Current status of screening and management of gestational diabetes in early pregnancy: a questionnaire survey in Japan

Our aim is to investigate the obstetric practices in Japan regarding the screening and management of gestational diabetes mellitus (GDM) diagnosed before 20 weeks of gestation (early-GDM). A web-based questionnaire survey was administered to 991 teaching hospitals between November 2021 and February 2022, and 602 responses were received (a response rate of 61%). Screening tests for all pregnant women in the first trimester were conducted in 553 (92%) hospitals, and nearly all of these hospitals (535/553 [97%]) adhered to an individual protocol, predominantly relying on random plasma glucose measurements (488/535 [91%]). A quarter (139 [26%]) implemented a risk profile assessment for GDM screening, taking into account factors such as previous gestational diabetes, prior macrosomia, and family history of diabetes. A small number (23 [4%]) targeted only women at high risk of GDM using the risk profile assessment. The majority of hospitals (501 [94%]) employed a 75 g oral glucose tolerance test as a diagnostic measure, and glycemic control for early-GDM was established in most hospitals (429 [80%]). Of the 535 hospitals that maintained an individual management protocol, 356 [67%] facilitated dietary management, self-monitoring of blood glucose, and insulin administration if needed to meet glycemic targets. Our survey revealed a widespread adoption of universal screening and subsequent treatment for early-GDM in Japan.