Predictors of Gestational Diabetes Mellitus in Chinese Women with Polycystic Ovary Syndrome: A Cross-Sectional Study

Abstract

Aims: This study aims to explore the independent predictors of gestational diabetes mellitus (GDM) in Chinese women with polycystic ovary syndrome (PCOS). Methods: This cross-sectional study analyzed primigravid women with PCOS and classified them as those with and without GDM. Independent risk factors and model performance were analyzed using multivariate logistic regression and the area under the curve (AUC) of receiver operating characteristic (ROC), respectively. Results: Maternal body mass index, waist circumference, waist-to-hip ratio (WHR), fasting glucose, insulin, sex hormone-binding globulin (SHBG), homeostasis model assessment-insulin resistance (HOMA-IR) before pregnancy, gestation weight gain before 24 weeks and the incidence of family history of diabetes were different in the 2 groups. Logistic regression analysis showed that pre-pregnancy WHR, SHBG, HOMA-IR and gestation weight gain before 24 weeks were the independent predictors of GDM. ROC curve analysis confirmed that gestation weight gain before 24 weeks (AUC 0.767, 95% CI 0.688-0.841), pre-pregnant WHR (AUC 0.725, 95% CI 0.649-0.802), HOMA-IR (AUC 0.711, 95% CI 0.632-0.790) and SHBG levels (AUC 0.709, 95% CI 0.625-0.793) were the strong risk factors. Conclusions: In Chinese women with PCOS, factors of gestation weight gain before 24 weeks, pre-pregnant WHR, HOMA-IR and SHBG levels are strongly associated with subsequent development of GDM.

A prospective cohort study of early‐pregnancy risk factors for gestational diabetes in polycystic ovarian syndrome

“…Specifically, higher FPG and IR (indicated by HOMA‐IR) and positive family history of diabetes all conferred higher risk for GDM. These findings are in agreement with observations from previous studies in PCOS women, highlighting the importance of IR in the pathogenesis of GDM . Importantly, previous studies demonstrated that FPG during early pregnancy is the strongest risk factor for GDM in the general population .…”

“…An additional possible explanation for the difference in GWG is related to the difference in early‐pregnancy BMI between PCOS‐GDM and PCOS‐non‐GDM women. In our study, PCOS‐GDM women were noted to have higher BMI than PCOS‐non‐GDM women, as observed in other studies . It has been demonstrated that obese women tend to gain less weight during pregnancy than those with normal BMI, which may explain the lower weight gain in the PCOS‐GDM women who had higher BMI early in pregnancy.…”

“…The sample size of our study was calculated based on the number of potential risk factors to be identified, incidence of GDM in our institution, and number of events per variable . Previous studies have reported 1 to 5 predictive risk factors for GDM in PCOS subjects . In our sample size calculation, we used an estimate of 6 risk factors, events per variable of 10, and a 30% incidence rate of GDM in PCOS women in our institution (based on our previous data).…”

“…In women without PCOS, risk factors for GDM include higher fasting plasma glucose (FPG) and body mass index (BMI), hypertriglyceridemia, abnormal lipid profile, and lower adiponectin . However, in PCOS women, early gestational characteristics linked to higher GDM risk have not been consistently identified . One study found that gestational weight gain before 24 weeks, pre‐pregnant waist‐to‐hip ratio, IR, and sex‐hormone binding globulin (SHBG) are significantly associated with higher risk of GDM .…”

“…[10][11][12][13][14] However, in PCOS women, early gestational characteristics linked to higher GDM risk have not been consistently identified. [15][16][17][18][19] One study found that gestational weight gain before 24 weeks, pre-pregnant waist-to-hip ratio, IR, and sex-hormone binding globulin (SHBG) are significantly associated with higher risk of GDM. 18 Another study identified first-degree relatives with type 2 diabetes mellitus, fasting glucose and insulin, androstenedione, and SHBG as predictors of GDM.…”