Details of a Researcher - Kasuga, Yoshifumi

Papers - Kasuga, Yoshifumi

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Perinatal outcomes in RhD-negative pregnant women in Japan

Takahashi K., Yoshida S., Aoki S., Tanaka S., Kawashima A., Kajiwara K., Kato N., Matsui H., Serizawa M., Tsuji S., Yamamoto T., Kinjo T., Nakamura N., Sagawa M., Sato M., Abe E., Nakanishi S., Fujimoto Y., Takahashi S., Sasaki H., Mukai Y., Hara S., Fukuta K., Kikuchi N., Hara E., Shiga T., Horiuchi C., Sado T., Matsubara Y., Akabane K., Harada A., Nagase H., Maeda K., Katagiri H., Sasahara J., Sugii H., Tamaru S., Waratani M., Tsukahara S., Shibukawa S., Kiyama T., Kasuga Y., Egawa M., Sato H., Tamamura C., Suemitsu T., Okamoto A., Samura O.

Scientific Reports 15 ( 1 ) 9921 2025.12

Managing RhD-negative pregnancies is vital for preventing hemolytic disease of the fetus and newborn, which occurs when RhD-negative mothers develop anti-D antibodies after exposure to RhD-positive fetal blood. This retrospective cohort study evaluated the proportion of RhD-negative pregnancies and newborns in Japan by assessing current management practices and outcomes. This study included RhD-negative pregnant women who delivered at 22 weeks or later at 47 Japanese facilities between April 2018 and March 2023. Pregnancies with unknown newborn RhD status were excluded. Data were obtained from medical records. Among the 1088 RhD-negative women, 1062 met the inclusion criteria. RhD-negative pregnancies comprised 0.71% of the total cohort, with 8.7% RhD-negative newborns. Anti-D immunoglobulin was administered in 96.5% of pregnancies, with a maternal spontaneous sensitization rate of 0.6% before 28 weeks and no sensitization detected from 28 weeks to postpartum. Sensitized RhD-negative women had higher cesarean section, preterm delivery, and neonatal hemolytic anemia rates than the non-sensitized group, leading to increased neonatal intensive care unit admissions. Despite the low incidence of RhD-negative pregnancies, this study underscores the need for tailored management strategies, suggesting that non-invasive prenatal diagnosis of fetal RhD status could prevent unnecessary anti-D immunoglobulin administration, improving outcomes and resource utilization in Japan.

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Mirror syndrome and placental ectopic liver in association with de novo SOS1 variant

Tanaka Y., Ikenoue S., Ueno A., Masugi Y., Yamada M., Suzuki H., Otani T., Fukutake M., Kasuga Y., Kosaki K., Tanaka M.

European Journal of Medical Genetics 77 105039 2025.10

ISSN 17697212

Mirror syndrome is a rare obstetric condition characterized by maternal fluid retention mirroring fetal hydrops. Placental ectopic liver tissue is an extremely rare non-trophoblastic placental tumor, potentially arising from aberrant hepatoblast migration. While its association with fetal hydrops has been reported, the clinical significance remains uncertain. We present a patient of maternal mirror syndrome linked to fetal hydrops due to a de novo SOS1 variant, with histopathological identification of placental ectopic liver tissue. A 32-year-old woman was admitted at 31 weeks’ gestation with fetal hydrops, presenting with bilateral pleural effusions, ascites, and subcutaneous edema. Due to worsening maternal pleural effusion, she was transferred to our hospital at 31 weeks and 6 days. Given progressive maternal and fetal deterioration, an emergency cesarean section was performed at 32 weeks due to concerns regarding maternal mirror syndrome. The female infant was delivered with severe respiratory distress and succumbed at 9 days of age. Trio-based exome sequencing identified a de novo heterozygous SOS1 variant (NM_005633.4:c.512T > A [p.V171G]), confirming a postmortem diagnosis of Noonan syndrome. Histopathological analysis of the placenta revealed ectopic liver tissue within the villi, confirmed by positive immunostaining for hepatocyte markers. A recent report of RIT1-associated mirror syndrome and non-immune hydrops fetalis (NIHF) further supports the role of Rasopathies in the pathogenesis of mirror syndrome. Our findings confirm that mirror syndrome is a potential manifestation of Rasopathies, while the role of ectopic liver tissue in the placenta remains uncertain. Future research should focus on genetic factors underlying mirror syndrome rather than incidental placental anomalies.

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ARID1A gene variants and fetal hydrocephalus: First evidence of mRNA decay escape.

Tanaka Y, Yamada M, Miya F, Otani T, Kasuga Y, Suzuki H, Inagaki N, White SM, Tanaka M, Kosaki K

European journal of medical genetics 105048 2025.09

ISSN 1769-7212

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Perinatal Outcomes of Chronic Abruption Oligohydramnios Sequence: A Multicenter Retrospective Observational Study

Kasuga Y., Fukuma Y., Kajikawa K., Akita K., Tamai J., Tanaka Y., Otani T., Fukutake M., Ikenoue S., Tanaka M.

Journal of Clinical Medicine 14 ( 15 ) 2025.08

ISSN 2077-0383

Objective: This study aimed to describe the perinatal and neonatal outcomes of chronic abruption oligohydramnios sequence in the Kanto region of Japan. Methods: This survey was conducted at 123 perinatal centers affiliated to this area. Data on the experience of managing chronic abruption oligohydramnios sequence between 1 January 2017, and 31 December 2022, were collected and analyzed. Results: Among the 82 cases of chronic abruption oligohydramnios sequence that were included in this study, there were seven miscarriages, five artificial abortions, and 70 deliveries beyond 22 gestational weeks (singleton: 68; twin: 2). In 82 patients, vaginal bleeding was the initial symptom of chronic abruption oligohydramnios sequence (88%). The mean gestational duration at the initial symptom onset was 17.3 ± 5.0 weeks. Of the 68 singleton pregnancies delivered after 22 gestational weeks, the mean gestational duration at delivery was 25.2 ± 2.8 weeks. In patients with chronic abruption oligohydramnios sequence, the mean white blood cell count at diagnosis and mean of the maximum white blood cell count during pregnancy were 11,589 ± 2885 and 15,357 ± 4745/μL, respectively; and the mean C-reactive protein at diagnosis and mean of the maximum C-reactive protein during pregnancy were 1.0 ± 1.2 and 2.0 ± 2.1 mg/L, respectively. Chorioamnionitis was identified in 43 patients (63%). All neonates were admitted to the neonatal intensive care unit. Of the 68 singleton neonates, 5 died immediately after birth. Conclusions: Chronic abruption oligohydramnios sequence is a rare perinatal complication that is possibly associated with infections, such as chorioamnionitis, and linked to adverse perinatal and neonatal outcomes.

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Association of Cord Blood Metabolic Biomarkers (Leptin, Adiponectin, IGF-1) with Fetal Adiposity Across Gestation †

Tamai J., Ikenoue S., Akita K., Hasegawa K., Otani T., Fukutake M., Kasuga Y., Tanaka M.

International Journal of Molecular Sciences 26 ( 14 ) 2025.07

ISSN 16616596

Childhood obesity is a substantial health problem worldwide. The origin of obesity (increased adiposity) can be partly traced back to intrauterine life. However, the determinants of fetal fat deposition remain unclear. This study investigated the association between cord blood adipocytokines related to lipid metabolism (leptin, adiponectin, and insulin-like growth factor-1 [IGF-1]) and fetal adiposity during gestation. A prospective study was conducted in a cohort of 94 singleton pregnancies. Fetal ultrasonography was performed at 24, 30, and 36 weeks of gestation. Estimated fetal adiposity (EFA) was calculated by integrating measurements of cross-sectional arm and thigh fat area percentages and anterior abdominal wall thickness. Plasma cytokine levels and C-peptide immunoreactivity (as a proxy for fetal insulin resistance) were evaluated in cord blood samples obtained at delivery. The associations of cord blood leptin, adiponectin and IGF-1 levels with EFA at 24, 30, and 36 weeks were determined by multiple linear regression, adjusted for potential covariates. The multivariate analyses indicated that leptin was significantly correlated with EFA at 30 and 36 weeks. Leptin was also positively correlated with C-peptide immunoreactivity in the umbilical cord. Cord adiponectin levels were not associated with EFA across gestation. Cord IGF-1 levels were significantly correlated with EFA and estimated fetal body weight (EFW) at 36 weeks. In conclusion, cord leptin was associated with EFA at 30 and 36 weeks, and IGF-1 was associated with EFA at 36 and EFW at 36 weeks. In Conclusion, cord leptin was associated with EFA at 30 and 36 weeks, and IGF-1 was associated with EFA and EFW at 36 weeks. Considering the effects of leptin and IGF-1 on fetal insulin resistance and lipid metabolism, increased levels of leptin and IGF-1 are potential plasma biomarkers of increased fetal adiposity, which may predispose to infant obesity and metabolic dysfunction in later life.

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Maternal Serum 25-Hydroxyvitamin D as a Possible Modulator of Fetal Adiposity: A Prospective Longitudinal Study

Akita K., Ikenoue S., Tamai J., Otani T., Fukutake M., Kasuga Y., Tanaka M.

International Journal of Molecular Sciences 26 ( 9 ) 2025.05

ISSN 16616596

25-hydroxyvitamin D (25(OH)D) regulates lipid metabolism, and its decrease is proposed as a pathogenesis of metabolic syndrome, gestational diabetes mellitus (GDM), and eventually fetal adiposity. Decreased 25(OH)D is also linked with the development of gestational diabetes mellitus (GDM), which is associated with increased fetal adiposity. Fetuses are dependent on the supply of 25(OH)D from maternal circulation. However, the influence of maternal serum 25(OH)D on fetal adiposity remains unclear. This study aimed to investigate the association between maternal serum 25(OH)D and fetal adiposity. A prospective longitudinal study was conducted in a cohort of 89 (including 21 GDM) singleton pregnancies. Maternal blood samples were obtained at 10, 24, 30, and 36 weeks, and fetal ultrasonography was performed at 24, 30, and 36 weeks of gestation. Estimated fetal adiposity (EFA) was calculated as the average z-score of cross-sectional arm and thigh percentage fat area and anterior abdominal wall thickness as previously reported. The multiple linear regression analyses indicated that maternal 25(OH)D levels across gestation were not associated with EFA at 24 and 30 weeks, while maternal 25(OH)D at 24 weeks was inversely correlated with EFA at 36 weeks. Particularly, in the GDM group, maternal 25(OH)D levels at 10, 24, 30, and 36 weeks all showed a significant negative correlation with EFA at 36 weeks. Decreased maternal serum 25(OH)D level could be an early biomarker of increased fetal adiposity in late gestation, especially in diabetic pregnancies.

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横紋筋融解症を発症し早産に至った筋強直性ジストロフィー合併妊娠の1例

山田郁, 大谷利光, 緒方泰彦, 石川直嗣, 梶川かおる, 秋田啓介, 玉井順子, 田中雄也, 春日義史, 池ノ上学, 山上亘, 田中守

東京産科婦人科学会会誌 ((一社)東京産科婦人科学会) 74 ( 2 ) 367 - 370 2025.04

ISSN 2186-0599

筋強直性ジストロフィー1型(DM1)はDMPK遺伝子の非翻訳領域であるCTGリピートの伸長によって生じ,筋骨格系,内分泌系や中枢神経系も冒す多臓器疾患である.今回,横紋筋融解症を発症し早産に至ったDM1合併妊娠の1例を経験したため報告する.症例は34歳,1妊0産,当院での着床前診断後の胚移植にて妊娠成立後,当院で妊婦健診を行っていた.妊娠25週2日,下腹部痛・嘔吐を主訴に当院を予約外受診し,血液検査で血清creatine kinase 8741U/Lと著明高値で,下腿の筋肉に圧痛を認めたため,DM1の急性増悪による横紋筋融解症と診断した.腎機能保護のため補液による保存的管理の方針とし,妊娠33週3日に陣痛発来・早産期前期破水を認め,緊急帝王切開術を実施した.産後1ヵ月の母体血清creatine kinaseは低下していた.妊娠中にDM1は急性増悪し,横紋筋融解症などの合併症を引き起こすことがある.DM1合併妊婦は常に原疾患の急性増悪を念頭において管理を行うことが望ましい.(著者抄録)

The Association Between Glucose Variability and Insulin Parameters in Gestational Diabetes Diagnosed After 24 Gestational Weeks

Kasuga Y., Kajikawa K., Ishikawa N., Ogata Y., Takahashi M., Akita K., Tamai J., Fukuma Y., Tanaka Y., Otani T., Fukutake M., Ikenoue S., Tanaka M.

Nutrients 17 ( 3 ) 2025.02

Background/Objectives: Recently, it was reported that glucose variability (GV) calculated using the 75 g oral glucose tolerance test (OGTT) is associated with adverse perinatal outcomes. However, its role in gestational diabetes mellitus (GDM) remains unclear. We investigated the association between GV and insulin parameters in Japanese women diagnosed with GDM after 24 weeks of gestation (late GDM). Methods: A total of 280 mothers with late GDM cared for at Keio University Hospital were included in this study. Using 75 g OGTT, the initial increase and subsequent decrease were calculated as the GV. Results: The initial increase was significantly positively associated with 1 h plasma glucose level (PG) and 2 h PG with 75 g OGTT (p < 0.001), but fasting PG, insulinogenic index (IGI), and homeostasis model assessment—insulin resistance were negatively associated with the initial increase (all p < 0.001). The subsequent decrease was significantly positively correlated with 1 h PG (p < 0.001) but negatively correlated with 2 h PG (p < 0.001), IGI (p = 0.009), and the whole-body insulin sensitivity index derived from the OGTT (p = 0.02). Insulin Secretion-Sensitivity Index-2 was not associated with an initial increase or subsequent decrease. Conclusions: Since the initial increase might reflect insulin secretion and the subsequent decrease might reflect insulin sensitivity in Japanese women with late GDM, GV could alter several insulin parameters. Further studies are required to investigate the usefulness of GV in the management of GDM.

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Should the Definition of Low Birth Weight Be Same in Every Ethnicity Considering the DOHaD Concept?

Kasuga Y, Tanaka M

Pediatric reports 17 ( 1 ) 2025.01

ISSN 2036-749X

Low birth weight (LBW) is a significant concern not only because of its association with perinatal outcomes, but also because of its long-term impact on future health. Despite the physical differences among individuals of different ethnicities, the definition of LBW remains the same for all ethnicities. This study aimed to explore and discuss this issue. We compiled national data from several countries and found that maternal height was negatively correlated with LBW incidence. We discovered the INTERGROWTH-21st chart may not be suitable for the Japanese population, as the Japanese birth weight chart differs from the INTERGROWTH-21st chart. Researchers have reported different LBW cutoff values used to assess adverse perinatal outcomes for different countries. However, there is currently no definition of LBW independent of the mother’s country of origin that can be used for predicting the risk of adverse health outcomes. Therefore, the current era of personalized healthcare may be the perfect time to establish a standard definition of LBW which is independent of the mother’s country of origin. Considering the future of healthcare, it seems an apt time to discuss the development of a more meaningful definition of LBW that can be applied across ethnicities. Further research is needed to investigate the cutoff values of LBW in every ethnicity.

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ジノプロストン腟用剤を用いて計画分娩を行った抗リン脂質抗体症候群および特発性血小板減少性紫斑病合併妊娠の1例

三浦あかり, 白石慧, 春日義史, 山上亘, 田中守

産科と婦人科 ((株)診断と治療社) 92 ( 1 ) 115 - 119 2025.01

ISSN 0386-9792

＜文献概要＞腎梗塞や脳梗塞の既往がある抗リン脂質抗体症候群と特発性血小板減少性紫斑病を合併した初産婦に対して,抗凝固療法を中止する時間を極力短縮したうえで計画分娩を行うため,ジノプロストン腟用剤を使用し経腟分娩に至った症例を経験した.抗凝固療法を行い,かつ血小板低下のある妊婦に対して,計画分娩を行う際にはジノプロストン腟用剤は1つの選択肢となる可能性が示唆された.

Analysis of the Japanese gestational diabetes mellitus diagnostic strategy during the coronavirus disease 2019 pandemic using DREAMBee study data

Kasuga Y., Miyakoshi K., Yokoyama M., Iwama N., Ichikawa R., Yamashita H., Yasuhi I., Ito A., Sone H., Abiko A., Harashima S., Kawasaki M., Arata N., Sato S., Iimura Y., Waguri M., Kawaguchi H., Masaoka N., Nakajima Y., Hiramatsu Y., Sugiyama T.

Journal of Diabetes Investigation 16 ( 6 ) 1119 - 1125 2025

ISSN 20401116

Aims/Introduction: We evaluated a simple diagnostic gestational diabetes mellitus (GDM) strategy (Japanese COVID-19 GDM strategy) published by the Japanese Society of Diabetes and Pregnancy using GDM group data from the Diabetes and Pregnancy Outcomes for Mother and Baby (DREAMBee) study. Materials and Methods: The study included 803 mothers with GDM diagnosed after 24 gestational weeks using an oral glucose tolerance test and 1,356 with normal glucose tolerance (NGT) from the DREMBee study. They were reclassified by the Japanese COVID-19 GDM strategies (COVID-19 GDM and COVID-19 NGT) using glycated hemoglobin (HbA1c) and random plasma glucose or fasting plasma glucose (FPG) levels. We evaluated the usefulness of the Japanese COVID-19 GDM strategy and investigated the parameters for diagnosing GDM managed with insulin therapy. Results: Participants (n = 2,159) were assigned to COVID-19 GDM (n = 413) and COVID-19 NGT (n = 1,746) groups. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Japanese COVID-19 GDM strategy were 35.4, 90.5, 68.9, and 70.3%, respectively. When the risk factors for insulin therapy were analyzed using a regression model, HbA1c and FPG levels were risk factors for GDM with insulin therapy (P < 0.0001). The cut-off value of HbA1c was 5.4% (sensitivity, 0.69; specificity, 0.66; PPV, 0.11; NPV, 0.97), and that of FPG was 86 mg/dL (sensitivity, 0.60; specificity, 0.77; PPV, 0.16; NPV, 0.96). Conclusions: The Japanese COVID-19 GDM strategy for GDM diagnosis after 24 weeks of gestation might be useful in emergency situations. However, further analysis of GDM outcomes diagnosed using this approach is necessary.

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Umbilical cord serum insulin-like growth factor-1 is associated with growth of fetal fractional limb volume: A prospective study

Ikenoue S., Tamai J., Akita K., Otani T., Fukutake M., Kasuga Y., Tanaka M.

Acta Obstetricia Et Gynecologica Scandinavica 2025

ISSN 00016349

Introduction: Insulin-like growth factor-1 (IGF-1) promotes protein and carbohydrate metabolism, which consequently affects birth weight. Fetal fractional limb volume has been proposed as a useful parameter for predicting birth weight and quantifying fetal soft tissue development. However, the relationship between umbilical cord serum IGF-1 levels and fetal fractional limb volume remains unclear. Herein, we aimed to investigate the association of cord serum IGF-1 levels with longitudinal changes in fetal fractional limb volume in uncomplicated pregnancies. Material and Methods: In this prospective study, 96 singleton pregnancies were followed. Fetal 3D ultrasonography was performed longitudinally at 24, 30, and 36 weeks of gestation to assess fractional arm volume and thigh volumes as cylindrical limb volumes, derived from 50% of the fetal total diaphysis length. Cord serum IGF-1 levels were measured using an electrochemiluminescence immunoassay. The relationship between cord blood IGF-1 levels and fetal fractional limb volume was analyzed using multiple linear regression; adjusted for potential confounding factors including maternal age, parity, pre-pregnancy body mass index, gestational weight gain, fetal sex, and gestational age at assessments. Results: Mean cord serum IGF-1 was 52.8 ± 18.4 ng/mL (mean ± SD). IGF-1 levels were not associated with fetal fractional limb volumes at 24 weeks and 30 weeks but were significantly correlated with fractional arm volume (r = 0.290, p = 0.006) and fractional thigh volume (r = 0.289, p = 0.006) at 36 weeks. After adjusting for covariates, cord serum IGF-1 explained 7.0% and 10.6% of the variation in fractional arm and thigh volumes at 36 weeks, respectively. Although IGF-1 was significantly correlated with the birth weight percentile, it did not correlate with the estimated fetal weight at 36 weeks. Conclusions: Cord serum IGF-1 levels significantly correlated with fetal fractional limb volumes in late gestation. Fractional limb volume may be an earlier and more sensitive ultrasound parameter affected by serum IGF-1 level than estimated fetal weight.

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胎児発育不全に右大動脈弓を伴った9番染色体トリソミーモザイクの1例

酒井美晴, 秋田啓介, 春日義史, 福間優花, 玉井順子, 田中雄也, 長谷川慶太, 大谷利光, 池ノ上学, 丸山哲夫, 青木大輔, 田中守

関東連合産科婦人科学会誌 ((一社)関東連合産科婦人科学会) 61 ( 4 ) 392 - 396 2024.11

ISSN 2186-0610

【緒言】9番染色体トリソミーモザイクは心奇形などを合併する周産期死亡率の高い予後不良な染色体異常である.今回我々は当院で周産期管理を行った胎児9番染色体トリソミーモザイクの1例を経験したので報告する.【症例】39歳.G2P1(第1子は妊娠36週で常位胎盤早期剥離による死産分娩).タイミング法で妊娠成立後,妊娠11週の頭殿長より分娩予定日を決定,当院で妊婦健診を行っていた.なお,無侵襲的出生前遺伝学的検査や羊水検査の受検はなかった.妊娠21週の胎児超音波断層法で大動脈縮窄症を疑い,精査を行った.妊娠23週時に胎児発育不全(-2.0SD),単一臍帯動脈,右大動脈弓,左上大静脈遺残と診断した.妊娠31週には推定体重1,071g(-3.0SD)となったことから入院管理とした.妊娠34週6日,胎児機能不全の診断で緊急帝王切開術を施行した.児は女児,1,119g(-4.0SD),Apgar score 7/8点(1/5分値),上記診断の他に眼瞼裂斜上,耳介低位,小顎を認めた.さらに,出生後の染色体検査で9番染色体トリソミーモザイクと診断された.【結語】今回我々は胎児発育不全に右大動脈弓を伴った9番染色体トリソミーモザイクの1例を経験した.本症例のように右大動脈弓を合併する場合もあり,9番染色体トリソミーモザイクは多彩な臨床像を呈することが再認識された.(著者抄録)

Abstracts of the 34th World Congress on Ultrasound in Obstetrics and Gynecology, 15-18 September 2024, Budapest, Hungary

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 64 2024.09

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Use of the Japanese gestational diabetes mellitus diagnostic strategy during the COVID-19 pandemic in Japan: A questionnaire survey

Kasuga Y., Miyakoshi K., Yokoyama M., Nakanishi S., Iwama N., Ichikawa R., Abiko A., Harashima S., Sugiyama T.

Journal of Obstetrics and Gynaecology Research 50 ( 6 ) 955 - 960 2024.06

ISSN 13418076

Aim: Some concerns exist that diagnosis of gestational diabetes mellitus (GDM) may be missed when the simplified diagnostic criteria of the Japanese Society of Diabetes and Pregnancy (JSDP) for GDM (published during the COVID-19 pandemic) are used. Moreover, limited data is available regarding how widespread these diagnostic criteria are used when managing GDM during the COVID-19 pandemic. Therefore, this study aimed to determine how GDM diagnosis has changed during the COVID-19 pandemic in Japan. Methods: The changes in GDM diagnosis during the COVID-19 pandemic were investigated using an online questionnaire to 2159 obstetric facilities in Japan. The questionnaire collected data on facility type, awareness of Japanese GDM diagnostic strategies, modifications to diagnostic methods for early and late GDM, and opinions on GDM management, with the pandemic divided into seven periods. Results: We received responses from 593 facilities (27%). Approximately 90% of the facilities did not change their diagnostic process for early GDM or late GDM (occurring after 24 weeks gestation). However, during the COVID-19 pandemic, 19 facilities discontinued the use of 75-g oral glucose tolerance tests before 24 weeks of gestation, and 17 facilities discontinued it after 24 weeks of gestation, instead using the aforementioned Japanese GDM diagnostic strategy. Conclusions: Although a limited number of facilities modified their diagnostic method in response to the COVID-19 pandemic, this study demonstrated that those that adjusted their diagnostic method primarily used the Japanese COVID-19 GDM strategy by the JSDP.

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Perinatal Outcomes of Diet Therapy in Gestational Diabetes Mellitus Diagnosed before 24 Gestational Weeks

Kasuga Y., Takahashi M., Kajikawa K., Akita K., Otani T., Ikenoue S., Tanaka M.

Nutrients 16 ( 11 ) 2024.05

To evaluate perinatal outcomes and risk factors for large for gestational age (LGA; birth weight over 90 percentile) in gestational diabetes diagnosed before 24 gestational weeks and treated with diet therapy alone until delivery (Diet Early gestational diabetes mellitus (Diet Early GDM)), we assessed the maternal characteristics and perinatal outcomes of patients with early GDM (n = 309) and normal glucose tolerance (NGT; n = 309) at Keio University Hospital. The gestational weight gain (GWG) expected at 40 weeks was significantly lower in the Diet Early GDM group than in the NGT group. The Diet Early GDM group exhibited a significantly lower incidence of low birth weight (<2500 g) and higher Apgar score at 5 min than the NGT group. Multiple logistic regression analysis revealed that the pre-pregnancy body mass index and GWG expected at 40 weeks were significantly associated with LGA for Diet Early GDM. No differences were observed in random plasma glucose levels in the first trimester, 75 g oral glucose tolerance test values, and initial increase or subsequent decrease between the two groups. Dietary early GDM did not exhibit a worse prognosis than NGT. To prevent LGA, it might be important to control maternal body weight not only during pregnancy but also before conception.

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血清hCG値の推移を観察した妊娠高血圧腎症合併間葉性異形成胎盤の1例

山本大貴, 田中邦生, 高橋まりな, 梶川かおる, 秋田啓介, 福間優花, 大谷利光, 池ノ上学, 春日義史, 山上亘, 田中守

東京産科婦人科学会会誌 ((一社)東京産科婦人科学会) 73 ( 2 ) 402 - 406 2024.04

ISSN 2186-0599

間葉性異形成胎盤(PMD)は5000妊娠に1例で発生する稀な胎盤形態異常である.今回我々は血清hCG値の推移を観察した妊娠高血圧腎症(PE)合併PMDの1例を経験したので報告する.症例は30歳,1妊0産.体外受精-胚移植で妊娠成立後,妊娠15週の経腹超音波断層法で胎盤に大小不同な嚢胞を多数認めた.血清hCGは417484mIU/mlであり,その後漸減したが妊娠後期も高値であり,PMDと胎児共存奇胎を鑑別に管理した.妊娠34週健診時,高血圧と蛋白尿を認めPEの診断となり,症状の増悪のため妊娠35週に緊急帝王切開術を施行した.児は2245gの女児,Apgar score 7/8点(1/5分値),明らかな外表奇形は認めなかった.胎盤は1237gで,病理組織学的検査でPMDと診断した.本症例では,妊娠初期に血清hCGが高値であるPMDではPE発症に注意し管理することが重要である可能性が示唆された.(著者抄録)

Sonographic changes in uterine vein thrombosis during pregnancy on transvaginal ultrasound

Sato A., Tanaka K., Sakuma M., Ikenoue S., Kasuga Y., Tanaka M.

Journal of Medical Ultrasonics 51 ( 2 ) 369 - 370 2024.04

ISSN 13464523

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Association of maternal obesity with growth of fetal fractional limb volume

Ikenoue S., Akiba Y., Ishii R., Otani T., Kasuga Y., Tanaka M.

Early Human Development 191 105990 2024.04

ISSN 03783782

Background: Maternal obesity influences birth weight and newborn adiposity. Fetal fractional limb volume has recently been introduced as a useful parameter for the proxy of fetal adiposity. However, the association between maternal adiposity and the growth of fetal fractional limb volume has not been examined. Aims: To investigate the association of maternal pre-pregnancy BMI with the growth of fetal fractional limb volume. Study design: Prospective cohort study. Subjects: Women with singleton uncomplicated pregnancies enrolled between July 2017 and June 2020. Outcome measures: Fetal fractional limb volume was assessed between 20 and 40 weeks' gestation, measured as cylindrical limb volume based on 50 % of the total diaphysis length. The measured fractional limb volume at each gestational week were converted to z-scores based on a previous report. The association between pre-pregnancy BMI and fetal fractional limb volume was examined. Maternal age, parity, gestational weight gain and fetal sex were considered as potential confounding variables. Results: Ultrasound scans of 455 fractional arm volume and thigh volume were obtained. Fractional limb volume increased linearly until the second trimester of gestation, then increased exponentially in the third trimester. Maternal pre-pregnancy BMI was significantly correlated with z-scores of fractional arm volume and thigh volume across gestation. The post-hoc analysis showed the association between pre-pregnancy BMI and fractional arm volume was significant especially between 34 and 40 weeks. Conclusions: Maternal obesity influences the growth pattern of fetal fractional limb volume. Fractional arm volume may potentially provide a useful surrogate marker of fetal nutritional status in late gestation.

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広汎子宮頸部摘出術後に生じる月経変化とその妊娠成績に及ぼす影響

松田理沙, 西尾浩, 松井友哉, 椎名美季, 大野あゆみ, 谷本慧子, 横田めぐみ, 春日義史, 岩田卓, 山上亘, 田中守

関東連合産科婦人科学会誌 ((一社)関東連合産科婦人科学会) 61 ( 1 ) 90 - 96 2024.03

ISSN 2186-0610

【目的】広汎子宮頸部摘出術(radical trachelectomy:RT)後の月経変化は一定の割合で発生するが,その妊娠成績への影響に関しての報告は限定的である.今回,当科でRTを施行した症例について月経変化が妊娠成績に及ぼす影響について検討した.【方法】2002年9月から2021年3月に当院で腹式RTを施行した289例を対象とし,手術前後での月経変化(月経量,持続日数,月経周期,月経痛の変化および無月経)の有無を診療録より調査した.さらに月経変化と妊娠成績の関連について統計学的に解析を行った.【成績】RTを施行した289例中102例(35.3%)が手術後に月経変化を認めていた.その内訳は月経痛が38例(13.1%),月経量減少もしくは持続日数の短縮が35例(12.1%),月経不順が29例(10.0%),持続日数延長が15例(5.2%)であった(重複あり).また無月経が14例(4.8%)に生じ,うち6例が子宮性無月経と診断された.月経変化のあった群では,月経変化のない群と比較し頸管狭窄の頻度が有意に高かった(56例54.9% vs 21例11.2%,p<0.001).さらに月経変化のあった群では妊娠率は有意に低く(24例23.5% vs 72例38.5%,p=0.013),不妊治療を必要とした症例の割合が高かった(46例75.4% vs 73例57.9%,p=0.023).最後に,月経変化のあった群での流産率は有意に高く(11例45.8% vs 15例22.1%,p=0.036),周産期合併症(切迫流早産,早産期前期破水,絨毛膜羊膜炎,胎盤位置異常など)の頻度が高い傾向を認めた(18例85.7% vs 40例61.5%,p=0.059).【結論】RT施行後の月経変化は妊娠成立およびその維持に影響を及ぼすことが示唆された.(著者抄録)

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