Study of blood glucose kinetics and glycemic control methods with the Real-Time Continuous Glucose Monitoring During labor of gestational diabetes and normal pregnant women.

2019 Fiscal Year Final Research Report

• Project/Area Number: 17K16852
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: Obstetrics and gynecology
• Research Institution: Okayama University
• Principal Investigator: MAKI JOTA 岡山大学, 大学病院, 助教 (20774178)
• Project Period (FY): 2017-04-01 – 2020-03-31
• Keywords: 妊娠糖尿病 / リアルタイムCGM / 分娩 / インスリン / 血糖 / 難産

Outline of Final Research Achievements

Details of blood glucose fluctuations during labor by stage are unknown. Here we investigated whether blood glucose kinetics are affected when the 2nd stage of labor is prolonged (labor dystocia). Japanese pregnant women with gestational diabetes mellitus and normal glucose tolerance test results who underwent perinatal management between May 2016 and March 2019 and gave birth to a single baby vaginally at 37 weeks or later were enrolled. Among the 116 enrolled pregnant women, 52 were excluded. Of the remaining 64, 32 had gestational diabetes mellitus and 32 had normal glucose tolerance. The major outcome of our study is that the prolongation of period 2 resulted in an increased blood glucose at delivery. The prolongation of 2nd stage significantly increased blood glucose kinetics in gestational diabetes mellitus patients (p = 0.022). Regression coefficient indicated that the blood glucose levels increased linearly by about 0.058 mg/dL for every 1-min duration of period 2.

Free Research Field

産婦人科　妊娠糖尿病

Academic Significance and Societal Importance of the Research Achievements

世界で初めて正常群および妊娠糖尿病妊婦の分娩中の血糖動態をリアルタイムCGMで明らかにした。血糖動態はGDM・対象群共に同様形態で，血糖上昇の主原因はGDMの有無ではなく，分娩進行の時期が血糖値に有意に影響を与え,分娩直後が最大値となることも初めて分かった．さらに現在論文投稿中であるが，分娩第2期の遷延は，対象群では血糖値に影響を認めなかったが, GDM群では遷延が直接血糖を有意に上昇させることが認められた．回帰係数の値から，Ⅱ期が1分長くなる毎に血糖値が約0.058mg/dlずつ直線的な上昇を認めた.
以上のように分娩中の妊婦の血糖管理を本邦から世界に発信する成果を上げることができた．