The risk factors of gestational diabetes mellitus in patients with polycystic ovary syndrome

Abstract

The influencing factors of gestational diabetes mellitus (GDM) in the polycystic ovary syndrome (PCOS) patients remain unclear, we aimed to investigate the risk factors of GDM in patients with PCOS, to provide reliable evidence for the prevention and treatment of GDM in PCOS patients.PCOS patients treated in our hospital from January 1, 2019 to October 31, 2020 were included. The personal and clinical treatment details of GDM and no GDM patients were analyzed. Logistic regressions were performed to analyze the factors influencing the occurrence of GDM.A total of 196 PCOS patients were included, the incidence of GDM in patients with PCOS was 23.98%. There were significant differences in the age, body mass index, insulin resistance index, fasting insulin, testosterone, androstenedione, and sex hormonebinding protein between GDM and no GDM patients with PCOS (all P < .05), and no significant differences in the family history of GDM, the history of adverse pregnancy, and multiple pregnancies were found (all P > .05). Age ≥30 years (odds ratio (OR) 2.418, 95% confidence interval (CI) 1.181-3.784), body mass index ≥24 kg/m 2 (OR 1.973, 95%CI 1.266-3.121), insulin resistance index ≥22.69 (OR 2.491,, fasting insulin ≥22.71 mIU/L (OR 2.508, 95%CI 1.166-5.057), testosterone ≥2.85 nmol/L (OR 1.821, 95%CI 1.104-2.762), androstenedione ≥6.63 nmol/L (OR 1.954, 95%CI 1.262-2.844), sex hormone-binding protein <64.22 nmol/L (OR 1.497, 95%CI 1.028-2.016) were the independent risk factors of GDM in patients with PCOS (all P < .05). The incidence of preeclampsia, premature delivery, premature rupture of membranes, polyhydramnios, and postpartum hemorrhage in the GDM group was significantly higher than that of the no-GDM group (all P < .05). There was no significant difference in the incidence of oligohydramnios between the 2 groups (P = .057).

Gestational Diabetes Mellitus and Preeclampsia: Correlation and Influencing Factors

“…The results still show that GDM did not increase the incidence of PE in pregnant women with PCOS, regardless of whether GDM occurred early or later ( 153 ). Another prospective study in China found that the incidence of PE in PCOS pregnant women with GDM is significantly higher than that in pregnant women without GDM but did not analyze whether it was independent associated with PE ( 154 ). Thus, the effect of GDM on PE in pregnant women with PCOS is less than the effect of PCOS on PE in women with GDM.…”

“…A Chinese prospective study found no difference in the incidence of PE between women with GDM with PCOS and those without PCOS, although the result was affected by factors such as small sample size and early intervention (151). Pregnant women with PCOS combined with GDM tend to be older and have higher pre pregnancy BMI (152)(153)(154). It is necessary to determine whether GDM associated with PE in pregnant women with PCOS.…”

Mechanisms of Insulin Resistance during Pregnancy

“…Many risk factors for the development of GDM are similar to those for T2DM. These risk factors include overweight and obesity, excessive gestational weight gain, advanced maternal age, multiparity, family history of T2DM or GDM, polycystic ovary syndrome (PCOS), physical inactivity, GDM in the previous pregnancy, certain ethnicities (including Asian ethnicity), a previous macrosomic child, Westernized diet, genetic polymorphisms, and intrauterine environment (low or high birth weight) [48,[59][60][61][62][63][64][65].…”

Gestational diabetes and other adverse pregnancy outcomes in polycystic ovary syndrome

“…Li et al [31 ▪▪ ] conducted a retrospective study of pregnant individuals with PCOS in China ( N = 196) using Rotterdam criteria for PCOS and IADPSG criteria for GDM to evaluate possible GDM risk factors. Using logistic regression models, the authors found several independent risk factors for GDM among pregnant individuals with PCOS: age at least 30 years, BMI at least 24 kg/m 2 , increased insulin resistance [measured by homeostatic model assessment for insulin resistance (HOMA-IR)], elevated testosterone, elevated androstenedione, and low SHBG [31 ▪▪ ]. Increased insulin resistance (HOMA-IR) in individuals with PCOS was proposed as the mechanism predisposing these individuals to GDM during pregnancy [31 ▪▪ ].…”