Relationship between Polycystic Ovarian Syndrome and Subsequent Gestational Diabetes Mellitus: A Nationwide Population-Based Study

Abstract

ObjectiveThis nationwide population-based study aims to explore the relationship between polycystic ovarian syndrome (PCOS) and subsequent gestational diabetes mellitus (GDM).MethodsData from 1998–2012 Taiwan National Health Insurance Research Database were used for this study. ICD9-CM codes 256.4X and 648.X were used separately for the diagnoses of PCOS and GDM, which were further confirmed by records of blood tests or ultrasonography to ensure the accuracy of the diagnoses. Women diagnosed at < 15 or > 45 years of age, and those diagnosed with overt diabetes mellitus or GDM prior to PCOS were excluded. During pregnancy, each woman with a previous diagnosis of PCOS was age-matched to 10 women without PCOS. Odds ratios (ORs) for risk of GDM were calculated by logistic regression analysis with adjustment for economic status and co-morbidities.ResultsAmong 7,629 eligible women with a valid PCOS diagnosis, 3,109 (42.87%) had subsequent pregnancies. GDM occurred frequently among women with a history of PCOS as compared to those without PCOS (20.46% vs. 10.54%, p<0.0001). Logistic regression analysis revealed that PCOS was associated with GDM (adjusted OR = 2.15; 95% CI:1.96–2.37). Among 3,109 affected patients, 1,160 (37.31%) had used medications for PCOS and 261 (8.39%) were treated with an oral hypoglycemic agent (OHA). There was no significant difference in development of GDM between the medication and no medication sub-groups (p>0.05). If not used after conception, OHAs did not reduce the risk of GDM (adjusted OR = 1.20; 95% CI:0.88–1.62).ConclusionsA history of PCOS is a significant and independent risk factor for development of GDM. Medication for PCOS or pre-pregnancy use of OHAs does not reduce the risk of GDM. When at-risk women become pregnant, they require closer surveillance for maternal and fetal well-being, and should follow a strict diet and adhere to weight gain control to avoid obstetric complications due to GDM.

Association between polycystic ovary syndrome and the risk of pregnancy complications

“…Of the 40 included studies (for a total of 17,816 PCOS in pregnancy and 123,756 pregnancies without PCOS), 15 studies had a prospective design, [10,11,16,20–22,25,26,31,32,35,38,42–44] while the remaining 25 [9,12–15,17–19,23,24,27–30,33,34,36,37,39–41,45–48] had a retrospective design. The baseline participant age was 25.9 to 32.8 years, while pre-BMI ranged from 20.8 to 29.7 in each individual study.…”

“…Study quality was assessed using the NOS scale (Table S1) and studies with scores greater than 6 were considered to be of high quality. [50] Overall, 3 studies had a score of 9, [9,16,42] 25 studies had a score of 8, [10,11,13–15,17,18,20,22,23,25,27–29,31–34,38–41,44,45,47] 7 studies had a score of 7, [12,19,21,24,26,37,46] and the remaining 5 studies had a score of 6 [30,35,36,43,48] (Table S1).…”

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

“…The median number of women with PCOS per study was 375 ( Table 1). The origin of the studies was: 12 European [4, 11, 14, 31-33, 35, 37, 39, 41, 44, 46, 49], 8 Asian [12,15,40,42,43,47,51,52], 7 American [13,34,38,45,48] and 3 Australian studies [10,36,50].…”

“…To date there is conflicting evidence whether PCOS per se increases the risk of GDM [8,9] or whether obesity is the key factor. Available studies regarding risk of GDM in PCOS are mainly retrospective [10][11][12][13][14][15]. Register-based data have demonstrated that the prevalence of GDM is significantly higher in Danish women with PCOS compared to controls (4 vs. 0.6 %, p<0.001) [4].…”

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

“…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].…”