Effect of Preconception Impaired Glucose Tolerance on Pregnancy Outcomes in Women With Polycystic Ovary Syndrome

Wei, Daimin; Zhang, Bo; Shi, Yuhua; Zhang, Lin; Zhao, Shigang; Du, Yanzhi; Xu, Leiting; Legro, Richard S.; Zhang, Heping; Chen, Zi‐Jiang

doi:10.1210/jc.2017-01294

Cited by 20 publications

(16 citation statements)

References 34 publications

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“…In PCOS patients developing GDM vs. PCOS patients with normal glucose tolerance during pregnancy, significantly increased insulin and HOMA-IR levels could already be observed preconceptionally and during early pregnancy [21]. Likewise, adverse pregnancy outcomes and gestational diabetes in PCOS patients could be linked to preconceptional impaired insulin sensitivity or impaired glucose tolerance [7,8].…”

Section: Discussionmentioning

confidence: 99%

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Maternal Overweight vs. Polycystic Ovary Syndrome: Disentangling Their Impact on Insulin Action in Pregnancy—A Prospective Study

Feichtinger

Linder

Rosicky

et al. 2020

JCM

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Background: To investigate insulin sensitivity and glucose metabolism in pregnant lean and overweight polycystic ovary syndrome (PCOS) patients vs. lean and overweight controls without PCOS. Methods: Prospective cohort study on 67 pregnant women (31 with PCOS and 36 controls, subdivided into overweight or obese and normal weight). All women underwent a 2h-OGTT including glucose, insulin, and C-peptide in early- and mid-gestation and were followed-up until delivery. Results: Insulin sensitivity and glucometabolic parameters were comparable between PCOS patients and controls, whereas marked differences were observed between overweight/obese and lean mothers. Impaired whole-body insulin sensitivity at early pregnancy is mainly a consequence of higher BMI (body mass index; p < 0.001) compared to PCOS (p = 0.216), whereby no interaction between overweight/obesity and PCOS was observed (p = 0.194). Moreover, overweight was significantly associated with gestational diabetes (p = 0.0003), whereas there were no differences between women with and without PCOS (p = 0.51). Birth weight was inversely related to whole-body insulin sensitivity (rho = −0.33, p = 0.014) and positively associated with higher pregestational BMI (rho = 0.33, p = 0.012), whereas there was no association with PCOS. Conclusions: Impaired insulin action was mainly a consequence of overweight rather than PCOS. Our data suggest that overweight is more relevant than PCOS for the effects on insulin sensitivity and impaired glucose metabolism.

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Section: Discussionmentioning

confidence: 99%

“…In particular, maternal overweight and obesity status have been shown to markedly affect glucose metabolism at early gestation, leading to gestational diabetes and adverse pregnancy outcomes [6]. However, pregestational impaired glucose tolerance in PCOS patients has been linked to pregnancy complications independent of their BMI [7,8].…”

Section: Introductionmentioning

confidence: 99%

Maternal Overweight vs. Polycystic Ovary Syndrome: Disentangling Their Impact on Insulin Action in Pregnancy—A Prospective Study

Feichtinger

Linder

Rosicky

et al. 2020

JCM

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“…The intrauterine environment in women with PCOS is influenced by maternal obesity, hyperinsulinemia, androgen excess and elevated fat mass in the offspring at birth (42) and later in life (43). Therefore, women with T2D or IGT should be identified as early as possible for example during preconception care and during fertility treatment (44). Individual screening for metabolic risk and initiation of lifestyle intervention and metformin treatment should be considered in all women with PCOS, who are seeking advice for fertility treatment.…”

Section: Ogtt During Preconception and Pregnancymentioning

confidence: 99%

Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

Andersen

Glintborg

2018

European Journal of Endocrinology

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Polycystic ovary syndrome (PCOS) is common in premenopausal women. The majority of women with PCOS have insulin resistance and the risk of type 2 diabetes mellitus (T2D) is higher in women with PCOS compared to controls. In non-pregnant women with PCOS, glycemic status may be assessed by oral glucose tolerance test (OGTT), fasting plasma glucose (FPG) or HbA1c. OGTT has been reckoned gold standard test for diagnosing T2D, but OGTT is rarely used for diagnostic purpose in other non-pregnant individuals at risk of T2D, apart from PCOS. OGTT has questionable reproducibility, and high sensitivity of the 2-h glucose value is at the expense of relatively low specificity, especially regarding impaired glucose tolerance (IGT). Furthermore, lean women with PCOS are rarely diagnosed with T2D and only few percent of normal-weight women have prediabetes. Glycemic status is necessary at diagnosis and during follow-up of PCOS, especially in women with high risk of T2D (obesity, previous gestational diabetes (GDM)). We suggest that OGTT should be used in the same situations in PCOS as in other patient groups at risk of T2D. OGTT is indicated for diagnosing GDM; however, OGTT during pregnancy may not be indicated in lean women with PCOS without other risk factors for GDM.

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“…Several further authors were able to demonstrate that preconceptional IR is a significant risk factor for developing GDM in non-PCOS (16) as well as in PCOS patients (35, 36). In uncomplicated pregnancies, IR increases physiologically and is necessary for proper materno-fetal glucose transfer.…”

Section: Discussionmentioning

confidence: 99%

Afamin predicts gestational diabetes in polycystic ovary syndrome patients preconceptionally

Köninger

Iannaccone

Hajder

et al. 2019

Endocrine Connections

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Background Patients suffering from polycystic ovary syndrome (PCOS) are often insulin resistant and at elevated risk for developing gestational diabetes mellitus (GDM). The aim of this study was to explore afamin, which can be determined preconceptionally to indicate patients who will subsequently develop GDM. Serum concentrations of afamin are altered in conditions of oxidative stress like insulin resistance (IR) and correlate with the gold standard of IR determination, the HOMA index. Methods Afamin serum concentrations and the HOMA index were analyzed post hoc in 63 PCOS patients with live births. Patients were treated at Essen University Hospital, Germany, between 2009 and 2018. Mann–Whitney U test, T test, Spearman’s correlation, linear regression models and receiver-operating characteristic (ROC) analyses were performed for statistical analysis. Results Patients who developed GDM showed significantly higher HOMA and serum afamin values before their pregnancy (P < 0.001, respectively). ROCs for afamin concentrations showed an area under the curve of 0.78 (95% confidence interval (CI) 0.65–0.90) and of 0.77 (95% CI 0.64–0.89) for the HOMA index. An afamin threshold of 88.6 mg/L distinguished between women who will develop GDM and those who will not with a sensitivity of 79.3% and a specificity of 79.4%. A HOMA index of 2.5 showed a sensitivity of 65.5% and a specificity of 88.2%. Conclusion The HOMA index and its surrogate parameter afamin are able to identify pre-pregnant PCOS patients who are at risk to develop GDM. Serum afamin concentrations are independent of fasting status and therefore an easily determinable biomarker.

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Effect of Preconception Impaired Glucose Tolerance on Pregnancy Outcomes in Women With Polycystic Ovary Syndrome

Abstract: Preconception IGT, independent from BMI, was associated with adverse pregnancy outcome compared with i-IFG and normoglycemia.

Cited by 20 publications

References 34 publications

Maternal Overweight vs. Polycystic Ovary Syndrome: Disentangling Their Impact on Insulin Action in Pregnancy—A Prospective Study

Maternal Overweight vs. Polycystic Ovary Syndrome: Disentangling Their Impact on Insulin Action in Pregnancy—A Prospective Study

Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT?

Afamin predicts gestational diabetes in polycystic ovary syndrome patients preconceptionally

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