Efficacy of Therapeutic Interventions for Gestational Diabetes Mellitus Diagnosed in Early Pregnancy

2021 Fiscal Year Final Research Report

• Project/Area Number: 19K18675
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 56040:Obstetrics and gynecology-related
• Research Institution: Yokohama City University
• Principal Investigator: Aoki Shigeru 横浜市立大学, 附属市民総合医療センター, 准教授 (50621546)
• Project Period (FY): 2019-04-01 – 2022-03-31
• Keywords: 妊娠糖尿病 / 耐糖能異常 / 妊娠

Outline of Final Research Achievements

We conducted a study to investigate the optimal Timing of Therapeutic Intervention for Gestational Diabetes Mellitus diagnosed in early pregnancy. In this study, women diagnosed with early-onset GDM were followed up without therapeutic intervention and underwent the 75-g OGTT again during 24-28 weeks of gestation.
Although women with early-onset GDM were followed up without treatment, the results of repeated 75-g OGTT during mid-pregnancy were normal in about 50%.
FPG levels were significantly higher in the first 75g-OGTT test than in the second 75g-OGTT test. There was no significant difference in either the 1-h or 2-h values. Compared with false positive early GDM(early75gOGTT; GDM, mid75gOGTT: Normal), true GDM(early75gOGTT; GDM, mid75gOGTT: GDM) was more frequently associated with adverse pregnancy outcomes.

Free Research Field

周産期医学

Academic Significance and Societal Importance of the Research Achievements

海外では妊娠糖尿病（GDM）は妊娠24-28週で診断するのがゴールデンスタンダードであるが、日本は妊娠初期から診断・治療を行っている。妊娠初期に診断されたGDMは、妊娠中期に向けて生理的に低下する空腹時血糖高値で診断されるケースが多く、妊娠中期にかけて無治療経過観察としても本来GDMを診断するべき妊娠24-28週では正常耐糖能となる症例が多かった。日本の初期から妊娠糖尿病を75gOGTTで診断し、治療を行うというGDMの治療戦略では本来治療の必要のない妊婦に対し介入を行っている可能性があり、過剰介入となっている可能性がある。日本のGDMの診断基準は改訂されるべきであろう。