Ichiro Yasuhi

Maternal serum triglyceride at 24–32 weeks’ gestation and newborn weight in nondiabetic women with positive diabetic screens

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.

Hyperinsulinemia increases the risk of gestational hypertension

Objective: To determine whether hyperinsulinemia is related to gestational hypertension. Methods: We measured the arterial blood pressure and the level of immunoreactive insulin (IRI) during a 75 g oral glucose tolerance test in a total of 84 pregnant women. Hyperinsulinemia was defined as a fasting IRI level ≥ 9 IU/1, while gestational hypertension was defined as arterial blood pressure ≥ 140/90 mmHg. Results: The incidence of gestational hypertension was higher in the hyperinsulinemic group (n = 29) than in the control group (n = 55) (24.1% vs. 7.3%, respectively P < 0.05). After controlling for maternal age, parity, pre‐pregnancy body mass index and the gestational age at the time of oral glucose tolerance test (OGTT), using a multiple regression model, the relative risk of developing gestational hypertension for a fasting insulin level was 1.19 (95% C.I., 1.03–1.38). Conclusion: Pregnant women with hyperinsulinemia are at increased risk of developing gestational hypertension.

A Case of Postpartum Cerebellar Infarction with Hemolysis, Elevated Liver Enzymes, Low Platelets (HELLP) Syndrome

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.

Risk factors associated with abnormal glucose tolerance in the early postpartum period among Japanese women with gestational diabetes

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).

Effect of maternal meal ingestion on fetal renal artery resistance.

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.

Influence of the interval between antenatal corticosteroid therapy and delivery on respiratory distress syndrome

In spite of the recommendation for rescue antenatal corticosteroids (ACS), the optimal time interval between primary and rescue courses has not been clearly demonstrated. The aim of this study was to determine the effects of the interval between a single ACS course and delivery on the incidence of respiratory distress syndrome (RDS).

Risk factors associated with respiratory disorders in late preterm infants.

Abstract Objective: Late preterm infants are still high risk for respiratory problems. The aim of this study was to identify risk factors associated with respiratory problems in Japanese late preterm infants. Methods: In this retrospective multicenter study, we included singleton late preterm deliveries at 34+0/7–36+6/7 weeks of gestation. We excluded cases with congenital anomalies. We defined neonatal respiratory disorders (NRD) as the combination of the need for mechanical ventilation or the use of nasal continuous positive airway pressure. We examined the perinatal risk factors associated with NRD. Results: We included 683 late preterm infants. We found that 13.7%, 6.8% and 2.6% of the infants with NRD were born at 34, 35 and 36 weeks of gestation, respectively. In a multivariate logistic regression analysis adjusting for confounders, the gestational age (GA) at birth (adjusted odds ratio 0.40 per week [95% confidence interval, 0.25–0.61]), cesarean birth (4.18 [2.11–8.84]), and a low Apgar score (33.3 [9.93–121.3]) were independent risk factors associated with NRD. Conclusions: An earlier GA, cesarean delivery, and a low Apgar score are independent risk factors associated with NRD in singleton late preterm infants. Patients with late preterm deliveries exhibiting these risk factors should be managed in the intensive delivery setting.

A Case of Type 1 Diabetes Mellitus Diagnosed during Follow-up of Gestational Diabetes Mellitus in the Early Postpartum Period

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.

Factors associated with patients with gestational diabetes in Japan being at increased risk of requiring intensive care

To investigate factors associated with high‐risk gestational diabetes (GDM) among patients with GDM.

The Routine Use of Prophylactic Oxytocin in the Third Stage of Labor to Reduce Maternal Blood Loss

Objective To demonstrate whether or not the routine use of prophylactic oxytocin (RUPO) reduces the blood loss and incidence of postpartum hemorrhaging (PPH). Methods We used a prospective cohort and a historical control in a tertiary perinatal care center in Japan. In the prospective cohort, we introduced RUPO in April 2012 by infusing 10 units of oxytocin per 500 mL of normal saline into a venous line after anterior shoulder delivery (RUPO group). In the historical control, oxytocin was administered via a case-selective approach (historical control group). We included completed singleton vaginal deliveries and compared the volume of blood loss and the incidence of PPH between the groups. Results We found a significantly lower volume of blood loss (520 ± 327 versus 641 ± 375 mL, p < 0.001) and a lower incidence of PPH (6.1% versus 14.0%, p < 0.001) in the RUPO group (n = 392) than in the control group (n = 407). Although the oxytocin dose was significantly higher in the RUPO group (12.8 ± 6.7 versus 10.1 ± 8.0 IU, p < 0.001), no adverse outcomes were observed to be associated with RUPO. Conclusions The introduction of RUPO significantly reduced blood loss and the incidence of PPH during completed singleton vaginal deliveries without an increase in adverse effects.