研究者詳細 - 春日　義史

論文 - 春日　義史

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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年02月

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年01月

ISSN 2036-749X

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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年11月

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年09月

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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年06月

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年05月

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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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年04月

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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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年04月

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年04月

ISSN 13464523

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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年03月

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)

Obstetric outcomes of transabdominal cerclage: A retrospective observational study in Japan

Kasuga Y., Tanigaki S., Seo K., Harada A., Kuwabara Y., Ishioka S., Tanaka M.

Journal of Obstetrics and Gynaecology Research 50 （ 10 ） 1835 - 1840 2024年

ISSN 13418076

Objective: This study aimed to investigate the obstetric outcomes of transabdominal cerclage (TAC) in Japan. Methods: Questionnaires on TAC were sent to 183 institutions performing high-quality perinatal management in Japan. As a first-step questionnaire, we asked whether TAC was performed between January 1, 2011, and December 31, 2022. In the second step of the questionnaire, the characteristics of all cases were asked from all institutions in which TAC was performed. Results: The response rate for the first survey was 59% (108/183). Of the 108 institutions, 27 performed TAC (25%) in 133 pregnancies. Of these 27 institutions, 19 responded to the second survey. One hundred twenty-five pregnancies were included in this study, five of which were aborted (gestational weeks <22 weeks), and 69 babies were born after 37 gestational weeks (55%). Eighty-two open abdominal cerclages were performed at 17 institutions and 43 laparoscopic TACs at three institutions. There were no differences in the age at TAC, gestational weeks at TAC, operative time of TAC, gestational weeks at delivery, incidence rate of second-trimester loss, or preterm delivery (before 37 gestational weeks) rate between the two groups. However, blood loss during open TAC was greater than that during laparoscopic TAC. Conclusion: TAC is a rare surgery for cervical insufficiency in Japan. TAC may be a safe and useful method for preventing second-trimester loss and preterm delivery in high-risk patients. TAC may also be a key option in Japan to improve perinatal outcomes in patients with cervical insufficiency.

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Origins of obesity in the womb: Fetal adiposity and its determinants

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

Journal of Obstetrics and Gynaecology Research 50 （ 12 ） 2178 - 2182 2024年

ISSN 13418076

Birth weight is an important predictor of perinatal complications and long-term health outcomes of offspring. Fetal programming influenced by maternal obesity, overnutrition, and hyperglycemia has been proposed as the fuel overload hypothesis. Recent investigations related with fetal body composition have revealed that neonatal adiposity can be predicted by fetal fat mass, and that maternal insulin resistance and serum leptin level are indicators of fetal adiposity. Based on the current evidence, the origins of obesity can partly be traced back into the fetal life. Further clarification of the determinants of fetal fat mass may lead to the clinical interventions and treatment strategies for fetal growth and development. This effort potentially leads to the elucidation of pathological conditions related with long-term health outcomes and the primary prevention of childhood obesity and early onset metabolic syndrome.

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Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks

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

Journal of Diabetes Investigation 15 （ 12 ） 1803 - 1808 2024年

ISSN 20401116

Aims/Introduction: This study evaluated the risk factors for insulin therapy before 24 gestational weeks (early insulin therapy) in pregnant women with gestational diabetes diagnosed before 24 gestational weeks (E-GDM). Materials and Methods: This study included 530 singleton mothers with E-GDM who underwent a 75 g oral glucose tolerance test (OGTT) in the first trimester at Keio University Hospital between January 2013 and December 2021. E-GDM can be classified according to its management into only diet therapy until delivery (Diet E-GDM), insulin therapy started before 24 gestational weeks (EarlyIns E-GDM), and insulin therapy started after 24 gestational weeks (LateIns E-GDM). We analyzed the risk factors for EarlyIns E-GDM. Results: Patients with EarlyIns E-GDM had a significantly higher maternal age at delivery, pre-pregnancy BMI, first trimester hemoglobin A1c, 1 h plasma glucose levels (1 h-PG), and 2 h-PG, as well as a more pronounced initial increase and subsequent decrease, compared with those in the Diet E-GDM group. However, the Apgar scores at both 1 and 5 min were significantly lower in patients with EarlyIns E-GDM than in those with Diet E-GDM. The number of abnormal values in the OGTT showed the largest area under the receiver operating characteristic curve (AUC) for predicting EarlyIns E-GDM (0.83, 95% confidence interval [CI]: 0.79–0.86), followed by the 1 h-PG value (AUC: 0.81, 95% CI: 0.77–0.85). The initial increase showed the third largest AUC (0.78, 95% CI: 0.74–0.82). Conclusions: Although further research is needed, our data suggest the importance of early insulin therapy in cases of E-GDM with multiple abnormal OGTT values, especially with high 1 h-PG levels and initial increase.

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Efficacy of controlled-release dinoprostone vaginal insert for elective induction of labor before due date

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

Journal of Obstetrics and Gynaecology Research 50 （ 12 ） 2226 - 2230 2024年

ISSN 13418076

Aim: The induction of labor before due date has recently been proved to reduce the rate of cesarean sections and is not associated with increased risk of adverse perinatal outcomes as compared to expectant management. Controlled-release dinoprostone (PGE2) vaginal insert has recently been approved for use in Japan. However, evidence regarding its efficacy in cervical ripening and labor induction before due date remains limited. We aimed to compare the efficacy of PGE2 vaginal inserts and mechanical dilation for labor induction before due date. Methods: This retrospective cohort study included 206 mothers at 37, 38, and 39 weeks' gestation delivered at our institution between January 2021 and October 2022. Perinatal outcomes, including the success rate of vaginal delivery, were compared between the PGE2 (n = 46) and metreurynter/laminaria tent (non-PGE2) (n = 160) groups. The success rate of vaginal delivery was defined as the proportion of women who delivered vaginally within 48 h of initiating oxytocin augmentation. Results: The success rate of vaginal delivery was significantly higher in the PGE2 group (37/49, 80.4%) than in the non-PGE2 group (106/177, 66.2%). Emergency cesarean section related to non-reassuring fetal status was performed with none in the PGE2 group and with eight (5.0%) in the non-PGE2 group. Conclusions: The rate of vaginal delivery was significantly higher in the PGE2 group for elective labor induction between 37 and 39 weeks. The PGE2 vaginal insert could increase the success rate of vaginal delivery for elective induction of labor at 39 weeks.

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Pregnancy complicated by fetal goiter following lung transplantation for idiopathic pulmonary arterial hypertension: A case study

Hamuro A., Kasuga Y., Saito S., Uchida H., Hiraide T., Yamada Y., Arimitsu T., Date H., Fukushima H., Tanaka M.

Taiwanese Journal of Obstetrics and Gynecology 64 （ 1 ） 131 - 133 2024年

ISSN 10284559

Objective: We report a case of pregnancy following lung transplantation (LT) for idiopathic pulmonary arterial hypertension (IPAH) in Japan. Case Report: A female developed IPAH at 14 years of age and underwent a successful bilateral living-donor lobar LT from her parents at 19 years of age (gravida 2, para 0). At the age of 40 years, the patient became pregnant via artificial insemination. At 28 weeks of gestation, polyhydramnios and a fetal goiter were detected on transabdominal ultrasound. The patient was diagnosed with deep vein thrombosis and pulmonary embolism. The patient underwent emergency cesarean section to deliver a male neonate weighing 1340 g (−0.41SD) at 30 weeks of gestation, with an Apgar score of 5/5 (1/5 min). Conclusion: To our knowledge, this is the first reported case of a successful pregnancy following LT in Japan. Specialists should work together to manage pregnancies following LT.

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A capture methyl-seq protocol with improved efficiency and cost-effectiveness using pre-pooling and enzymatic conversion

Hasegawa K., Nakabayashi K., Ishiwata K., Kasuga Y., Hata K., Tanaka M.

BMC Research Notes （BMC Research Notes） 16 （ 1 ） 141 2023年12月

Objective: The opportunities for sequencing-based methylome analysis of clinical samples are increasing. To reduce its cost and the amount of genomic DNA required for library preparation, we aimed to establish a capture methyl-seq protocol, which adopts pre-pooling of multiple libraries before hybridization capture and TET2/APOBEC-mediated conversion of unmethylated cytosine to thymine. Results: We compared a publicly available dataset generated by the standard Agilent protocol of SureSelect XT Human Methyl-Seq Kit and our dataset obtained by our modified protocol, EMCap, that adopted sample pre-pooling and enzymatic conversion. We confirmed that the quality of DNA methylation data was comparable between the two datasets. As our protocol, EMCap, is more cost-effective and reduces the amount of input genomic DNA, it would serve as a better choice for clinical methylome sequencing.

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Efficacy and safety of a telemedicine system in subjects with gestational diabetes mellitus (TELEGLAM): Study protocol for a randomized controlled trial

Aoyama K., Nakajima Y., Meguro S., Sato Y., Goto R., Hida M., Arimitsu T., Kasuga Y., Tanaka M., Itoh H.

Heliyon 9 （ 11 ） e22504 2023年11月

ISSN 24058440

Background: Strict glycemic control is important to prevent perinatal complications in patients with gestational diabetes mellitus (GDM). Patients often require insulin injection, and frequent hospital visits are necessary to adjust the dose of insulin, which is considered burdensome for pregnant patients. Telemedicine may reduce the burden of hospital visits, and previous studies have reported its safety in GDM patients. This study aimed to evaluate the efficacy of telemedicine in GDM patients, focusing on patient satisfaction and health economic indicators. Methods: This is a single-center, two-arm, randomized, open-label parallel-group study. Subjects will be selected from the patient population attending the Department of Endocrinology, Metabolism, and Nephrology, Keio University School of Medicine, Japan. Patients diagnosed with GDM by an oral glucose tolerance test (OGTT) by 29 weeks and 6 days of gestation who have undergone self-monitoring of blood glucose (SMBG) and insulin injection are eligible for inclusion. In the intervention group, telemedicine will be administered using the MeDaCa telemedicine system developed by the Medical Data Card, Inc., Tokyo, Japan. Subjects in the control group will be examined face-to-face every 2–3 weeks, as usual. We set health economic indicators and patient satisfaction as the primary endpoints, and will perform a cost-consequence analysis. Glycemic control indicators and perinatal outcomes will be evaluated as secondary endpoints. Conclusions: Eligible patients are currently being recruited. Recruitment will be completed when the expected number of patients are enrolled.

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自然妊娠成立後,経腟分娩に至ったOHVIRA症候群合併妊娠の一例

林宥希, 福間優花, 春日義史, 玉井順子, 葉室明香, 田中雄也, 長谷川慶太, 池ノ上学, 小林佑介, 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） 60 （ 4 ） 683 - 688 2023年11月

ISSN 2186-0610

【緒言】Obstructed hemivagina and ipsilateral renal anomaly(OHVIRA)症候群はMueller管の癒合不全により,子宮形態異常,腟血腫,患側の腎形成不全を呈する稀な疾患である.今回OHVIRA症候群と診断した後,自然妊娠が成立し,36週で経腟分娩に至った症例を経験したので報告する.【症例】23歳,1妊0産.妊娠前に撮影した骨盤部MRI検査で重複子宮を認め,患側の右子宮は腟との連続性を認めず留血腫も見られなかった.さらに右腎欠損を伴うことよりOHVIRA症候群と診断した.妊娠10週5日に当科にて左子宮に自然妊娠を確認した.妊娠31週5日に子宮頸管長は15.0mmと短縮し,妊娠33週5日で切迫早産管理目的に緊急入院とした.妊娠36週0日に一時退院としたが,妊娠36週5日に前期破水し,妊娠36週6日に経腟分娩に至った.【結語】我々はOHVIRA症候群と診断した後,自然妊娠が成立し,妊娠36週に経腟分娩に至った症例を経験した.OHVIRA症候群合併妊娠では本症例のように経腟分娩可能な症例もあり,形態異常の程度が多岐にわたるため,個々の症例に合わせた検討が必要である.(著者抄録)

Factors associated with low birthweight among late preterm singletons in Japan using pregnancy birth registry data

Kasuga Y., Tanaka K., Akita K., Tamai J., Hamuro A., Fukuma Y., Hasegawa K., Ikenoue S., Tanaka M.

Journal of Developmental Origins of Health and Disease 14 （ 5 ） 584 - 590 2023年10月

ISSN 20401744

Late preterm (LP, born between 34 0/7 and 36 6/7 weeks of gestation) infants may experience several adverse outcomes, similar to those experienced by low birthweight (LBW, birthweight <2500 g) infants. However, while LP infants are often born with LBW, the association between LP and LBW remains unknown. This study aimed to investigate LBW rate and independent risk factors for LBW in LP singleton neonates. We retrospectively analyzed data of LP singleton neonates, born between 2013 and 2017, from the Japan Society of Obstetrics and Gynecology Successive Pregnancy Birth Registry System. The exclusion criteria included stillbirths and infants with missing data. Logistic regression analyses were performed to investigate maternal and perinatal factors associated with LBW in LP singletons. LBW was observed in 62.5% (n = 35,113) of 56,160 LP singleton births. In the multiple logistic regression analysis, LBW in LP neonates was independently associated with modifiable maternal factors, including pre-pregnancy underweight, inadequate gestational weight gain, and smoking during pregnancy, as well as non-modifiable factors, including younger maternal age, nulliparity, hypertensive disorder of pregnancy, preeclampsia, cesarean section delivery, and female offspring. According to the Japanese pregnancy birth registry data, more than half of LP neonates were LBW. We previously discussed the issue of LBW regarding infants with different backgrounds, as there are many different causes of LBW. Several risk factors should be subdivided and considered for the risk of LP and LBW.

Access to Document (DOI)

非常時妊娠糖尿病診断に関する調査研究報告

春日義史, 宮越敬, 横山真紀, 中西沙由理, 岩間憲之, 市川雷師, 安孫子亜津子, 原島伸一, 杉山隆, 日本糖尿病・妊娠学会非常時GDM診断に関するワーキンググループ

糖尿病と妊娠（(一社)日本糖尿病・妊娠学会） 23 （ 2 ） S - 50 2023年08月

ISSN 1347-9172

目的:コロナ禍で妊娠糖尿病(gestational diabetes mellitus:GDM)診断がどのように変化したかを明らかにする。方法:全国の分娩取り扱い施設(2159施設)に対し、コロナ禍でのGDM診断方法の変化について調査した(回答率27%)。結果:妊娠24週未満/以降GDMともに90%前後の施設が診断方法を変更しなかった。一方、妊娠24週未満では19施設、24週以降では17施設が75g経口糖負荷試験を中止し、日本糖尿病・妊娠学会による「妊娠中の糖代謝異常のスクリーニング～COVID-19パンデミック対応～」を使用した。結論:今後のさらなる非常時に備え、有用な簡易型診断基準を作成するため、リスク因子抽出などの検討が必要であると考えられた。(著者抄録)

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