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Fukuoka M, Yasuhi I, Yamashita H, Ashimoto K, Kurata N, Yamaguchi J, Koga M, Sugimi S, Suga S, Fukuda M. Achievement of Target Glycemic Goal with Simple Basal Insulin Regimen in Women with Gestational Diabetes: A Prospective Cohort Study. J Diabetes Res 2023; 2023:9574563. [PMID: 37283948 PMCID: PMC10241582 DOI: 10.1155/2023/9574563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023] Open
Abstract
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 <95 mg/dL at fasting and <120 mg/dL postprandial and accepted <130 mg/dL for the latter. If the target glucose did not reach with the regimen, we switched to the multiple daily injection (MDI) with additional prandial insulin aspart. We compared the SMBG profile before delivery as well as the perinatal outcomes between the SII and MDI groups. Among 361 women (age 33.7 years, nullipara 41%, prepregnancy body mass index 23.2 kg/m2) with GDM, 59%, 18%, and 23% were in the diet-alone, SII, and MDI groups, respectively. Consequently, regarding women requiring insulin therapy, 43% were treated with the SII regimen throughout pregnancy. The severity of baseline hyperglycemia according to the SMBG data at baseline was the MDI>the SII>the diet group. The rate of achieving target glucose levels before delivery in the SII group at fasting, postprandial < 120 mg/dL and <130 mg/dL were 93%, 54% and 87%, respectively, which were similar to that in the MDI group (93%, 57%, and 93%, respectively), with no significant differences in perinatal outcomes. In conclusion, more than 40% of women with GDM requiring insulin therapy achieved the target glucose goal with this simple insulin regimen without any increase in adverse effects.
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Affiliation(s)
- Misao Fukuoka
- Department of Obstetrics and Gynecology, National Hospital Organization (NHO) Nagasaki Medical Center, Omura-City, Nagasaki, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization (NHO) Nagasaki Medical Center, Omura-City, Nagasaki, Japan
| | - Hiroshi Yamashita
- Department of Obstetrics and Gynecology, National Hospital Organization (NHO) Nagasaki Medical Center, Omura-City, Nagasaki, Japan
| | - Kensuke Ashimoto
- Department of Obstetrics and Gynecology, National Hospital Organization (NHO) Nagasaki Medical Center, Omura-City, Nagasaki, Japan
- Department of Obstetrics and Gynecology, Kameda General Hospital, Kamogawa, Chiba, Japan
| | - Nao Kurata
- Department of Obstetrics and Gynecology, National Hospital Organization (NHO) Nagasaki Medical Center, Omura-City, Nagasaki, Japan
| | - Junko Yamaguchi
- Department of Obstetrics and Gynecology, National Hospital Organization (NHO) Nagasaki Medical Center, Omura-City, Nagasaki, Japan
| | - Megumi Koga
- Department of Obstetrics and Gynecology, National Hospital Organization (NHO) Nagasaki Medical Center, Omura-City, Nagasaki, Japan
| | - So Sugimi
- Department of Obstetrics and Gynecology, National Hospital Organization (NHO) Nagasaki Medical Center, Omura-City, Nagasaki, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, National Hospital Organization (NHO) Nagasaki Medical Center, Omura-City, Nagasaki, Japan
| | - Masashi Fukuda
- Department of Obstetrics and Gynecology, National Hospital Organization (NHO) Nagasaki Medical Center, Omura-City, Nagasaki, Japan
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Kawasaki M, Arata N, Sugiyama T, Moriya T, Itakura A, Yasuhi I, Uchigata Y, Kawasaki E, Sone H, Hiramatsu Y. Risk of fetal undergrowth in the management of gestational diabetes mellitus in Japan. J Diabetes Investig 2023; 14:614-622. [PMID: 36734310 PMCID: PMC10034960 DOI: 10.1111/jdi.13977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 12/07/2022] [Accepted: 01/08/2023] [Indexed: 02/04/2023] Open
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.
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Affiliation(s)
- Maki Kawasaki
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Naoko Arata
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Tatsumi Moriya
- Health Care Center, Kitasato University, Sagamihara, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Yasuko Uchigata
- Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Eiji Kawasaki
- Department of Diabetes and Endocrinology, Shin-Koga Hospital, Kurume, Fukuoka, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology, and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Yuji Hiramatsu
- Okayama City General Medical Center, Okayama City, Japan
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Yamashita H, Fukuoka M, Yasuhi I. Pathologic subtypes in Japanese women with gestational diabetes. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ohkuchi A, Suzuki H, Matsubara K, Watanabe K, Saitou T, Oda H, Obata S, Kondo S, Noda K, Miyoshi J, Ikenoue S, Nomiyama M, Seki H, Sukegawa S, Ichigo S, Ando H, Fuseya C, Shimomura T, Suzuki R, Mimura K, Yasuhi I, Fukuda M, Hara S, Kurashina R, Shiozaki A, Matsubara S, Saito S. Exponential increase of the gestational-age-specific incidence of preeclampsia onset (COPE study): a multicenter retrospective cohort study in women with maternal check-ups at <20 weeks of gestation in Japan. Hypertens Res 2022; 45:1679-1689. [DOI: 10.1038/s41440-022-01013-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/08/2022] [Accepted: 08/13/2022] [Indexed: 11/09/2022]
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Maki S, Tanaka H, Takakura S, Nii M, Tanaka K, Ogura T, Kotera M, Nishimura Y, Tamaru S, Ushida T, Tanaka Y, Kikuchi N, Kinjo T, Kawamura H, Takano M, Nakamura K, Suga S, Kasai M, Yasui O, Nagao K, Maegawa Y, Kotani T, Endo M, Yasuhi I, Aoki S, Aoki Y, Yoshida Y, Nakata M, Sekizawa A, Ikeda T. Tadalafil treatment for fetuses with early-onset growth restriction: a protocol for a multicentre, randomised, placebo-controlled, double-blind phase II trial (TADAFER IIb). BMJ Open 2022; 12:e054925. [PMID: 35701067 PMCID: PMC9198796 DOI: 10.1136/bmjopen-2021-054925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION TheTADAlafil treatment for Fetuses with early-onset growth Restriction: multicentrer, randomizsed, phase II trial (TADAFER II) study showed the possibility of prolonging the pregnancy period in cases of early-onset fetal growth restriction; however, it was an open-label study. To establish further evidence for the efficacy of tadalafil in this setting, we planned a multicentre, randomised, placebo-controlled, double-blind trial. METHODS AND ANALYSIS This trial will be conducted in 180 fetuses with fetal growth restriction enrolled from medical centres in Japan; their mothers will be randomised into three groups: arm A, receiving two times per day placebo; arm B, receiving one time per day 20 mg tadalafil and one time per day placebo and arm C, receiving 20 mg two times per day tadalafil. The primary endpoint is the prolongation of gestational age at birth, defined as days from the first day of the protocol-defined treatment to birth. To minimise bias in terms of fetal baseline conditions and timing of delivery, a fetal indication for delivery as in TADAFER II will be established in this trial. The investigator will evaluate fetal baseline conditions at enrolment and decide the timing of delivery based on this indication. ETHICS AND DISSEMINATION This study has been approved by Mie University Hospital Clinical Research Review Board on 22 July 2019 (S2018-007). Written informed consent will be obtained from all mothers before recruitment. Our findings will be widely disseminated through peer-reviewed publications. TRIAL REGISTRATION jRCTs041190065.
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Affiliation(s)
- Shintaro Maki
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Sho Takakura
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Toru Ogura
- Clinical Research Support Center, Mie University Hospital, Tsu, Mie, Japan
| | - Mayumi Kotera
- Clinical Research Support Center, Mie University Hospital, Tsu, Mie, Japan
| | - Yuki Nishimura
- Clinical Research Support Center, Mie University Hospital, Tsu, Mie, Japan
| | - Satoshi Tamaru
- Clinical Research Support Center, Mie University Hospital, Tsu, Mie, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuhiro Tanaka
- Department of Obstetrics and Gynecology, Shinshu University Graduate School of Medicine, Matsumoto, Nagano, Japan
| | - Norihiko Kikuchi
- Department of Obstetrics and Gynecology, Shinshu University Graduate School of Medicine, Matsumoto, Nagano, Japan
| | - Tadatsugu Kinjo
- Department of Obstetrics and Gynecology, University of the Ryukyus, Nakagami-gun, Okinawa, Japan
| | - Hiroshi Kawamura
- Department of Obstetrics and Gynecology, Fukui University Graduate School of Medicine, Fukui, Japan
| | - Mayumi Takano
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Otaku, Tokyo, Japan
| | - Koji Nakamura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Michi Kasai
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Osamu Yasui
- Department of Obstetrics and Gynecology, Showa University Graduate School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Kenji Nagao
- Department of Obstetrics and Gynecology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Yuka Maegawa
- Department of Obstetrics and Gynecology, Mie Chuo Medical Center, Tsu, Mie, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yoichi Aoki
- Department of Obstetrics and Gynecology, University of the Ryukyus, Nakagami-gun, Okinawa, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, Fukui University Graduate School of Medicine, Fukui, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Otaku, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University Graduate School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Yamashita H, Ogawa M, Fukuoka M, Yasuhi I. Risk factors associated with intensive insulin therapy in lean Japanese women with gestational diabetes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Fukuoka M, Yasuhi I, Yamashita H, Honda A, Yamaguchi J, Koga M, Sugimi S, Umezaki Y, Suga S, Fukuda M. 399 Simple basal insulin regimen in women with mild gestational diabetes. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yamashita H, Yasuhi I, Fukuoka M, Honda A, Yamaguchi J, Koga M, Sugimi S, Umezaki Y, Suga S, Fukuda M. 400 The risk of postpartum glucose intolerance in lean japanese women with gestational diabetes. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yamashita H, Yasuhi I, Koga M, Sugimi S, Umezaki Y, Fukuoka M, Suga S, Fukuda M, Kusuda N. Fetal sex and maternal insulin resistance during mid-pregnancy: a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:560. [PMID: 32972384 PMCID: PMC7513312 DOI: 10.1186/s12884-020-03242-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/08/2020] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
- Hiroshi Yamashita
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 kubara 2-chome, 856-8562, Omura-City, Nagasaki, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 kubara 2-chome, 856-8562, Omura-City, Nagasaki, Japan.
| | - Megumi Koga
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 kubara 2-chome, 856-8562, Omura-City, Nagasaki, Japan
| | - So Sugimi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 kubara 2-chome, 856-8562, Omura-City, Nagasaki, Japan
| | - Yasushi Umezaki
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 kubara 2-chome, 856-8562, Omura-City, Nagasaki, Japan
| | - Misao Fukuoka
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 kubara 2-chome, 856-8562, Omura-City, Nagasaki, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 kubara 2-chome, 856-8562, Omura-City, Nagasaki, Japan
| | - Masashi Fukuda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 kubara 2-chome, 856-8562, Omura-City, Nagasaki, Japan
| | - Nobuko Kusuda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 kubara 2-chome, 856-8562, Omura-City, Nagasaki, Japan
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Naruse K, Shigemi D, Hashiguchi M, Imamura M, Yasunaga H, Arai T, Yasuhi I, Ozaki Y, Sakajo A, Tajima A, Tsutsumi S, Nakayama S, Yamasaki T, Nakago S, Hiramatsu Y, Mochizuki J, Hashiguchi M, Naruse K, Arai T. Placental abruption in each hypertensive disorders of pregnancy phenotype: a retrospective cohort study using a national inpatient database in Japan. Hypertens Res 2020; 44:232-238. [DOI: 10.1038/s41440-020-00537-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/16/2020] [Accepted: 07/25/2020] [Indexed: 02/02/2023]
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Kino E, Ohhashi M, Kawagoe Y, Sameshima H, Kamitomo M, Suga S, Yasuhi I, Funakoshi T. Impact of tocolysis-intent magnesium sulfate and beta-adrenergic agonists on perinatal brain damage in infants born between 28-36 weeks' gestation. J Obstet Gynaecol Res 2020; 46:2027-2035. [PMID: 32779268 DOI: 10.1111/jog.14364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 05/06/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022]
Abstract
AIMS Magnesium sulfate has neuroprotective effects in preterm infants. Whether other antepartum treatments interfere with the neuroprotective actions is not well known. This study aims to explore the impacts of antenatal administration of Magnesium sulfate or beta-2 adrenergic agonists as tocolytic agents on the developing brain in premature infants. METHODS This is a retrospective cohort study in four tertiary perinatal centers in Japan. We collected data of pregnant women and infants born between 28 and 36 weeks for tocolytic agents, gestational age, sex, antenatal corticosteroid, fetal growth restriction, pathological chorioamnionitis, low umbilical arterial pH values (<7.1), multiple pregnancy, mode of delivery and institutions after excluding clinical chorioamnionitis, non-reassuring fetal status or major anomalies. Tocolytic agents were categorized into four groups: no-tocolysis, magnesium sulfate, beta-2 adrenergic agonists and the combination of them. We conducted multiple comparisons with multivariate analyses using generalized linear regression models to compare the prevalence of a poor perinatal outcome defined as infant's death, brain damage, particularly cerebral palsy and developmental delay. RESULTS Among 1083 infants, 39% were no-tocolysis, 47% were magnesium sulfate, 41% were beta-2 adrenergic agonists and 27% were combination group, including the duplication. The incidence of poor perinatal outcome was decreased by magnesium sulfate (OR 0.27, 95% CI 0.10-0.72), but not changed significantly by beta-2 adrenergic agonists (OR 1.28, 95% CI 0.63-2.59) or the combination group (OR 2.24, 95% CI 0.67-7.54), compared with the no-tocolysis. CONCLUSION The combination therapy for tocolysis with beta-2 adrenergic agonists diminished the magnesium sulfate neuroprotective action after adjusting for covariables.
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Affiliation(s)
- Emi Kino
- Department of Obstetrics and Gynecology, University of Miyazaki, Miyazaki, Japan
| | | | - Yasuyuki Kawagoe
- Department of Obstetrics and Gynecology, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Sameshima
- Department of Obstetrics and Gynecology, University of Miyazaki, Miyazaki, Japan
| | - Masato Kamitomo
- Department of Obstetrics and Gynecology, Kagoshima City Hospital, Kagoshima, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Toru Funakoshi
- Department of Obstetrics and Gynecology, Hyogo Prefectural Kobe Children's Hospital, Hyougo, Japan
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Miyoshi Y, Kaneko S, Suga S, Koga M, Sugimi S, Yamashita H, Yamaguchi M, Yasuhi I. Comparison of the benefits and hemodynamic side effects of oxytocin between intravenous infusion with and without bolus injection during caesarean section. J OBSTET GYNAECOL 2020; 41:557-561. [PMID: 32729350 DOI: 10.1080/01443615.2020.1780421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to compare the benefits and hemodynamic side effects of oxytocin between intravenous infusion with and without a bolus injection during a caesarean section. Women with singleton pregnancies who underwent caesarean sections under spinal anaesthesia were included. Oxytocin was administered by an iv bolus injection (5 U) followed by an intravenous infusion (10 U of oxytocin in 500 mL normal saline); this was switched to just an intravenous infusion. The amount of blood loss did not differ between the groups. In a multivariate analysis, the adjusted odds ratios for the risk of hypotension (≥20% reduction of systolic BP) and tachycardia (heart rate ≥100 bpm) were 4.5 (95% confidence interval [CI], 1.6-12.5) and 3.7 (95%CI 1.9-7.2) in the iv bolus group, respectively, compared with the just the infusion group. The oxytocin administration by iv bolus injection did not decrease blood loss and increased the rate of hemodynamic side effects.Impact statementWhat is already known on this subject? Oxytocin is used as the first-line uterotonic treatment to prevent a postpartum haemorrhage in women undergoing Caesarean Sections. Oxytocin is known to relax vascular smooth muscle, which can cause hypotension and tachycardia. The protocols for administering oxytocin during CS vary by institution.What do the results of this study add? Combined treatment with oxytocin by iv bolus injection (5 U) followed by iv infusion (10 U of oxytocin in 500 mL normal saline) during CS increased the risk of developing adverse hemodynamic side effects, including hypotension, tachycardia, and the need for vasopressors, without any benefit in the control of intraoperative blood loss in comparison to iv infusion alone.What are the implications of these findings for clinical practice and/or further research? We should abandon the iv bolus injection of oxytocin during CS, especially for women undergoing an elective CS who are not in labour.
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Affiliation(s)
- Yasuhiro Miyoshi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan.,Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Shohei Kaneko
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Megumi Koga
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - So Sugimi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Hiroshi Yamashita
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Michiko Yamaguchi
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
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Kawasaki M, Arata N, Sakamoto N, Osamura A, Sato S, Ogawa Y, Yasuhi I, Waguri M, Hiramatsu Y. Risk factors during the early postpartum period for type 2 diabetes mellitus in women with gestational diabetes. Endocr J 2020; 67:427-437. [PMID: 31969529 DOI: 10.1507/endocrj.ej19-0367] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
For women with gestational diabetes mellitus (GDM), the evaluation of glucose tolerance (GT) in the early postpartum period is universally recommended. Nevertheless, few studies have evaluated the risk factors for T2DM on the basis of GT data obtained during the early postpartum period. We aimed to identify the risk factors for type 2 diabetes mellitus (T2DM) by evaluating GT in the first 12 weeks postpartum (12wPP) in women with GDM and to categorize the risk using a combination of the principal risk factors. This retrospective multicenter observational study included 399 East Asian women with GDM who underwent a 75-g oral glucose tolerance test (OGTT) within 12wPP, which was repeated annually or biennially and used to identify the postpartum development of T2DM. Forty-three women (10.8%) developed T2DM during a median follow-up period of 789 ± 477 days. The independent risk factors for T2DM were pre-pregnancy obesity (BMI ≥25 kg/m2), early postpartum impairment in glucose tolerance (IGT), and an early postpartum glycated hemoglobin (HbA1c) ≥5.7%. The odds ratios (95% confidence intervals) for T2DM were 3.2 (1.3-7.8) in women with either early postpartum IGT or pre-pregnancy obesity, 9.2 (3.0-28.3) in those with early postpartum IGT, pre-pregnancy obesity, and HbA1c <5.7%, and 51.4 (16.1-163.9) in those with early postpartum IGT, pre-pregnancy obesity, and HbA1c ≥5.7%, compared with those without obesity or IGT. T2DM risk in East Asian women with GDM should be stratified according to pre-pregnancy obesity and early postpartum IGT, and these patients should be followed up and receive appropriate care for their risk category.
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Affiliation(s)
- Maki Kawasaki
- Department of Health Policy, National Center for Child Health and Development, Tokyo 157-0074, Japan
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Naoko Arata
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Naoko Sakamoto
- Department of Epidemiologic Research, Faculty of Nursing, Toho University, Tokyo 143-8540, Japan
| | - Anna Osamura
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan
| | - Siori Sato
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Yoshihiro Ogawa
- Department of Molecular and Cellular Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki 856-8562, Japan
| | - Masako Waguri
- Department of Obstetric Medicine, Osaka Women's and Children's Hospital, Izumi, Osaka 594-1101, Japan
| | - Yuji Hiramatsu
- Okayama City General Medical Center, Okayama 700-0962, Japan
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Miyoshi Y, Suga S, Sugimi S, Kurata N, Yamashita H, Yasuhi I. Vaginal Ureaplasma urealyticum or Mycoplasma hominis and preterm delivery in women with threatened preterm labor. J Matern Fetal Neonatal Med 2020; 35:878-883. [PMID: 32131651 DOI: 10.1080/14767058.2020.1733517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Amniotic fluid infection with Ureaplasma urealyticum or Mycoplasma hominis can cause chorioamnionitis and preterm birth. The aim of this study was to examine whether vaginal Ureaplasma urealyticum/Mycoplasma hominis colonization is predictive of preterm delivery in patients exhibiting signs of threatened preterm birth or those with asymptomatic short cervix.Methods: The present retrospective study, which was performed in a perinatal tertiary center, included patients carrying a singleton pregnancy who were referred to the emergency Ob/Gyn unit because of regular preterm uterine contractions and/or short cervical length (<20 mm) at 22-33 weeks of gestation, and in whom a vaginal U. urealyticum/M. hominis examination (Urea-arginine LYO-2, BioMerieux®) was performed. Univariate and multivariate analyses were performed to assess the association between vaginal U. urealyticum or M. hominis and chorioamnionitis or preterm delivery.Results: The median gestational age of the 94 enrolled patients was 29.9 weeks, and 54 (57%) of the patients were vaginal U. urealyticum/M. hominis-positive. The preterm delivery rate in the positive group was higher than in the negative group (53 versus 25%; p = .007). Vaginal U. urealyticum/M. hominis positivity was found to be an independent risk factor for preterm birth at <37 weeks of gestation (adjusted odds ratio = 4.0, 95% confidence interval, 1.1-15.3) in a multivariate analysis adjusted for age, history of preterm delivery and conization, gestational age, cervical length, presence of vaginal bleeding, vaginal fetal fibronectin and serum C-reactive protein at test. U. urealyticum/M. hominis positivity was not associated with delivery at <34 weeks or chorioamnionitis.Conclusion: A positive vaginal U. urealyticum/M. hominis culture is an independent predictive factor for preterm birth in patients with symptomatic threatened preterm labor and/or short cervix.
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Affiliation(s)
- Yasuhiro Miyoshi
- National Hospital, Organization Nagasaki Medical Center, Nagasaki, Japan.,Zimba Mission Hospital, Zimba, Zambia
| | - Sachie Suga
- National Hospital, Organization Nagasaki Medical Center, Nagasaki, Japan
| | - So Sugimi
- National Hospital, Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Nao Kurata
- National Hospital, Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Hiroshi Yamashita
- National Hospital, Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Ichiro Yasuhi
- National Hospital, Organization Nagasaki Medical Center, Nagasaki, Japan
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15
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Yasuhi I, Yamashita H, Maeda K, Nomiyama M, Mizunoe T, Tada K, Fujiwara A, Kodama T, Emoto I, Okura N, Kawakami K, Maekawa Y. 842: Comparisons of perinatal and postpartum outcomes between women with early- and late-diagnosed gestational diabetes. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Yasuhi I, Yamashita H, Kawasaki Y, Maeda K, Nomiyama M, Mizunoe T, Tada K, Fujiwara A, Kodama T, Emoto I, Okura N, Kawakami K, Maekawa Y. 858: Leptin and the association between breastfeeding and insulin resistance in women with current gestational diabetes. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Yasuhi I, Yamashita H, Maeda K, Nomiyama M, Mizunoe T, Tada K, Fujiwara A, Kodama T, Emoto I, Okura N, Kawakami K, Maekawa Y. 742: Different effect of breastfeeding against diabetes between obese and non-obese women with gestational diabetes. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.11.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Miyagi Y, Tada K, Yasuhi I, Maekawa Y, Okura N, Kawakami K, Yamaguchi K, Ogawa M, Kodama T, Nomiyama M, Mizunoe T, Miyake T. New method for determining fibrinogen and FDP threshold criteria by artificial intelligence in cases of massive hemorrhage during delivery. J Obstet Gynaecol Res 2019; 46:256-265. [PMID: 31762151 DOI: 10.1111/jog.14166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/10/2019] [Indexed: 02/06/2023]
Abstract
AIM To investigate the feasibility of a novel method using artificial intelligence (AI), in which the fibrinogen criterion was determined by the quantitative relation between the distributions of fibrin/fibrinogen degradation products (FDPs) and fibrinogen. METHODS A dataset of 154 deliveries comprising more than 2000 g of blood lost due to hemorrhage, excluding disseminated intravascular coagulation (DIC), among patients from eight national perinatal centers in Japan from 2011 to 2015 were obtained. The fibrinogen threshold criterion was identified by using the function that best fit the distributions of FDP as determined by AI. FDP production was described by differential equations using a dataset containing fibrinogen levels less than the fibrinogen criterion and solved numerically. RESULTS A fibrinogen level of 237 mg/dL as the threshold criterion was obtained. The FDP threshold criteria were 2.0 and 8.5 mg/dL for no coagulopathy and a failed coagulation system, respectively. CONCLUSION The fibrinogen threshold criterion for patients with massive hemorrhage excluding DIC at delivery were obtained by selecting the functions that best fit the distributions of FDP data by using AI.
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Affiliation(s)
- Yasunari Miyagi
- Medical Data Labo, Okayama, Japan.,Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan.,Miyake Ofuku Clinic, Okayama, Japan
| | - Katsuhiko Tada
- Department of Obstetrics and Gynecology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Yuka Maekawa
- Department of Obstetrics and Gynecology, National Hospital Organization Mie Chuo Medical Center, Tsu, Japan
| | - Naofumi Okura
- Department of Obstetrics and Gynecology, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan
| | - Kosuke Kawakami
- Department of Obstetrics and Gynecology, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masanobu Ogawa
- Research Center for Environment and Developmental Medical Sciences, Kyusyu University, Fukuoka, Japan.,Department of Obstetrics and Gynecology/Clinical Research Institute, National Hospital Organization Kyusyu Medical Center, Fukuoka, Japan
| | - Takashi Kodama
- Department of Obstetrics and Gynecology, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Makoto Nomiyama
- Department of Obstetrics and Gynecology, National Hospital Organization Saga National Hospital, Saga, Japan
| | - Tomoya Mizunoe
- Department of Obstetrics and Gynecology, National Hospital Organization Kure Medical Center, Kure, Japan
| | - Takahito Miyake
- Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
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19
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Yasuhi I, Yamashita H, Maeda K, Nomiyama M, Mizunoe T, Tada K, Yorozu M, Ogawa M, Kodama T, Yamaguchi K, Okura N, Kawakami K, Maekawa Y, Hayashi K. High-intensity breastfeeding improves insulin sensitivity during early post-partum period in obese women with gestational diabetes. Diabetes Metab Res Rev 2019; 35:e3127. [PMID: 30635961 DOI: 10.1002/dmrr.3127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/18/2018] [Accepted: 12/23/2018] [Indexed: 12/11/2022]
Abstract
AIM To investigate whether high-intensity breastfeeding (HIB) reduces insulin resistance during early post-partum period in women with gestational diabetes (GDM), independent of post-partum weight change (PWC). MATERIALS AND METHODS In this multicentre prospective study, we included Japanese women with GDM who underwent a 75-g oral glucose tolerance test (OGTT) during early post-partum. We measured plasma insulin during OGTT to obtain a homeostasis model of assessment of insulin resistance (HOMA-IR). We defined the condition in which infants were fed by breastfeeding alone or greater than or equal to 80% of the volume as HIB, and other statuses, including partial and nonbreastfeeding, as non-HIB. We investigated the association between post-partum HOMA-IR and the breastfeeding status after adjusting for confounders including PWC. RESULTS Among 222 women with GDM who underwent the OGTT at 7.9 ± 2.3 weeks post-partum with a PWC of -7.8 ± 3.4 kg, although the rate of abnormal glucose tolerance (prediabetes and diabetes) did not differ between the groups (33% vs 32%), the HOMA-IR in the HIB women (n = 166) was significantly lower than that in the non-HIB women (n = 56) (1.12 ± 0.85 vs 1.72 ± 1.43, P = 0.0002). The effect of the HIB was independently associated with lower HOMA-IR after adjusting for confounders including PMC. However, the subgroup analysis according to their pre-pregnancy obesity states showed that the effect was seen only in the obese subjects (BMI ≥ 25). CONCLUSIONS In obese Japanese women with GDM, HIB has a significant effect in reducing insulin resistance during early post-partum, independent of the post-partum weight loss.
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Affiliation(s)
- Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Hiroshi Yamashita
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Kazuhisa Maeda
- Department of Obstetrics and Gynecology, Shikoku Medical Center for Children and Adults, Zentsuji, Japan
| | - Makoto Nomiyama
- Department of Obstetrics and Gynecology, Saga Hospital, Saga, Japan
| | - Tomoya Mizunoe
- Department of Obstetrics and Gynecology, Kure Medical Center, Kure, Japan
| | - Katsuhiko Tada
- Department of Obstetrics and Gynecology, Okayama Medical Center, Okayama, Japan
| | - Moe Yorozu
- Department of Obstetrics and Gynecology, Okayama Medical Center, Okayama, Japan
| | - Masanobu Ogawa
- Department of Obstetrics and Gynecology, Kyusyu Medical Center, Fukuoka, Japan
| | - Takashi Kodama
- Department of Obstetrics and Gynecology, Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Ken Yamaguchi
- Department of Obstetrics and Gynecology, Kyoto Medical Center, Kyoto, Japan
| | - Naofumi Okura
- Department of Obstetrics and Gynecology, Kokura Medical Center, Kitakyushu, Japan
| | - Kosuke Kawakami
- Department of Obstetrics and Gynecology, Kokura Medical Center, Kitakyushu, Japan
| | - Yuka Maekawa
- Department of Obstetrics and Gynecology, Mie Chuo Medical Center, Tsu, Japan
| | - Kimikazu Hayashi
- Department of Obstetrics and Gynecology, Kanmon Medical Center, Shimonoseki, Japan
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20
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Ikeoka T, Sako A, Kuriya G, Yamashita H, Yasuhi I, Horie I, Ando T, Abiru N, Kawakami A. Type 1 Diabetes Mellitus Diagnosed during Follow-up of Gestational Diabetes Mellitus in the Early Postpartum Period. Intern Med 2018; 57:3413-3418. [PMID: 30101928 PMCID: PMC6306539 DOI: 10.2169/internalmedicine.1188-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/06/2018] [Indexed: 11/10/2022] Open
Abstract
A 27-year-old woman with a history of gestational diabetes mellitus (GDM) developed type 1 diabetes mellitus (T1D) in the early postpartum period. Women with a history of GDM are at an increased risk of developing T1D, which is rarer than type 2 diabetes mellitus. A postpartum follow-up 75-g oral glucose tolerance test and the measurement of glutamic acid decarboxylase autoantibodies aided in the early detection of T1D in this patient. Careful attention should be paid to women with a history of GDM who exhibit clinical features suggestive of future development of T1D.
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Affiliation(s)
- Toshiyuki Ikeoka
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Japan
| | - Ayaka Sako
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Japan
| | - Genpei Kuriya
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Japan
| | - Hiroshi Yamashita
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Ichiro Horie
- Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takao Ando
- Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Norio Abiru
- Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Atsushi Kawakami
- Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Japan
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21
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Ichinose K, Sato S, Kitajima Y, Horai Y, Fujikawa K, Umeda M, Fukui S, Nishino A, Koga T, Kawashiri SY, Iwamoto N, Tamai M, Nakamura H, Origuchi T, Yasuhi I, Masuzaki H, Kawakami A. The efficacy of adjunct tacrolimus treatment in pregnancy outcomes in patients with systemic lupus erythematosus. Lupus 2018; 27:1312-1320. [PMID: 29665758 DOI: 10.1177/0961203318770536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Systemic lupus erythematosus (SLE) involves multiple organ systems and primarily affects women during their reproductive years. Pregnancy in a woman with SLE may lead to higher rates of disease flares. Little is known regarding which medications are safe to maintain remission and/or treat flares throughout such pregnancies. Here we retrospectively analyzed the efficacy of tacrolimus (TAC) in the pregnancy outcomes of SLE patients. We studied the 54 deliveries of 40 SLE patients over an eight-year period from 2008 to 2016. We used analyses of covariance with adjustments for the propensity score and inverse probability of treatment weights to compare the patient backgrounds between the TAC users and non-TAC users. TAC was administered to the patient in 15 of the 54 (27.8%) pregnancies, and these patients had a significantly higher dose of prednisolone, hypocomplementemia, lower estimated glomerular filtration rate, past history of lupus nephritis, and complication with antiphospholipid syndrome. In the adjusted background of the TAC deliveries, the risks of decreased fetal body weight, low birth weight infant, non-reassuring fetal status (NRFS), and preterm birth were not increased compared to the non-TAC deliveries. Thrombocytopenia and hypertension during the pregnancy were extracted as independent predictive risk factors for decreased fetal body weight and NRFS, respectively. We had anticipated that the maternal and fetal outcomes in the TAC-use deliveries would be poor before the analysis; however, the TAC-use group showed no significant difference in risks contributing to outcomes compared to the non-TAC group, suggesting that adjunct TAC treatment corrected various risk factors during the lupus pregnancies.
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Affiliation(s)
- K Ichinose
- 1 Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - S Sato
- 2 Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Y Kitajima
- 3 Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Y Horai
- 4 Department of Rheumatology, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Japan
| | - K Fujikawa
- 5 Department of Rheumatology, JCHO Isahaya General Hospital, Isahaya, Japan
| | - M Umeda
- 1 Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - S Fukui
- 1 Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A Nishino
- 1 Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Koga
- 1 Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - S Y Kawashiri
- 1 Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - N Iwamoto
- 1 Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Tamai
- 1 Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - H Nakamura
- 1 Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Origuchi
- 6 Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - I Yasuhi
- 7 Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura, Japan
| | - H Masuzaki
- 3 Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - A Kawakami
- 1 Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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22
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Kugishima Y, Yasuhi I, Yamashita H, Sugimi S, Umezaki Y, Suga S, Fukuda M, Kusuda N. Risk factors associated with the development of postpartum diabetes in Japanese women with gestational diabetes. BMC Pregnancy Childbirth 2018; 18:19. [PMID: 29310607 PMCID: PMC5759797 DOI: 10.1186/s12884-017-1654-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 12/29/2017] [Indexed: 02/08/2023] Open
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.
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Affiliation(s)
- Yukari Kugishima
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan.
| | - Hiroshi Yamashita
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - So Sugimi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Yasushi Umezaki
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Masashi Fukuda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
| | - Nobuko Kusuda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki, 856-8562, Japan
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23
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Yasuhi I, Yamashita H, Nomiyama M, Ogawa M, Okura N, Kawakami K, Hayashi K, Mizunoe T, Kodama T, Tada K, Yorozu M, Maeda K, Maeda M, Maekawa Y, Yamaguchi K. 991: Maternal adiponectin in associated with early postpartum insulin resistance in women with current gestational diabetes. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yamashita H, Yasuhi I, Kugishima Y, Sugimi S, Umezaki Y, Suga S, Fukuda M, Kusuda N. Factors associated with patients with gestational diabetes in Japan being at increased risk of requiring intensive care. Int J Gynaecol Obstet 2017; 140:170-174. [PMID: 29044502 DOI: 10.1002/ijgo.12354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/14/2017] [Accepted: 10/17/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate factors associated with high-risk gestational diabetes (GDM) among patients with GDM. METHODS The present retrospective study included women with singleton pregnancies diagnosed with GDM using International Association of Diabetes and Pregnancy Study Group criteria at a single tertiary perinatal care center in Japan between July 1, 2010, and October 31, 2014. High-risk GDM was defined as patients who required at least 20 units of insulin therapy a day, delivering a large-for-gestational age neonate regardless of insulin therapy, or both. Maternal characteristics and diagnostic test results were investigated to identify associations with the high-risk criteria, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS Among 217 patients, 95 (43.8%) were categorized as high risk. After adjusting for confounders, a fasting plasma glucose level at diagnosis of at least 4.66 mmol/L (adjusted OR 2.88, 95% CI 1.51-5.58) and pre-pregnancy body mass index (calculated as weight in kilograms divided by the square of height in meters) of at least 24 (adjusted OR 3.27, 95% CI 1.60-6.90) were independently associated with meeting the high-risk criteria. CONCLUSION Among Japanese patients with GDM, pre-pregnancy body mass index and fasting plasma glucose levels could be used to identify high-risk patients requiring intensive care during pregnancy.
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Affiliation(s)
- Hiroshi Yamashita
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura, Japan
| | - Yukari Kugishima
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura, Japan
| | - So Sugimi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura, Japan
| | - Yasushi Umezaki
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura, Japan
| | - Masashi Fukuda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura, Japan
| | - Nobuko Kusuda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura, Japan
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Yasuhi I, Soda T, Yamashita H, Urakawa A, Izumi M, Kugishima Y, Umezaki Y. The effect of high-intensity breastfeeding on postpartum glucose tolerance in women with recent gestational diabetes. Int Breastfeed J 2017; 12:32. [PMID: 28725256 PMCID: PMC5513345 DOI: 10.1186/s13006-017-0123-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/03/2017] [Indexed: 12/17/2022] Open
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.
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Affiliation(s)
- Ichiro Yasuhi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
| | - Tomoko Soda
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
| | - Hiroshi Yamashita
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
| | - Atsuko Urakawa
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
| | - Mihoko Izumi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
| | - Yukari Kugishima
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
| | - Yasushi Umezaki
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, 1001-1 2-chome Kubara, Omura City, Nagasaki 856-8562 Japan
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Tanase‐Nakao K, Arata N, Kawasaki M, Yasuhi I, Sone H, Mori R, Ota E. Potential protective effect of lactation against incidence of type 2 diabetes mellitus in women with previous gestational diabetes mellitus: A systematic review and meta-analysis. Diabetes Metab Res Rev 2017; 33:e2875. [PMID: 28072911 PMCID: PMC5434910 DOI: 10.1002/dmrr.2875] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 12/16/2022]
Abstract
Lactation may protect women with previous gestational diabetes mellitus (GDM) from developing type 2 diabetes mellitus, but the results of existing studies are inconsistent, ranging from null to beneficial. We aimed to conduct a systematic review to gather available evidence. Databases MEDLINE, CINAHL, PubMed, and EMBASE were searched on December 15, 2015, without restriction of language or publication year. A manual search was also conducted. We included observational studies (cross-sectional, case-control, and cohort study) with information on lactation and type 2 diabetes mellitus incidence among women with previous GDM. We excluded case studies without control data. Data synthesis was conducted by random-effect meta-analysis. Fourteen reports of 9 studies were included. Overall risk of bias using RoBANS ranged from low to unclear. Longer lactation for more than 4 to 12 weeks postpartum had risk reduction of type 2 diabetes mellitus compared with shorter lactation (OR 0.77, 95% CI 0.01-55.86; OR 0.56, 95% CI 0.35-0.89; OR 0.22, 95% CI 0.13-0.36; type 2 diabetes mellitus evaluation time < 2 y, 2-5 y, and >5 y, respectively). Exclusive lactation for more than 6 to 9 weeks postpartum also had lower risk of type 2 diabetes mellitus compared with exclusive formula (OR 0.42, 95% CI 0.22-0.81). The findings support the evidence that longer and exclusive lactation may be beneficial for type 2 diabetes mellitus prevention in women with previous GDM. However, the evidence relies only on observational studies. Therefore, further studies are required to address the true causal effect.
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Affiliation(s)
- Kanako Tanase‐Nakao
- Division of Maternal Medicine, Center for Maternal‐Fetal, Neonatal and Reproductive MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Naoko Arata
- Division of Maternal Medicine, Center for Maternal‐Fetal, Neonatal and Reproductive MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Maki Kawasaki
- Department of Health PolicyNational Center for Child Health and DevelopmentTokyoJapan
| | - Ichiro Yasuhi
- Department of Obstetrics and GynecologyNational Hospital Organization Nagasaki Medical CenterNagasakiJapan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and MetabolismNiigata University Faculty of MedicineNiigataJapan
| | - Rintaro Mori
- Department of Health PolicyNational Center for Child Health and DevelopmentTokyoJapan
| | - Erika Ota
- Department of Health PolicyNational Center for Child Health and DevelopmentTokyoJapan
- Department of Global Health Nursing, Graduate School of Nursing SciencesSt. Luke's International UniversityTokyoJapan
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Yasuhi I, Yamashita H, Suga S, Fukuoka M, Koga M, Sugimi S, Umezaki Y, Fukuda M, Kusuda N. 527: Fetal gender and maternal insulin resistance during mid-pregnancy. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yasuhi I, Yamashita H, Suga S, Fukuoka M, Koga M, Sugimi S, Umezaki Y, Fukuda M, Kusuda N. 528: Insulin resistance during midpregnancy is associated with maternal weight gain throughout pregnancy in non-obese women with normal glucose tolerance test. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yasuhi I, Myoga M, Suga S, Sugimi S, Umezaki Y, Fukuda M, Yamashita H, Kusuda N. Influence of the interval between antenatal corticosteroid therapy and delivery on respiratory distress syndrome. J Obstet Gynaecol Res 2016; 43:486-491. [DOI: 10.1111/jog.13242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/21/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Ichiro Yasuhi
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
| | - Mai Myoga
- Department of Obstetrics & Gynecology; School of Medicine, University of Occupational and Environmental Health; Fukuoka Japan
| | - Sachie Suga
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
| | - So Sugimi
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
| | - Yasushi Umezaki
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
| | - Masashi Fukuda
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
| | - Hiroshi Yamashita
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
| | - Nobuko Kusuda
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
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Mito A, Arata N, Sakamoto N, Miyakoshi K, Waguri M, Osamura A, Kugishima Y, Metoki H, Yasuhi I. Present status of clinical care for postpartum patients with hypertensive disorders of pregnancy in Japan: findings from a nationwide questionnaire survey. Hypertens Pregnancy 2015; 34:209-20. [PMID: 25774557 DOI: 10.3109/10641955.2014.1001902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the present status of clinical care for postpartum patients with hypertensive disorders of pregnancy (HDP) in Japan. METHODS We conducted a nationwide questionnaire survey of obstetricians, internists and hypertension specialists and analyzed 686 valid responses. RESULTS Though HDP is widely known as a risk factor for subsequent hypertension and cardiovascular disease, over one-third of obstetricians terminated their postpartum follow-up of HDP patients without referring them to other departments. CONCLUSION It is important to establish an effective referral system, whereby patients with HDP can be smoothly transferred to primary care or a specialist physician after childbirth for long-term monitoring and management of blood pressure.
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Affiliation(s)
- Asako Mito
- Division of Maternal Medicine, Center for Maternal-Fetal-Neonatal and Reproductive Medicine, National Center for Child Health and Development , Tokyo , Japan
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Suga S, Yasuhi I, Aoki M, Nomiyama M, Kubo N, Kawakami K, Okura N, Okazaki K, Ota A, Kawada K. Risk factors associated with respiratory disorders in late preterm infants. J Matern Fetal Neonatal Med 2015; 29:447-51. [DOI: 10.3109/14767058.2014.1003804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kugishima Y, Yamashita H, Yasuhi I, Miyoshi Y, Mizutani Y, Sugimi S, Umezaki Y, Suga S, Fukuda M, Kusuda N. 562: Risk factors associated with developing postpartum diabetes in Japanese women with gestational diabetes. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Umezaki Y, Ito M, Nakashima M, Mihara Y, Naruke Y, Kurohama H, Yatsunami N, Yasuhi I. S100P is a useful marker for differentiation of ovarian mucinous tumors. EUR J GYNAECOL ONCOL 2015; 36:138-141. [PMID: 26050349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The S100P protein stimulates cell proliferation and survival, thereby contributing to tumor progression. The purpose of this study was to evaluate S100P expression in the three subtypes of mucinous cystic tumors, cystadenomas, borderline tumors, and adenocarcinomas. The authors examined nuclear S100P expression in 60 mucinous ovarian tumor specimens, including 24 specimens of mucinous cystadenoma, 15 of borderline tumors, and 21 of adenocarcinomas. Immunohistochemistry revealed S100P expression followed one of three patterns: (1) Expressed in most nuclei of mucinous epithelial cells, (2) sporadic (spotted or patchy) expression, or (3) absent or rarely expressed in the nuclei of mucinous epithelial cells. Most adenomas showed the first expression pattern, and borderline tumors often showed a patchy expression pattern. Adenocarcinomas generally demonstrated absence of S100P expression. These data suggest that S100P is a useful histological marker to differentiate between benign, borderline, and malignant mucinous tumors of the ovary.
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Kugishima Y, Yasuhi I, Yamashita H, Fukuda M, Kuzume A, Sugimi S, Umezaki Y, Suga S, Kusuda N. Risk factors associated with abnormal glucose tolerance in the early postpartum period among Japanese women with gestational diabetes. Int J Gynaecol Obstet 2014; 129:42-5. [PMID: 25497883 DOI: 10.1016/j.ijgo.2014.09.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/21/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify the risk factors associated with abnormal glucose tolerance (AGT) on the first postpartum oral glucose tolerance test (OGTT) among Japanese women with gestational diabetes (GDM). METHODS In a retrospective study, data were analyzed from women with GDM who underwent their first postpartum OGTT 6-8weeks post partum at a center in Omura, Japan, between January 1, 2007, and December 31, 2011. Women with diabetes or impaired glucose tolerance were deemed to have postpartum AGT. The association between postpartum AGT and various risk factors was analyzed. RESULTS Among 169 women who underwent a postpartum OGTT, 58 (34.3%) had AGT. The significant risk factors associated with postpartum AGT in univariate analysis were pre-pregnancy body mass index (P=0.096), 1-hour plasma glucose (P=0.006), hemoglobin A1c (P<0.001), insulinogenic index (P=0.05), an insulinogenic index of less than 0.4 (P=0.006), and insulin therapy during pregnancy (P<0.001). Independent risk factors identified by multivariate logistic regression models were insulinogenic index (odds ratio [OR] 0.10, 95% confidence interval [CI] 0.01-0.74; P=0.002), an insulinogenic index of less than 0.4 (OR 5.70, 95% CI 1.69-21.66; P=0.005), and insulin therapy during pregnancy (OR 3.43, 95% CI 1.03-12.55; P=0.044). CONCLUSION Among Japanese women with GDM, a lower insulinogenic index and use of insulin therapy during pregnancy are associated with early postpartum AGT.
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Affiliation(s)
- Yukari Kugishima
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Japan.
| | - Hiroshi Yamashita
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Masashi Fukuda
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Akiko Kuzume
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - So Sugimi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Yasushi Umezaki
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Sachie Suga
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Nobuko Kusuda
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
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Sugiyama T, Metoki H, Hamada H, Nishigori H, Saito M, Yaegashi N, Kusaka H, Kawano R, Ichihara K, Yasuhi I, Hiramatsu Y, Sagawa N. A retrospective multi-institutional study of treatment for mild gestational diabetes in Japan. Diabetes Res Clin Pract 2014; 103:412-8. [PMID: 24485857 DOI: 10.1016/j.diabres.2013.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 10/17/2013] [Accepted: 12/18/2013] [Indexed: 12/16/2022]
Abstract
AIMS To determine whether treating mild gestational diabetes mellitus (GDM) is associated with improvement of pregnancy outcomes in Japan. METHODS In a multi-institutional retrospective study, we examined pregnant women meeting the criteria for mild GDM (i.e., only one abnormal value [OAV] for 75-g OGTT; fasting glucose ≥100 mg/dL, 1-h postprandial glucose ≥180 mg/dL, and 2-h postprandial glucose ≥150 mg/dL), receiving either routine prenatal care (non-treatment group) or dietary intervention alone or dietary intervention with self-monitoring of blood glucose and/or insulin therapy, if necessary (treatment group). Pregnancy outcomes were compared between these groups. RESULTS Data from 893 eligible women were collected from 30 institutions. Participants included 542 untreated and 351 treated women. Although there were no significant differences in baseline clinical characteristics or maternal and perinatal outcomes between these groups, the incidence of large-for-gestational-age (LGA) infants was lower in the treatment group (P=0.07). Multiple logistic regression analysis (MLRA) revealed that pre-pregnancy BMI and gestational weight gain were associated with LGA infants, while 75-g OGTT results were unrelated to LGA. When overweight and obese women were the subjects, the number of LGA infants was significantly lower in the intervention than in the control group, and gestational weight gain was significantly lower in the treatment than in the control group. MLRA showed that intervention was significantly related to a lower incidence of LGA infants. CONCLUSIONS Our study suggests that maternal BMI impacts fetal growth and that treatment for overweight or obese mothers with OAV is associated with a lower frequency of LGA infants.
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Affiliation(s)
- Takashi Sugiyama
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan.
| | - Hirohito Metoki
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Hirotaka Hamada
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Hidekazu Nishigori
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan
| | - Hideto Kusaka
- Department of Obstetrics and Gynecology, National Hospital Organization Mie Chuo Medical Center, Tsu, Mie 514-1101, Japan
| | - Reo Kawano
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Kiyoshi Ichihara
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki 856-8562, Japan
| | - Yuji Hiramatsu
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Norimasa Sagawa
- Department of Obstetrics and Gynecology, Rakuwakai Otowa Hospital, Kyoto 607-8062 Japan
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Kishikawa T, Miyashita T, Fujiwara E, Shimomura O, Yasuhi I, Niino D, Ito M, Amenomori M, Osumimoto H, Osumi M, Eguchi K, Migita K. Multicentric reticulohistiocytosis associated with ovarian cancer. Mod Rheumatol 2014. [DOI: 10.3109/s10165-007-0600-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yamashita H, Yasuhi I, Fukuda M, Kugishima Y, Yamauchi Y, Kuzume A, Hashimoto T, Sugimi S, Umezaki Y, Suga S, Kusuda N. The association between maternal insulin resistance in mid-pregnancy and neonatal birthweight in uncomplicated pregnancies. Endocr J 2014; 61:1019-24. [PMID: 25109752 DOI: 10.1507/endocrj.ej14-0163] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
There have been few studies performed to address the association between the degree of physiological increase in maternal insulin resistance during pregnancy and neonatal birthweight in non-diabetic pregnancy. We attempted to determine whether maternal insulin resistance, as measured by homeostasis model assessment-insulin resistance (HOMA-IR), in mid-pregnancy is associated with neonatal birthweight in normal pregnancies. In this retrospective observational study, we measured HOMA-IR in singleton healthy pregnant women who underwent a 75 g oral glucose tolerance test (OGTT) in mid-pregnancy because of a positive diabetes screen. Using multivariate analyses to adjust for maternal parity, pre-gestational obesity, gestational weight gain, plasma glucose levels, and gestational age at delivery, we tested the association between HOMA-IR and birthweight in their offspring. We also tested the association HOMA-IR and a risk of large-for-gestational-age (LGA) infants. In 655 Japanese women, HOMA-IR was positively associated with birthweight after adjusting for these confounders (p<0.05). A higher HOMA-IR was significantly associated with an increased incidence of LGA infants with an adjusted odds ratio of 1.53 (95% confidence interval, 1.10-2.15) per 1 unit of HOMA-IR. The degree of maternal insulin resistance in mid-pregnancy was associated with birthweight and the risk of giving birth to an LGA infant in normal pregnancies, independent of maternal obesity and glucose levels.
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Affiliation(s)
- Hiroshi Yamashita
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center, Omura 856-8562, Japan
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Miyoshi Y, Suga S, Mizutani Y, Fukuda M, Yamashita H, Yasuhi I. A case of severe posterior reversible encephalopathy syndrome in a preeclamptic woman in the early postpartum period. Hypertens Res Pregnancy 2014. [DOI: 10.14390/jsshp.2.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yasuhiro Miyoshi
- Department of Obstetrics and Gynecology, Nagasaki Medical Center
| | - Sachie Suga
- Department of Obstetrics and Gynecology, Nagasaki Medical Center
| | | | - Masashi Fukuda
- Department of Obstetrics and Gynecology, Nagasaki Medical Center
| | | | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, Nagasaki Medical Center
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Yasuhi I, Yamashita H, Fukuda M, Kugishima Y, Watanabe T, Mizutani Y, Kuzume A, Hashimoto T, Sugimi S, Umezaki Y, Suga S, Kusuda N. 261: Cord serum C peptide levels in large-for-gestational age infants in diabetic and non-diabetic mothers. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kugishima Y, Yasuhi I, Yamashita H, Fukuda M, Watanabe T, Mizutani Y, Kuzume A, Hashimoto T, Sugimi S, Umezaki Y, Suga S, Kusuda N. 262: Risk factors associated with postpartum impaired glucose tolerance at the first postpartum screening in women with gestational diabetes. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sugimi S, Suga S, Yasuhi I, Hashimoto T, Yatsunami N, Umezaki Y, Kugishima Y, Fukuda M, Yamashita H, Kusuda N. W127 RISK FACTOR ASSOCIATED WITH PRETERM BIRTH BEFORE 35 WEEKS IN ASYMPTOMATIC SINGLETON PREGNANT WOMEN WITH A SHORT CERVIX. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Suga S, Yasuhi I, Aoki M, Nomiyama M, Kubo N, Kawakami K, Okura N, Maeda M, Okazaki K, Kawada K. W125 RISK FACTORS ASSOCIATED WITH RESPIRATORY PROBLEMS IN LATE PRETERM INFANTS: JAPAN NATIONAL HOSPITAL ORGANIZATION (NHO) NETWORK STUDY. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61850-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yasuhi I. [Evidence-based medicine derived from HAPO study]. Nihon Rinsho 2012; 70 Suppl 5:94-100. [PMID: 23156373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Ichiro Yasuhi
- Department of Obstetrics and Gynecology, NHO Nagasaki Medical Center
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Yamashita H, Fukuda M, Kugishima Y, Yamauchi Y, Kuzume A, Hashimoto T, Sugimi S, Yatsunami N, Suga S, Kusuda N, Yasuhi I. 202: The association between maternal insulin resistance in mid pregnancy and neonatal birth weight in uncomplicated pregnancies. Am J Obstet Gynecol 2012. [DOI: 10.1016/j.ajog.2011.10.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Soh Y, Yasuhi I, Nakayama D, Ishimaru T. A case of postpartum cerebellar infarction with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Gynecol Obstet Invest 2003; 53:240-2. [PMID: 12186992 DOI: 10.1159/000064564] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cerebellar infarction has been described rarely during pregnancy, and there has been no case report of cerebellar infarction with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. A 39-year-old Japanese primipara had postpartum HELLP syndrome soon after cesarean section at term. Several hours later, she developed cerebellar infarction which was fatal. HELLP syndrome may have contributed to the development of cerebellar infarction in the case.
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Affiliation(s)
- Yoko Soh
- Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, Nagasaki, Japan
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Ikeda Y, Yasuhi I, Ishimaru T. 423 Ultrasound fetal subcutaneous thickness measurement as a predictor of fetal body fat stores in diabetic pregnancy. Am J Obstet Gynecol 2001. [DOI: 10.1016/s0002-9378(01)80455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kitajima M, Oka S, Yasuhi I, Fukuda M, Rii Y, Ishimaru T. Maternal serum triglyceride at 24--32 weeks' gestation and newborn weight in nondiabetic women with positive diabetic screens. Obstet Gynecol 2001; 97:776-80. [PMID: 11339933 DOI: 10.1016/s0029-7844(01)01328-x] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether elevated midpregnancy maternal serum lipid levels predict newborn weight at term and the risk of large for gestational age (LGA) infants in women with positive diabetic screen but normal glucose tolerance test. METHODS Japanese gravidas who had positive diabetic screens and normal 75-g oral glucose tolerance tests (GTT) at 24--32 weeks were enrolled. Subjects with complications, including diabetes, hypertension, or fetal anomalies were excluded, as were women with multifetal gestations. Fasting serum triglyceride, free fatty acids, and total cholesterol levels were measured at the time of GTT. We tested the association between maternal variables and birth weight by univariable analysis. We used multivariable analysis to test whether the association between fasting lipids and birth weight was independent of prepregnant maternal body mass index (BMI), maternal weight gain during pregnancy, and plasma glucose levels at GTT. We also used multiple logistic regression analysis to determine whether maternal hyperlipidemia, defined as more than the 75th percentile of each lipid, is a risk factor for having an LGA infant. RESULTS We enrolled 146 subjects. Among measured maternal lipids, only triglyceride levels correlated with birth weight in univariable analysis (r = 0.22, P =.009). Birth weight also was correlated with prepregnant maternal BMI (r = 0.18, P =.04) and fasting plasma glucose levels (r = 0.17, P =.04). The association between maternal fasting triglyceride level and birth weight remained significant after adjusting for prepregnant BMI, maternal weight gain, fasting plasma glucose levels, fetal gender, and gestational age at birth (P =.01). Logistic regression analysis showed that fasting maternal hypertriglyceridemia (over 259 mg/dL) was the significant predictor of LGA infants, independent of prepregnant BMI, maternal weight gain, and maternal plasma glucose levels (odds ratio 11.6; 95% confidence interval 1.1, 122; P =.04). CONCLUSION In women with positive diabetic screens but normal GTTs, fasting triglyceride levels at 24-32 weeks correlated positively with newborn weight at term, independent of maternal plasma glucose levels and obesity. Maternal fasting serum triglyceride levels in midpregnancy might be an independent predictor of fetal macrosomia in those women.
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Affiliation(s)
- M Kitajima
- Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, Nagasaki, Japan.
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Abstract
OBJECTIVE To test the hypothesis that elevated midpregnancy serum insulin (IRI) and C-peptide (CP) concentrations are associated with later development of pregnancy-induced hypertension (PIH), independent of prepregnancy obesity and midpregnancy blood pressure. RESEARCH DESIGN AND METHODS In this prospective study, a cohort of normotensive women, ages > or = years performed a 50-g glucose challenge test at 24-30 weeks' gestational age. Blood samples were collected after an overnight fast and 1 h after glucose ingestion. Serum IRI and CP concentrations were measured in each sample. Maternal height, blood pressure and proteinuria were measured at the time of glucose challenge testing and after 36 weeks' gestational age. RESULTS Of 320 subjects enrolled 44 women (13.8%) had subsequent PIH. Crude odds ratios (ORs) for devevelopment of PIH associated with each 1 U rise in log fasting IRI, log lasting CP. and glucosed-induced increase in CP (expressed as log [postprandial CP/fasting CP]) were 2.0 (95% CI 1.3-3.3), 1.8 (CI 1.2-2.7), and 2.3 (CI 1.1-4.9) respectively. After controlling for prepregnancy BMI, gestational age, and midpregnancy mean arterial pressure, adjusted ORs corresponding to log fastig IRI and CP for the development of PIH were 1.3 (95% CI 0.7-2.3) and 1.7 (CI 1.1-2.7) respectively, and, afterq adjustment for fasting CP, the adjusted OR of the glucose-induced rise in log CP was 3.7 (CI 1.5-9.3). CONCLUSIONS Mid-pregnancy tasting and postoral glucose CP levels are associated with subsequent development of PIH, independent of maternal obesity and midpregnancy baseline blood pressure. These findings many reflect an amplified beta3-cell response to glycemic stimulus, similar to that found in states of insulin resistance, that appears to be independently associated with PIH.
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Affiliation(s)
- I Yasuhi
- Department of Obstetrics and Gynecology, Brown University School of Medicine, Providence, Rhode Island, USA.
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Oka S, Yasuhi I, Hirai M, Yamashita H, Ishimaru T. Transplacental nutrients transfer in women with impaired glucose tolerance. Placenta 1998. [DOI: 10.1016/s0143-4004(98)91213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
OBJECTIVE To examine whether maternal meal ingestion affects the fetal circulation in uncomplicated pregnancies. METHODS A simple crossover blinded study was designed for late uncomplicated singleton pregnancies. After overnight fasting, two different maternal meal states were tested. In one state, pregnant women had a standard 600-kcal breakfast at 8 AM (phase A). The other state consisted of maintaining fasting (phase B). Both states were assigned to each woman within 3 days in randomized order. Fetal Doppler studies of the umbilical, middle cerebral, and renal arteries and the descending aorta were performed at 7 AM (the fasting state) and at 10 AM (the fed state or the continuous fasting state). RESULTS Twenty women underwent the crossover study. Regardless of the maternal meal state, no significant change was observed in the pulsatility index (PI) of either the umbilical artery (n = 20), the middle cerebral artery (n = 19), or the descending aorta (n = 15). However, the PI of the fetal renal artery decreased significantly after maternal meal ingestion (n = 14) (phase A, 2.36 +/- 0.16 versus 2.09 +/- 0.33; P = .021). There was no such change in the PI after prolonged fasting (phase B, 2.44 +/- 0.32 versus 2.39 +/- 0.44; P = .75). CONCLUSION Fetal renal artery resistance decreased after maternal meal ingestion in normally grown fetuses during late pregnancy. This decrease in the resistance may be associated with increased fetal urine production after maternal meals.
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Affiliation(s)
- I Yasuhi
- Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, Japan
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