Clinical challenges in early pregnancy in Japan: An update on gestational diabetes
Open accessAI snapshot
Written from the paper’s full text.
TL;DR
This narrative review summarizes evidence on gestational diabetes mellitus (GDM) diagnosis and treatment in Japan, with a focus on early pregnancy. It argues that early GDM is associated with adverse outcomes and may benefit from treatment, but direct evidence in Japanese populations remains limited.
Key findings
- GDM is diagnosed by a 75-g OGTT at 24–28 weeks using at least one threshold: pre-load 92 mg/dL, 1-h 180 mg/dL, or 2-h 153 mg/dL; Japan uses the same IADPSG criteria, including in early pregnancy.
- Japanese studies cited report that GDM diagnosed in the second half of pregnancy is associated with significantly higher risk of premature birth (<37 weeks), birthweight >90th percentile, hypertensive disorders of pregnancy, and cesarean section; early-pregnancy GDM has been linked to higher pre-eclampsia and cesarean section.
- The TOBOGM RCT enrolled women at 17 hospitals and performed 75-g OGTT at 4–19 weeks; intervention for early GDM significantly reduced adverse neonatal events, with no statistically significant differences in hypertensive disorders of pregnancy or neonatal lean body mass.
- In TOBOGM subgroup analysis, the high-threshold group (95/191/162 mg/dL) showed no significant association with large-for-gestational-age or small-for-gestational-age infants, while the low-threshold group’s intervention reduced large-for-gestational-age risk but increased small-for-gestational-age risk; a secondary analysis found adverse perinatal outcomes increased with early GDM despite treatment from 24–28 weeks compared with late GDM.
Methods
- Narrative review/update synthesizing published literature on GDM diagnosis and treatment, including the HAPO study, ACHOIS, TOBOGM, and Japanese epidemiological and retrospective studies.
- No primary sample or new data collection; the paper discusses an ongoing Japanese registry study, the Diabetes and Pregnancy Outcome for Mother and Baby study.
- Main analysis is narrative synthesis of trial and observational evidence, with no systematic search, meta-analysis, or formal quality appraisal described.
Limitations
- The paper states there is little direct evidence for GDM strictly defined in early pregnancy by pre-load ≥92 mg/dL, 1-h ≥180 mg/dL, and 2-h ≥153 mg/dL, and that further intervention studies are essential in Japan.
- It notes that many TOBOGM participants met the Japanese definition of obesity, and that Japan did not participate in the HAPO study.
- Evident from the text: this is a narrative review without primary data, systematic search strategy, or formal risk-of-bias assessment.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
19 of 32 cited sources checked · 10 supported · 0 flagged · accuracy not yet measured
- Premisecitation
In the ACHOIS trial, the intervention group had a significantly lower risk of neonatal complications than the non-intervention group among GDM cases.
“In the GDM cases in ACHOIS, the intervention group had a significantly lower risk of neonatal complications than the non‐intervention group 13 .”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [13] Crowther CA, Hiller JE, Moss JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477– 2486. 15951574 source
- Premisecitation
GDM increases the mother's susceptibility to developing type 2 diabetes.
“The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study 1 and subsequently follow‐up studies 2 , 3 , 4 have reported that gestational diabetes mellitus (GDM) is associated with various adverse pregnancy outcomes, which increases the mother's susceptibility to developing type 2 diabetes, and the child's susceptibility to developing obesity and impaired glucose tolerance in the future 3 , 4 , 5”
Quote in the paperNot a substantial claim3 of 3 sources checked- cites [3] Lowe WLJ, Lowe LP, Kuang A, et al. Maternal glucose levels during pregnancy and childhood adiposity in the hyperglycemia and adverse pregnancy outcome follow‐up study. Diabetologia 2019; 62: 598– 610. 30648193 PMC6421132 source
The Introduction discusses maternal diabetes during pregnancy in relation to childhood adiposity, and the Discussion reports an association between maternal glucose and childhood adiposity. Neither addresses whether GDM increases a mother's later risk of type 2 diabetes. Searches for subsequent maternal or postpartum type 2 diabetes found no supporting passage in our copy; page numbers were not available. (LLM, conf=0.76)
Experimental — accuracy not yet measured - cites [4] Lowe WLJ, Scholtens DM, Kuang A, et al. Hyperglycemia and adverse pregnancy outcome follow‐up study (HAPO FUS): maternal gestational diabetes mellitus and childhood glucose metabolism. Diabetes Care 2019; 42: 372– 380. 30655380 PMC6385693 source
- cites [5] Chu LCH, Sugiyama T, Ma RCW. Recent updates and future perspectives on gestational diabetes mellitus: an important public health challenge. J Diabetes Investig 2021; 12: 1944– 1947. PMC8565418 34529362 source
- Premiseown data
Blood glucose levels during 75-g OGTT differ between early and late pregnancy.
“Indeed, our research has shown that blood glucose levels during 75‐g OGTT differ between early and late pregnancy 12 .”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [12] Iwama N, Sugiyama T, Metoki H, et al. Difference in the prevalence of gestational diabetes mellitus according to gestational age at 75‐g oral glucose tolerance test, in Japan: the JAGS trial. J Diabetes Investig 2019; 10: 1576– 1585. PMC6825953 30897272 source
- Premisecitation
A GDM diagnosis in early pregnancy is associated with adverse pregnancy outcomes compared with a GDM diagnosis in late pregnancy using previous diagnostic criteria in Japan.
“We also previously showed that a GDM diagnosis in early pregnancy was associated with adverse pregnancy outcomes compared with a GDM diagnosis in late pregnancy using a previous diagnostic criteria in Japan 11 .”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [11] Usami T, Yokoyama M, Ueno M, et al. Comparison of pregnancy outcomes between women with early‐onset and late‐onset gestational diabetes in a retrospective multi‐institutional study in Japan. J Diabetes Investig 2020; 11: 216– 222. PMC6944816 31199576 source
- Premisecitation
Several randomized controlled trials (RCTs) have provided evidence of improved perinatal outcomes of GDM in the second half of pregnancy.
“Although the diagnostic criteria for GDM differ, several randomized controlled trials (RCTs) have provided evidence of improved perinatal outcomes of GDM in the second half of pregnancy.”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [13] Crowther CA, Hiller JE, Moss JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477– 2486. 15951574 source
The Abstract describes one randomized trial enrolling women with gestational diabetes at 24–34 weeks’ gestation, and the Results report fewer serious perinatal complications with treatment (1% versus 4%). The paper supports improved outcomes in the second half of pregnancy, but it does not establish the claim that several RCTs had provided such evidence; its discussion instead notes a lack of data from large randomized trials and mentions another trial as ongoing. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [14] Wu ET, Nien FJ, Kuo CH, et al. Diagnosis of more gestational diabetes lead to better pregnancy outcomes: comparing the International Association of the Diabetes and Pregnancy Study Group criteria, and the Carpenter and Coustan criteria. J Diabetes Investig 2016; 7: 121– 126. PMC4718104 26816609 source
The Discussion (page unavailable) reports improved pregnancy outcomes in this study and cites one randomized trial that found treatment of mild GDM reduced fetal overgrowth and cesarean delivery. It does not report evidence from several RCTs or establish that those trials concerned treatment in the second half of pregnancy. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Premisecitation
Gestational diabetes mellitus (GDM) is associated with various adverse pregnancy outcomes.
“The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study 1 and subsequently follow‐up studies 2 , 3 , 4 have reported that gestational diabetes mellitus (GDM) is associated with various adverse pregnancy outcomes, which increases the mother's susceptibility to developing type 2 diabetes, and the child's susceptibility to developing obesity and impaired glucose tolerance in the future 3 , 4 , 5”
Quote in the paperSubstantial claim2 of 3 sources checked- cites [1] HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991– 2002. 18463375 source
- cites [2] Lowe WLJ, Scholtens DM, Lowe LP, et al. Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity. JAMA 2018; 320: 1005– 1016. 30208453 PMC6143108 source
- cites [3] Lowe WLJ, Lowe LP, Kuang A, et al. Maternal glucose levels during pregnancy and childhood adiposity in the hyperglycemia and adverse pregnancy outcome follow‐up study. Diabetologia 2019; 62: 598– 610. 30648193 PMC6421132 source
- Premisereasoning
The ACHOIS trial was not based on the IADPSG criteria for GDM.
“However, that RCT study was not based on the IADPSG criteria for GDM.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [13] Crowther CA, Hiller JE, Moss JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477– 2486. 15951574 source
- Interpretationreasoning
There is little direct evidence for GDM strictly defined as pre-loading value ≥92 mg/dL, 1-h loading value ≥180 mg/dL, and 2-h loading value ≥153 mg/dL.
“Although there is evidence that intervention in GDM in the second half of pregnancy improves perinatal prognosis, there is little direct evidence for GDM strictly defined as pre‐loading value ≥92 mg/dL, 1‐h loading value ≥180 mg/dL and 2‐h loading value ≥153 mg/dL; as such, further intervention studies are essential in Japan.”
Quote in the paperSubstantial claim - Premisecitation
In the HAPO study, the respective values with odds ratios of 2.00 for 75-g OGTT were 95 mg/dL pre-loading, 191 mg/dL at 1-h, and 162 mg/dL at 2-h.
“Furthermore, the respective values with odds ratios of 2.00 for 75‐g OGTT were 95 mg/dL pre‐loading, 191 mg/dL at 1‐h and 162 mg/dL at 2‐h.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991– 2002. 18463375 source
- Interpretationcitation
The perinatal prognosis of GDM in the second half of pregnancy, as defined by these diagnostic criteria, is poor among Japanese women.
“These findings show that the perinatal prognosis of GDM in the second half of pregnancy, as defined by these diagnostic criteria, is poor among Japanese women.”
Quote in the paperSubstantial claim - Premisecitation
In the TOBOGM study, among individuals with GDM in the first half of pregnancy, the intervention group had a significantly reduced risk of adverse neonatal events compared with the control group.
“In individuals with GDM in the first half of pregnancy, the intervention group had a significantly reduced risk of adverse neonatal events compared with the control group.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] Simmons D, Immanuel J, Hague WM, et al. Treatment of gestational diabetes mellitus diagnosed early in pregnancy. N Engl J Med 2023; 388: 2132– 2144. 37144983 source
- Premisecitation
The diagnostic criteria for GDM in Japan are the same as those of the International Association of Diabetes and Pregnancy Study Groups (IADPSG).
“The diagnostic criteria in Japan are the same as those of the IADPSG 7 .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [7] Itakura A, Satoh S, Aoki S, et al. Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology and Japan Association of Obstetricians and Gynecologists, 2020 edition. J Obstet Gynaecol Res 2023; 49: 5– 53. 36251613 source
- Premisecitation
The diagnostic criteria for GDM in the first half of pregnancy used in the TOBOGM study were the same as those used in Japan.
“As aforementioned, the diagnostic criteria for GDM in the first half of pregnancy used in the TOBOGM study were the same as those used in Japan; as such, these findings could be considered useful.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [15] Simmons D, Immanuel J, Hague WM, et al. Treatment of gestational diabetes mellitus diagnosed early in pregnancy. N Engl J Med 2023; 388: 2132– 2144. 37144983 source
- cites [7] Itakura A, Satoh S, Aoki S, et al. Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology and Japan Association of Obstetricians and Gynecologists, 2020 edition. J Obstet Gynaecol Res 2023; 49: 5– 53. 36251613 source
- Premisecitation
In the TOBOGM study, when the outcome was birthweight, no significant association was found between the high-threshold group's intervention and the risk of large for gestational age or small for gestational age in infants.
“When the outcome was birthweight, no significant association was found between the high‐threshold group's intervention and the risk of large for gestational age or small for gestational age in infants.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] Simmons D, Immanuel J, Hague WM, et al. Treatment of gestational diabetes mellitus diagnosed early in pregnancy. N Engl J Med 2023; 388: 2132– 2144. 37144983 source
- Premisecitation
Many of the women studied in the TOBOGM study met the Japanese definition of obesity.
“However, it should be noted that many of the women who were studied met the Japanese definition of obesity in the TOBOGM study.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] Simmons D, Immanuel J, Hague WM, et al. Treatment of gestational diabetes mellitus diagnosed early in pregnancy. N Engl J Med 2023; 388: 2132– 2144. 37144983 source
- Interpretationreasoning
The differences in the TOBOGM study are presumed to reflect infant malnutrition caused by the intervention.
“These differences are presumed to reflect infant malnutrition caused by the intervention.”
Quote in the paperNot a substantial claim - Interpretationnone given
The perinatal prognosis of GDM is poor in both the second and first halves of pregnancy.
“The perinatal prognosis of GDM is poor, in both the second and first halves of pregnancy.”
Quote in the paperNot a substantial claim - Premisecitation
In the HAPO study, the odds ratio for infant birth weight >90th percentile, umbilical cord blood C-peptide >90th percentile, and infant body fat mass >90th percentile was 1.75 for 75-g OGTT pre-loading values of 92 mg/dL, 1-h loading values of 180 mg/dL, and 2-h loading values of 153 mg/dL.
“In the HAPO study, the odds ratio for infant birth weight >90th percentile, umbilical cord blood C‐peptide >90th percentile and infant body fat mass >90th percentile was 1.75 for 75‐g OGTT pre‐loading values of 92 mg/dL, 1‐h loading values of 180 mg/dL and 2‐h loading values of 153 mg/dL.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991– 2002. 18463375 source
- May combine two claims. 8
- The quote only partly states this claim. 1
May combine two claims.
PremisecitationGDM increases the child's susceptibility to developing obesity and impaired glucose tolerance in the future.
“The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study 1 and subsequently follow‐up studies 2 , 3 , 4 have reported that gestational diabetes mellitus (GDM) is associated with various adverse pregnancy outcomes, which increases the mother's susceptibility to developing type 2 diabetes, and the child's susceptibility to developing obesity and impaired glucose tolerance in the future 3 , 4 , 5”
Quote in the paperNot a substantial claim3 of 3 sources checked- cites [3] Lowe WLJ, Lowe LP, Kuang A, et al. Maternal glucose levels during pregnancy and childhood adiposity in the hyperglycemia and adverse pregnancy outcome follow‐up study. Diabetologia 2019; 62: 598– 610. 30648193 PMC6421132 source
The Introduction and Discussion report an association between GDM or higher maternal glucose and childhood obesity or adiposity, including in children aged 10–14 years. They do not report impaired glucose tolerance in the children, and the paper describes an association rather than establishing that GDM causes either outcome. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [4] Lowe WLJ, Scholtens DM, Kuang A, et al. Hyperglycemia and adverse pregnancy outcome follow‐up study (HAPO FUS): maternal gestational diabetes mellitus and childhood glucose metabolism. Diabetes Care 2019; 42: 372– 380. 30655380 PMC6385693 source
- cites [5] Chu LCH, Sugiyama T, Ma RCW. Recent updates and future perspectives on gestational diabetes mellitus: an important public health challenge. J Diabetes Investig 2021; 12: 1944– 1947. PMC8565418 34529362 source
The paper’s concluding discussion and Figure 1 caption (indexed as Abstract; page unavailable) describe a potential future risk of obesity and diabetes in offspring of mothers with GDM. They do not specifically report impaired glucose tolerance in the child, and frame the intergenerational effect as potential rather than established. (LLM, conf=0.86)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationGDM diagnosed during the second half of pregnancy using the IADPSG criteria is associated with a significantly higher risk of premature birth (<37 weeks), birthweight >90th percentile, hypertensive disorders of pregnancy, and cesarean section among Japanese women.
“Although Japan did not participate in the HAPO study, a separate Japanese epidemiological study showed that GDM diagnosed during the second half of pregnancy using these diagnostic criteria was associated with a significantly higher risk of premature birth (<37 weeks), birthweight >90th percentile, hypertensive disorders of pregnancy and cesarean section 8 .”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [8] Li HY, Sheu WH. Updates for hyperglycemia in pregnancy: the ongoing journey for maternal–neonatal health. J Diabetes Investig 2022; 13: 1652– 1654. PMC9533052 35794788 source
The paper’s Abstract reports Japanese cohort findings for GDM diagnosed after 24 weeks, including a higher prevalence of large-for-gestational-age births in the late-GDM group than the early-GDM group. It does not report the claimed significantly higher risk of premature birth or specify the IADPSG criteria or birthweight >90th percentile. It reports hypertensive disorders and cesarean section as more prevalent in early GDM than late GDM. (LLM, conf=0.84)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationWomen diagnosed with GDM during the first half of pregnancy have a higher incidence of pre-eclampsia and cesarean section.
“Incidentally, one study on the prognosis of GDM in the first half of pregnancy in Japan reported that women diagnosed with GDM during the first half of pregnancy had a higher incidence of pre‐eclampsia and cesarean section 10 .”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [10] Kyozuka H, Yasuda S, Murata T, et al. Adverse obstetric outcomes in early‐diagnosed gestational diabetes mellitus: the Japan Environment and Children's Study. J Diabetes Investig 2021; 12: 2071– 2079. PMC8565414 33960705 source
The Results (Table 3; page unavailable) report a higher cesarean-delivery rate in the early-diagnosed GDM group. They also report more hypertensive disorders of pregnancy, but the Methods define that broader outcome as new-onset hypertension; the paper does not report pre-eclampsia incidence separately. (LLM, conf=0.88)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationGDM based on IADPSG criteria is associated with improved pregnancy outcomes, although it increases the incidence of GDM.
“A retrospective cohort study showed that GDM based on IADPSG criteria was associated with improved pregnancy outcomes, although it increases the incidence of GDM 14 .”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [14] Wu ET, Nien FJ, Kuo CH, et al. Diagnosis of more gestational diabetes lead to better pregnancy outcomes: comparing the International Association of the Diabetes and Pregnancy Study Group criteria, and the Carpenter and Coustan criteria. J Diabetes Investig 2016; 7: 121– 126. PMC4718104 26816609 source
May combine two claims.
PremisecitationThe policy of using similar diagnostic cutoff values in the first half of pregnancy as in the second half of pregnancy has led to an increase in the incidence of GDM in Japan, as well as other countries.
“This policy has led to an increase in the incidence of GDM in Japan, as well as other countries 8 , 9 .”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [8] Li HY, Sheu WH. Updates for hyperglycemia in pregnancy: the ongoing journey for maternal–neonatal health. J Diabetes Investig 2022; 13: 1652– 1654. PMC9533052 35794788 source
The diagnosis-of-GDM discussion (section labeled Abstract; page unavailable) says the one-step method leads to earlier diagnosis at the expense of increased GDM prevalence. It does not say that using similar cutoffs in the first and second halves of pregnancy caused an increase in Japan or other countries. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [9] Behboudi‐Gandevani S, Amiri M, Bidhendi Yarandi R, et al. The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta‐analysis. Diabetol Metab Syndr 2019; 11: 11. 30733833 PMC6359830 source
The Conclusion (page unavailable) says that lowering diagnostic thresholds is associated with a significant increase in GDM incidence. The paper does not establish that using similar cutoffs in the first and second halves of pregnancy caused an increase in Japan or elsewhere; its Results only note that studies from Japan were included. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Rests on an assumption: Japan uses similar diagnostic cutoff values for GDM in the first half of pregnancy as in the second half of pregnancy.
May combine two claims.
PremisecitationIn the TOBOGM study, no statistically significant differences were observed between the intervention and control groups for hypertensive disorders of pregnancy and neonatal lean body mass.
“Furthermore, no statistically significant differences were observed between hypertensive disorders of pregnancy and neonatal lean body mass.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] Simmons D, Immanuel J, Hague WM, et al. Treatment of gestational diabetes mellitus diagnosed early in pregnancy. N Engl J Med 2023; 388: 2132– 2144. 37144983 source
May combine two claims.
PremisecitationIn the TOBOGM study, the low-threshold group's intervention reduced the risk in large for gestational age infants, but increased the risk in small for gestational age infants.
“In contrast, the low‐threshold group's intervention reduced the risk in large for gestational age infants, but increased the risk in small for gestational age infants.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] Simmons D, Immanuel J, Hague WM, et al. Treatment of gestational diabetes mellitus diagnosed early in pregnancy. N Engl J Med 2023; 388: 2132– 2144. 37144983 source
The quote only partly states this claim.
PremisecitationA secondary analysis of the TOBOGM study showed that adverse perinatal outcomes were increased with GDM diagnosed during the first half of pregnancy, despite treatment from 24 to 28 weeks' gestation, compared with GDM diagnosed during the second half of pregnancy.
“GDM diagnosed during the first half of pregnancy, despite treatment from 24 to 28 weeks' gestation, compared with GDM diagnosed during the second half of pregnancy 16 .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [16] Simmons D, Immanuel J, Hague WM, et al. Perinatal outcomes in early and late gestational diabetes mellitus after treatment from 24 to 28 weeks' gestation: a TOBOGM secondary analysis. Diabetes Care 2024: dc231667. 38421672 source
May combine two claims.
PremisecitationThe HAPO study, which formed the basis of the diagnostic criteria for GDM, was based on the 75-g OGTT from 24 to 32 weeks of pregnancy, and not on blood glucose levels identified during 75-g OGTT in the first half of pregnancy.
“An important point is that the HAPO study, which formed the basis of the diagnostic criteria for GDM, was based on the 75‐g OGTT from 24 to 32 weeks of pregnancy, and not on the blood glucose levels identified during 75‐g OGTT in the first half of pregnancy.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991– 2002. 18463375 source
The paper relies on this without support.
Japan uses similar diagnostic cutoff values for GDM in the first half of pregnancy as in the second half of pregnancy.
“Furthermore, Japan uses similar diagnostic cutoff values as the GDM diagnostic criteria in the first half of pregnancy as in the second half of pregnancy.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
ACHOIS trial is assigned two different reference numbers
MinorThe main text cites the ACHOIS trial as reference 13, which the reference list identifies as the Crowther et al. treatment trial. The figure caption instead cites ACHOIS as reference 15, which is the TOBOGM study.
“One such example is the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial. In that RCT, 75‐g OGTT was carried out between 24 and 34 weeks of pregnancy, with GDM defined as a preloading value of <140 mg/dL and a 2‐h loading value between 140 and 198 mg/dL. In the GDM cases in ACHOIS, the intervention group had a significantly lower risk of neonatal complications than the non‐intervention group 13 .”
“the randomized controlled trial (RCT; Australian Carbohydrate Intolerance Study in Pregnant Women [ACHOIS] 15 ) showed the effectiveness of screening, diagnosis and treatment for GDM.”
TOBOGM trial is assigned two different reference numbers
MinorThe main text cites the TOBOGM study as reference 15, but the figure caption cites it as reference 13. The reference list identifies 15 as the early-pregnancy treatment study and 13 as the Crowther et al. treatment trial.
“The Treatment of Booking GDM (TOBOGM) study was an RCT carried out at 17 hospitals enrolling women during their first half of pregnancy 15 .”
“The RCT (Treatment of Booking GDM [TOBOGM]13 ) showed the intervention's effectiveness for early GDM.”
Cites
Hyperglycemia and adverse pregnancy outcomes
(2008) · New England Journal of Medicine · doi:10.1056/nejmoa0707943 · Cited by 5,563 · see citing works
International Association of Diabetes and Pregnancy Study Groups Consensus Panel (2010) · Diabetes Care · doi:10.2337/dc09-1848 · Cited by 5,390 · see citing works
Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes
Crowther, C. A., Hiller, J. E., Moss, J. R., McPhee, A. J., Jeffries, W. S., & Robinson, J. S. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa042973 · Cited by 3,159 · see citing works
Lowe, W. L., Scholtens, D. M., Lowe, L. P., Kuang, A., Nodzenski, M., Talbot, O., Catalano, P. M., Linder, B., Brickman, W. J., Clayton, P., et al. (2018) · JAMA · doi:10.1001/jama.2018.11628 · Cited by 591 · see citing works
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Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy
Simmons, D., Immanuel, J., Hague, W. M., Teede, H., Nolan, C. J., Peek, M. J., Flack, J. R., McLean, M., Wong, V., Hibbert, E., et al. (2023) · New England Journal of Medicine · doi:10.1056/nejmoa2214956 · Cited by 366 · see citing works
Behboudi-Gandevani, S., Amiri, M., Bidhendi Yarandi, R., & Ramezani Tehrani, F. (2019) · Diabetology & Metabolic Syndrome · doi:10.1186/s13098-019-0406-1 · Cited by 321 · see citing works
on behalf of the HAPO Follow-up Study Cooperative Research Group, Lowe, W. L., Lowe, L. P., Kuang, A., Catalano, P. M., Nodzenski, M., Talbot, O., Tam, W.-H., Sacks, D. A., McCance, D., et al. (2019) · Diabetologia · doi:10.1007/s00125-018-4809-6 · Cited by 294 · see citing works
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Self-citationKyozuka, H., Yasuda, S., Murata, T., Fukuda, T., Yamaguchi, A., Kanno, A., Sato, A., Ogata, Y., Hosoya, M., Yasumura, S., et al. (2021) · Journal of Diabetes Investigation · doi:10.1111/jdi.13569 · Cited by 37 · see citing works
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Self-citationRisk of fetal undergrowth in the management of gestational diabetes mellitus in Japan
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Self-citationUpdates for hyperglycemia in pregnancy: The ongoing journey for maternal–neonatal health
Li, H., & Sheu, W. H. (2022) · Journal of Diabetes Investigation · doi:10.1111/jdi.13881 · Cited by 4 · see citing works
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- Authors
- Sugiyama, T., Kawasaki, M., & Arata, N.
- Affiliations
- Ehime University (JP)
- National Center For Child Health and Development (JP)
- Corresponding author
- Sugiyama, Takashi
- Venue
- Journal of Diabetes Investigation
- Publisher
- Wiley
- Published
- 2024-09-26
- Volume
- 15
- Issue
- 12
- Pages
- 1729-1731
- ISSN
- 2040-1116 (ISSN-L)
- 2040-1124
- PMC
- PMC11615692
- OpenAlex
- W4402935778
- Semantic Scholar
- 706b7e8cfdcfdae44d91a326b2110f467eea4da6
- Cited by
- 0
- References
- 17
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Diabetes Investigation (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- gestational diabetes mellitus, early pregnancy, clinical management, Japanese women
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-20.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-20.
Cited sources are checked by gpt-6-sol.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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