Gestational diabetes mellitus among Norwegian women with polycystic ovary syndrome: prevalence and risk factors according to the WHO and the modified IADPSG criteria

Abstract

Objective: The consequences of the recently proposed International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria for gestational diabetes mellitus (GDM) in women with polycystic ovary syndrome (PCOS) are not known. We compared the prevalence rates and risk factors for GDM in PCOS women according to both the WHO and the modified IADPSG criteria. Design: Post hoc analyses from a randomized, multicenter study were used. Methods: Fasting and 2-h plasma glucose levels were measured using a 75 g oral glucose tolerance test. GDM was diagnosed according to both the WHO and the modified IADPSG criteria.Results: The prevalence rates of GDM according to the WHO and the modified IADPSG criteria were 9.2 and 15.0% at week 12, 18.7 and 18.7% at week 19, and 25.6 and 24.2% at week 32. Shorter stature and increased insulin levels were correlated with WHO-GDM, but not with modified IADPSG-GDM at weeks 12 and 19. Less weight gain in pregnancy predicted GDM according to both sets of criteria. GDM diagnosis was correlated with less maternal weight loss the first year post-partum. Conclusions: No difference was found in the prevalence of GDM between the two sets of criteria used. Less weight gain in pregnancy was associated with GDM, independent of the diagnostic criteria used. Reduced weight loss the first year post-partum in women with GDM raises the question of whether GDM diagnosis per se or the fact that these women lose less weight after pregnancy predicts later diabetes mellitus.

Polycystic ovary syndrome and hyperglycaemia in pregnancy. A narrative review and results from a prospective Danish cohort study

“…343 review articles were excluded and additionally 463 articles were excluded because of irrelevance. Thirty studies fullfilled inclusion criteria; 10 prospective [31][32][33][34][35][36][37][38][39][40] and 20 retrospective studies [4, 10-15, 23, 41-52]. Included studies reported data on 11,263 women with PCOS and 1,389,161 controls.…”

“…Twelve different sets of diagnostic criteria for GDM were used in the 30 studies ( Table S2). The most frequently used criteria were those of the American College of Obstetricians and Gynecologists (ACOG) [53] (n=7) [23,32,33,39,42,45,49], followed by American Diabetes Association (ADA2000) [54] (n=6) [13,34,[41][42][43]52], WHO1999 [55] (n=5) [33,35,37,38,51], WHO13/International Association of the Diabetes and Pregnancy Study Group (IADPSG) [26,56] (n=3) [15,40,47], Danish criteria (GDM-DK) [18] (n=2) [4,46] and the Modified IADPSG (n=2) [35,37]. The following criteria were only applied in one study each: National Diabetes Data Group (NDDG) [57] (n=1) [12] and Australasian Diabetes in Pregnancy Society (ADIPS) [58] (n=1) [50].…”

“…Five out of 30 studies [23,32,35,37,39] included no control group and additional seven out of 30 studies [31,38,41,47,49,51,52] included less than 50 women with PCOS. Four studies [4,12,14,45] were register-based and BMI was not reported.…”

“…Fasting and 2 h glucose thresholds values varied from 4.8 to 7.0 mmol/l and 8.0 to 12.2 mmol/l, respectively. In a post-hoc analysis on 273 pregnant women with PCOS, Helseth et al [35] applied both WHO13/IADPSG and WHO1999 GDM criteria on their study cohort of women with PCOS and reported a GDM prevalence of 24.2 and 25.6 %, respectively. Even though GDM rates were similar, less than onethird of women with GDM by one of the two sets of criteria fulfilled both criteria.…”

Pregnancy in PCOS Women and their History of Diabetes

“…The varying association of PCOS with GDM depends on the population studied due to genetic factors where the metabolic syndrome in parents and their siblings seems to be fundamental to the pathogenesis of PCOS [14,15]. Franks et al conclude that PCOS is inherited on an oligogenic basis and the co-morbidity and phenotype are due to the interaction of a small number of key genes with environmental and nutritional factors [16].…”