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

Feichtinger, Michael; Linder, Tina; Rosicky, Ingo; Eppel, Daniel; Schatten, Christian; Eppel, Wolfgang; Husslein, Peter; Tura, Andrea; Göbl, Christian

doi:10.3390/jcm10010035

Cited by 3 publications

(4 citation statements)

References 24 publications

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“…However, based on our analyses, this potential bias may determine inaccuracies in PREDIM calculation not exceeding 10-15%, which appears acceptable from a clinical point of view (details not shown). It is also worth noting that PREDIM provided reliable findings in some previous studies in pregnancy [56,102,107].…”

Section: Discussionsupporting

confidence: 58%

“…In summary, we are not aware of any dataset with larger number of participants and all necessary features for the goals of the current study. On the other hand, the size of the current dataset is similar (slightly larger) to that analyzed in some of our previous studies related to pregnancy, where the glucose/insulin/C-peptide OGTT was available [ 56 , 100 – 102 ]. Of note, in one of those studies we already applied a technique classified within the machine learning domain (i.e., principal component analysis) [ 101 ].…”

Section: Discussionmentioning

confidence: 96%

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TyGIS: improved triglyceride-glucose index for the assessment of insulin sensitivity during pregnancy

Salvatori

Linder

Eppel

et al. 2022

Cardiovasc Diabetol

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Background The triglyceride-glucose index (TyG) has been proposed as a surrogate marker of insulin resistance, which is a typical trait of pregnancy. However, very few studies analyzed TyG performance as marker of insulin resistance in pregnancy, and they were limited to insulin resistance assessment at fasting rather than in dynamic conditions, i.e., during an oral glucose tolerance test (OGTT), which allows more reliable assessment of the actual insulin sensitivity impairment. Thus, first aim of the study was exploring in pregnancy the relationships between TyG and OGTT-derived insulin sensitivity. In addition, we developed a new version of TyG, for improved performance as marker of insulin resistance in pregnancy. Methods At early pregnancy, a cohort of 109 women underwent assessment of maternal biometry and blood tests at fasting, for measurements of several variables (visit 1). Subsequently (26 weeks of gestation) all visit 1 analyses were repeated (visit 2), and a subgroup of women (84 selected) received a 2 h-75 g OGTT (30, 60, 90, and 120 min sampling) with measurement of blood glucose, insulin and C-peptide for reliable assessment of insulin sensitivity (PREDIM index) and insulin secretion/beta-cell function. The dataset was randomly split into 70% training set and 30% test set, and by machine learning approach we identified the optimal model, with TyG included, showing the best relationship with PREDIM. For inclusion in the model, we considered only fasting variables, in agreement with TyG definition. Results The relationship of TyG with PREDIM was weak. Conversely, the improved TyG, called TyGIS, (linear function of TyG, body weight, lean body mass percentage and fasting insulin) resulted much strongly related to PREDIM, in both training and test sets (R2 > 0.64, p < 0.0001). Bland–Altman analysis and equivalence test confirmed the good performance of TyGIS in terms of association with PREDIM. Different further analyses confirmed TyGIS superiority over TyG. Conclusions We developed an improved version of TyG, as new surrogate marker of insulin sensitivity in pregnancy (TyGIS). Similarly to TyG, TyGIS relies only on fasting variables, but its performances are remarkably improved than those of TyG.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 96%

TyGIS: improved triglyceride-glucose index for the assessment of insulin sensitivity during pregnancy

Salvatori

Linder

Eppel

et al. 2022

Cardiovasc Diabetol

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“…Irregular menstrual patterns are a significant and independent risk factor for the development of GDM [10][11][12]. The most common risk factor identified across the majority of studies is a high BMI of over 25 kg/m2 [12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Section: Risk Factors That Increase the Incidence And Prevalence Of G...mentioning

confidence: 99%

“…The current estimated prevalence of GDM in pregnant women with PCOS between studies was 26%, significantly higher than healthy controls [10,16,19,[21][22][23]26,27,35,38,40,41,44,47,[50][51][52][53][54][55]. However, several studies observed that there was no significant difference in the incidence or prevalence of GDM between pregnant women with and without PCOS [13,15,31,52,56]. When comparing whether or not women were amenorrheic or oligomenorrheic before pregnancy, there were conflicting results where one study found that the amenorrheic group was significantly more likely to develop GDM by 7.69%, while the other study found that oligomenorrhea was significantly associated with GDM concerning women with PCOS [12,14].…”

Section: Incidence Of Gestational Diabetes Mellitus In Polycystic Ova...mentioning

confidence: 99%

Gestational Diabetes Mellitus in the Setting of Polycystic Ovarian Syndrome: A Systematic Review

Slouha,

Alvarez,

Gates

et al. 2023

Cureus

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Gestational diabetes mellitus (GDM) is the most common complication of pregnancy that arises in the 2nd and 3rd trimesters, leading to significant complications for the mother and her neonates, such as an increased rate of pregnancy-induced hypertension and miscarriages, while neonates may have a large birth weight, hypoglycemia, or macrosomnia. Numerous risk factors can lead to GDM; however, a significant one is polycystic ovarian syndrome (PCOS). PCOS is the most common endocrine pathology beginning before puberty, and due to significant hormonal changes, it is not diagnosed until after puberty. PCOS requires at least three of the following symptoms: hyperandrogenism, menstrual irregularities, or polycystic ovary morphology. While it is agreed that women with PCOS are at a significantly increased risk of GDM, no publication to our knowledge has evaluated the full relationship of GDM in the setting of PCOS. This paper aimed to assess this relationship and determine how it may differ for pregnant women with only GDM by determining the prevalence of GDM, the variations within phenotypes, the influence of fertilization methods, specific risk factors, maternal outcomes, and neonatal outcomes. The prevalence of GDM was significantly increased in women with PCOS compared to healthy controls, and some studies have found that phenotype A may be more likely to lead to GDM. Risk factors were similar to pregnant women with only GDM, but with GDM and PCOS specifically, preconception low sex hormone-binding globulin, increased BMI > 25 kg/m2, and preconception impaired glucose tolerance were specific. While maternal outcomes were similar to pregnant women with only GDM, women with GDM and PCOS were even more likely to develop pregnancy-induced hypertension and early miscarriage. Neonates from mothers with GDM and PCOS were more likely to have low birth weights compared to mothers with just GDM who had high birth weights. The evaluation of the relationship between GDM and PCOS allows for illumination of the need to evaluate influences that currently lack research, such as phenotype variation and influences of fertilization method. This also promotes the need to develop predictive algorithms based on risk factors to prevent these adverse outcomes for mothers and neonates.

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The incidence of gestational diabetes mellitus among women with polycystic ovary syndrome: a meta-analysis of longitudinal studies

Yan

Qiu

Liu

et al. 2022

BMC Pregnancy Childbirth

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Background Previous studies have shown that polycystic ovary syndrome is a predictor of gestational diabetes mellitus, but we do not know exactly how many polycystic ovary syndrome patients may develop gestational diabetes mellitus. Currently, the incidence of gestational diabetes mellitus among women with polycystic ovary syndrome varies greatly across studies, ranged from 4.12% to 59.50%. Besides, many factors have been found to be related to the incidence of gestational diabetes mellitus among women with polycystic ovary syndrome, but the results among different studies are not consistent. The possible causes of inconsistencies between the current estimates were unclear. This review aimed at exploring the pooled incidence of gestational diabetes mellitus among women with polycystic ovary syndrome, summarizing possible causes of the inconsistencies in the current estimates, try to provide a reference for prevention of gestational diabetes mellitus and polycystic ovary syndrome in the future. Methods Systematic searches of different databases (including EMBASE, Web of Science, MEDLINE, The Cochrane Library, CNKI and PubMed) were conducted for studies published until 31 May 2021. Statistical analyses were performed using R software, the pooled incidence of gestational diabetes mellitus among polycystic ovary syndrome patients was combined using random effects model. Cochrane’s “Tool to Assess Risk of Bias in Cohort Studies” was used for quality assessment. Results Twenty-two longitudinal studies were included. A total of 24,574 women with polycystic ovary syndrome were identified in the 22 articles, of which 4478 were reported with gestational diabetes mellitus. The pooled incidence of gestational diabetes mellitus among women with polycystic ovary syndrome was 20.64%, with a 95% CI of 14.64% to 28.30%. In the meta-regression model, several variables including age, area, quality score and sample size were suggested as significant sources of heterogeneity, accounted for 77.57% of the heterogeneity across studies. Conclusions Evidence in this review suggests that gestational diabetes mellitus were common among women with polycystic ovary syndrome. More research is needed to found effective interventions for preventing gestational diabetes mellitus among women with polycystic ovary syndrome.

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

Cited by 3 publications

References 24 publications

TyGIS: improved triglyceride-glucose index for the assessment of insulin sensitivity during pregnancy

TyGIS: improved triglyceride-glucose index for the assessment of insulin sensitivity during pregnancy

Gestational Diabetes Mellitus in the Setting of Polycystic Ovarian Syndrome: A Systematic Review

The incidence of gestational diabetes mellitus among women with polycystic ovary syndrome: a meta-analysis of longitudinal studies

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