukutake M., Ikenoue S., Ochiai D., Matsumoto T., Tanaka K., Minegishi K., Kuji N., Roberts R., Aoki D., Tanaka M.

BJOG: An International Journal of Obstetrics and Gynaecology （BJOG: An International Journal of Obstetrics and Gynaecology） 124 （ 11 ） 1729 - 1735 2017年04月

ISSN 1471-0528

© 2017 Royal College of Obstetricians and Gynaecologists Objective: To investigate the association between mid-trimester residual cervical length (CL) and the risk of preterm birth in pregnancies after abdominal radical trachelectomy (RT). Design: Retrospective cohort study. Setting: University hospital. Population: A total of 33 deliveries after 22 weeks’ gestation in 30 women who underwent abdominal RT including prophylactic cervical cerclage and perinatal care between January 2002 and May 2016. Methods: The association between mid-trimester residual CL (the distance between the cerclage and the external cervical os) and gestational age at delivery was investigated. Receiver–operating characteristics (ROC) curve analysis was performed to estimate the optimal cut-off values of the mid-trimester residual CL for the prediction of preterm birth. Main outcome measures: Preterm birth before 34 weeks’ gestation. Results: Mid-trimester residual CL showed a significant correlation with gestational age at delivery (r = 0.36, P < 0.05). There was a significant difference in residual CL between women who did and those who did not give birth before 34 weeks (P < 0.05). Mid-trimester residual CL < 13 mm was a good predictor of birth before 34 weeks, with a sensitivity of 67%, specificity of 75%, positive predictive value of 55% and negative predictive value of 86% (area under ROC curve, 0.75). Conclusions: Mid-trimester residual CL is significantly correlated with gestational age at delivery. Residual CL assessment could be used to reassure physicians and women that there is only a small chance of preterm birth in pregnancies after abdominal RT. Tweetable abstract: Mid-trimester residual cervical length is a good predictor of preterm birth after radical trachelectomy.

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Mid-trimester residual cervical length and the risk of preterm birth in pregnancies after abdominal radical trachelectomy

Kasuga Y., Miyakoshi K., Nishio H., Akiba Y., Otani T., Fukutake M., Ikenoue S., Ochiai D., Matsumoto T., Tanaka K., Minegishi K., Kuji N., Roberts R., Aoki D., Tanaka M.

BJOG: An International Journal of Obstetrics and Gynaecology 2017年

ISSN 1470-0328

Objective: To investigate the association between mid-trimester residual cervical length (CL) and the risk of preterm birth in pregnancies after abdominal radical trachelectomy (RT). Design: Retrospective cohort study. Setting: University hospital. Population: A total of 33 deliveries after 22 weeks' gestation in 30 women who underwent abdominal RT including prophylactic cervical cerclage and perinatal care between January 2002 and May 2016. Methods: The association between mid-trimester residual CL (the distance between the cerclage and the external cervical os) and gestational age at delivery was investigated. Receiver-operating characteristics (ROC) curve analysis was performed to estimate the optimal cut-off values of the mid-trimester residual CL for the prediction of preterm birth. Main outcome measures: Preterm birth before 34 weeks' gestation. Results: Mid-trimester residual CL showed a significant correlation with gestational age at delivery (r = 0.36, P < 0.05). There was a significant difference in residual CL between women who did and those who did not give birth before 34 weeks (P < 0.05). Mid-trimester residual CL < 13 mm was a good predictor of birth before 34 weeks, with a sensitivity of 67%, specificity of 75%, positive predictive value of 55% and negative predictive value of 86% (area under ROC curve, 0.75). Conclusions: Mid-trimester residual CL is significantly correlated with gestational age at delivery. Residual CL assessment could be used to reassure physicians and women that there is only a small chance of preterm birth in pregnancies after abdominal RT. Tweetable abstract: Mid-trimester residual cervical length is a good predictor of preterm birth after radical trachelectomy.

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Clinical impact of women with gestational diabetes mellitus by the new consensus criteria

Ikenoue Satoru, Miyakoshi Kei, Saisho Yoshifumi, Sakai Kensuke, Kasuga Yoshifumi, Fukutake Marie, Izumi Yoko, Matsumoto Tadashi, Minegishi Kazuhiro, Yoshimura Yasunori

Endocrine Journal 61 （ 4 ） 353 - 358 2014年

ISSN 0918-8959

There is a paucity of information on perinatal data regarding gestational diabetes mellitus (GDM) by the new criteria from a real experience because the number of health care associations implementing the new criteria is still limited. The aim of this study is to investigate perinatal features of the new criteria-defined GDM. We reviewed a total of 995 women with singleton pregnancy that underwent GDM screening followed by a diagnostic oral glucose tolerance test (OGTT). All women found to have GDM underwent self-monitoring of blood glucose measurements as well as dietary management. Insulin treatment was initiated when dietary treatment did not achieve the glycemic goal. Of the 995 women, 141 had GDM (14.2%): 104 with one, 27 with two, and 10 with three abnormal OGTT values. Women with two or three abnormal OGTT values (2/3-AV) needed insulin treatment more frequently than those with one abnormal OGTT value (1-AV) (70.3% vs 23.1%, P<0.0001). After adjustment for age, pregravid overweight, gestational weeks at diagnosis, a first-degree family history of diabetes was correlated with the implementation of insulin treatment in women with 1-AV (adjusted odds ratio 3.9; 95% Confidence Interval 1.7-9.2; P = 0.001). When compared perinatal outcomes between women with normal glucose tolerance and GDM, fetal growth and the occurrence of pregnancy-induced hypertension were comparable between the two groups. Our data suggest that the IADPSG-defined GDM with 1-AV show less severe glucose intolerance, but might be at risk of insulin requirement when a first-degree family history of diabetes exists.

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Clinical impact of women with gestational diabetes mellitus by the new consensus criteria: Two year experience in a single institution in Japan

Ikenoue S., Miyakoshi K., Saisho Y., Sakai K., Kasuga Y., Fukutake M., Izumi Y., Matsumoto T., Minegishi K., Yoshimura Y.

Endocrine Journal （Endocrine Journal） 61 （ 4 ） 353 - 8 2014年

ISSN 0918-8959

There is a paucity of information on perinatal data regarding gestational diabetes mellitus (GDM) by the new criteria from a real experience because the number of health care associations implementing the new criteria is still limited. The aim of this study is to investigate perinatal features of the new criteria-defined GDM. We reviewed a total of 995 women with singleton pregnancy that underwent GDM screening followed by a diagnostic oral glucose tolerance test (OGTT). All women found to have GDM underwent self-monitoring of blood glucose measurements as well as dietary management. Insulin treatment was initiated when dietary treatment did not achieve the glycemic goal. Of the 995 women, 141 had GDM (14.2%): 104 with one, 27 with two, and 10 with three abnormal OGTT values. Women with two or three abnormal OGTT values (2/3-AV) needed insulin treatment more frequently than those with one abnormal OGTT value (1-AV) (70.3% vs 23.1%, P<0.0001). After adjustment for age, pregravid overweight, gestational weeks at diagnosis, a first-degree family history of diabetes was correlated with the implementation of insulin treatment in women with 1-AV (adjusted odds ratio 3.9; 95% Confidence Interval 1.7-9.2; P = 0.001). When compared perinatal outcomes between women with normal glucose tolerance and GDM, fetal growth and the occurrence of pregnancy-induced hypertension were comparable between the two groups. Our data suggest that the IADPSG-defined GDM with 1-AV show less severe glucose intolerance, but might be at risk of insulin requirement when a first-degree family history of diabetes exists. © The Japan Endocrine Society.

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Complete chorion-amnion separation presenting as a stuck fetus

Kasuga Yoshifumi, Miyakoshi Kei, Ikenoue Satoru, Kadohira Ikuko, Matsumoto Tadashi, Minegishi Kazuhiro, Yoshimura Yasunori

Acta Obstetricia et Gynecologica Scandinavica 92 （ 8 ） 990 - 991 2013年08月

ISSN 0001-6349

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Marked decline in beta cell function during pregnancy leads to the development of glucose intolerance in Japanese women

Saisho Y., Miyakoshi K., Ikenoue S., Kasuga Y., Matsumoto T., Minegishi K., Yoshimura Y., Itoh H.

Endocrine Journal （Endocrine Journal） 60 （ 4 ） 533 - 539 2013年

ISSN 0918-8959

The aim of this study is to investigate glucose metabolism longitudinally during pregnancy to explore mechanisms underlying gestational diabetes mellitus (GDM). We reviewed a total of 62 pregnant Japanese women who underwent a 75g oral glucose tolerance test (OGTT) twice during pregnancy (median: early, 13; late, 28 weeks' gestation) because of positive GDM screening. All showed normal OGTT results in early pregnancy. Based on late OGTT, 15 had GDM (late- onset GDM) and 47 normal glucose tolerance (NGT). In early pregnancy, there were no significant differences in insulin sensitivity (insulin sensitivity index derived from OGTT [ISOGTT] and homeostasis model assessment for insulin resistance [HOMA-IR]) and insulin secretion (a ratio of the total area-under-the-insulin-curve to the total area-under-the-glucose-curve [AUCins/glu] and insulinogenic index [IGI]) between the NGT and late-onset GDM groups. In each group, insulin sensitivity significantly decreased from early to late pregnancy, most in the late-onset GDM group (each p < 0.05). The insulin secretion showed no significant changes with advancing pregnancy in both of the groups, although late-onset GDM showed significantly lower IGI compared with NGT in late OGTT (p < 0.05). When assessed beta cell function by OGTT-derived disposition index (i.e. Insulin Secretion-Sensitivity Index-2 and IGI/fasting insulin), the indices significantly decreased from early to late pregnancy in the both groups (each p < 0.05). Women with late-onset GDM showed significantly lower indices compared with NGT (each p < 0.05). The failure of beta cell to compensate for decreased insulin sensitivity could contribute to the development of the late-onset GDM. © The Japan Endocrine Society.

Antenatal management of recurrent fetal goitrous hyperthyroidism associated with fetal cardiac failure in a pregnant woman with persistent high levels of thyroidstimulating hormone receptor antibody after ablative therapy

Matsumoto T., Miyakoshi K., Saisho Y., Ishii T., Ikenoue S., Kasuga Y., Kadohira I., Sato S., Momotani N., Minegishi K., Yoshimura Y.

Endocrine Journal （Endocrine Journal） 60 （ 12 ） 1281 - 1287 2013年

ISSN 0918-8959

High titer of maternal thyroid-stimulating hormone receptor antibody (TRAb) in patients with Graves' disease could cause fetal hyperthyroidism during pregnancy. Clinical features of fetal hyperthyroidism include tachycardia, goiter, growth restriction, advanced bone maturation, cardiomegaly, and fetal death. The recognition and treatment of fetal hyperthyroidism are believed to be important to optimize growth and intellectual development in affected fetuses. We herein report a case of fetal treatment in two successive siblings showing in utero hyperthyroid status in a woman with a history of ablative treatment for Graves' disease. The fetuses were considered in hyperthyroid status based on high levels of maternal TRAb, a goiter, and persistent tachycardia. In particular, cardiac failure was observed in the second fetus. With intrauterine treatment using potassium iodine and propylthiouracil, fetal cardiac function improved. A high level of TRAb was detected in the both neonates. To the best of our knowledge, this is the first report on the changes of fetal cardiac function in response to fetal treatment in two siblings showing in utero hyperthyroid status. This case report illustrates the impact of prenatal medication via the maternal circulation for fetal hyperthyroidism and cardiac failure. ©The Japan Endocrine Society.

Access to Document (DOI)

当院における新診断基準導入後の妊娠糖尿病の臨床像に関する検討

池ノ上学, 宮越敬, 税所芳史, 春日義史, 門平育子, 松本直, 峰岸一宏, 吉村泰典

糖尿病と妊娠（(一社)日本糖尿病・妊娠学会） 13 （ 1 ） 80 - 83 2013年

ISSN 1347-9172

既報の新基準妊娠糖尿病(GDM)の臨床像は、旧基準でのデータベース解析をもとに推測されたものが多く、基準改定後の実際の臨床像に関して十分な知見は得られていない。そこでわれわれは、基準改定後に当院にて妊娠初期から周産期管理を行った単胎妊婦853例を対象に、GDMの臨床像について後方視的検討を行った。853例中GDM例は101例(11.8%)、overt diabetesは3例(0.3%)であった。さらに経口糖負荷試験(OGTT)陽性ポイント数に関して、OGTT 1点陽性例は69例(68%)、2点/3点陽性例は32例(2点陽性例:24例、3点陽性例:8例)であった。また101例中55例は妊娠初期スクリーニングにて検出された。分娩までの血糖コントロールに関して、OGTT 1点陽性例に比べてOGTT 2点/3点陽性例のインスリン導入率は有意に高値であった(20%vs.84%、p<0.05)。なお、OGTT 1点陽性例のなかでは、糖尿病家族歴を有する場合にインスリン療法を要する頻度が高率であった。本検討により、OGTT 1点陽性例はGDMの過半数を占めることが示され、糖尿病家族歴を有するOGTT 1点陽性例では、インスリン療法を要する可能性を念頭においた周産期管理が必要と考えられた。(著者抄録)

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