Pregnancy complications and glucose intolerance in women with polycystic ovary syndrome

Abstract

POLYCYSTIC OVARY SYNDROME (PCOS) is a common endocrine and metabolic disorder present in 5-15% of women of reproductive age depending on the diagnostic criteria used [1,2]. The common features of PCOS are hyperandrogenism, irregular menstruation and polycystic ovaries by ultrasonography [3,4]. In addition, insulin resistance, hyperandrogenism and obesity might play important roles in the pathophysiologic process of PCOS, and the interaction of these factors might result in an increased risk of not only type 2 diabetes mellitus, metabolic syndrome and cardiovascular disease [5][6][7] Abstract. Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by insulin resistance and hyperandrogenism. The interaction of these factors might result in increased risks of miscarriage and pregnancy complications such as gestational diabetes mellitus (GDM). To examine the pregnancy risks in women with PCOS, we compared obstetrical outcomes between patients with and without PCOS. We also studied the differences in maternal characteristics, glucose intolerance and pregnancy complications between PCOS patients with and without GDM, with and without obesity, and between successful pregnancies and miscarriages. We observed a high incidence of GDM and prevalence of GDM diagnosis in the first trimester in PCOS. Patients with GDM had higher body mass index (BMI) and lower homeostasis model assessment of β-cell function (HOMA-β) at preconception than those without GDM. Obese pregnant women with PCOS demonstrated a high incidence of GDM with severe insulin resistance, including high fasting insulin, HOMA of insulin resistance (HOMA-IR), and HOMA-β at preconception compared with normal-weight patients. BMI was significantly correlated with HOMA-IR or HOMA-β, and both indices were lower in PCOS patients with than without GDM for the same BMI. There were no significant differences in maternal characteristics (excluding maternal age) between PCOS patients with successful pregnancy and PCOS patients with miscarriages. Our data suggest that pregnant women with PCOS have an increased risk of GDM, especially if they have obesity and/or poorer insulin secretion. Measure of β-cell function, such as HOMA-β, at preconception might be a useful predictor of the risk of GDM in pregnant PCOS patients.Key words: Polycystic ovary syndrome, Insulin resistance, Pregnancy complication, Gestational diabetes mellitus gestational diabetes mellitus (GDM) [8].Because insulin resistance and obesity might affect the course of pregnancy in women with PCOS, we compared the obstetrical outcomes between the patients with PCOS and without PCOS. We also examined the differences in maternal characteristics and perinatal outcomes between PCOS patients with and without GDM and with and without obesity. Furthermore, we examined the differences in maternal characteristics between successful pregnancies and miscarriages to determine the risks of pregnancy loss in women with PCOS. Materials and MethodsA total of 64 Japanese pregnant women with PCOS (includ...

Valuable predictors of gestational diabetes mellitus in infertile Chinese women with polycystic ovary syndrome: a prospective cohort study

“…Similar to Ashrafi et al [7] and Sawada et al's [6] studies, we also failed to find the statistically significant difference of preconception BMI in PCOS. According to the criteria for Asians by WHO, overweight was defined when BMI !…”

“…Maternal and fetal effects of uncontrolled GDM include preeclampsia, stillbirths, macrosomia and birth trauma [4]. The reported prevalence of GDM in women with PCOS in previous studies ranged from 20.46% to 44.4% [5][6][7]. A recent prospective study showed an incidence of GDM about three times higher in PCOS patients than in controls (14.7 versus 5.3%, respectively) [8].…”

Pregnancy-related outcomes for women with polycystic ovary syndrome

“…16,26 Insulin resistance is also thought to have a direct effect on vascular function and is, therefore, implicated in the increased pregnancy complications seen in women with PCOS. 7 In one study, no differences were found in the preconception period between women with PCOS diagnosed with GDM compared to women without GDM in respect to maternal age, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI) or testosterone; 26 however, patients with GDM had higher BMI and lower homeostasis model assessment of β-cell function (HOMA-β). Obese pregnant women with PCOS demonstrated a high incidence of GDM with severe insulin resistance, including high fasting insulin, HOMA-IR and HOMA-β at preconception compared with normal-weight patients.…”

“…Obese pregnant women with PCOS demonstrated a high incidence of GDM with severe insulin resistance, including high fasting insulin, HOMA-IR and HOMA-β at preconception compared with normal-weight patients. 26 As such, measuring β-cell function, such as HOMA-β, at preconception may predict the risk of GDM in pregnant PCOS patients, and a reduction of BMI in the preconception period may reduce the chance of developing GDM. In Sterling et al, 16 the risk of being diagnosed with GDM in pregnant women with PCOS was 15.5% compared to 5% in the control group.…”

High insulin impaired ovarian function in early pregnant mice and the role of autophagy in this process

“…PCOS and T2DM are characterized by hyperinsulinemia [2]. PCOS is an endocrine and metabolic disorder with a prevalence ranging from 5 to 13% in women of reproductive age.…”