Polycystic ovary syndrome and gestational diabetes mellitus

PCOS is a heterogeneous disorder affecting 5-10% of women of reproductive age. It is characterized by chronic anovulation with oligo-/amenorrhea, infertility, typical sonographic appearance of the ovaries, and clinical or biochemical hyper-androgenism. Insulin resistance is present in 40-50% of patients, especially in obese women.23

Holte et al.24 reported a higher rate of ultrasonographic, clinical, and endocrine signs of PCOS in 34 women who had had GDM 3-5 years before, compared to 36 matched controls with uncomplicated pregnancies. Five of the women (15%) with previous GDM had developed manifest diabetes. The authors concluded that women with previous GDM and PCOS may form a distinct subgroup from women with normal ovaries and previous GDM, who may be more prone to develop features of insulin-resistance syndrome.

Many other researchers reported similar results. Kousta et al.25 found a higher prevalence of PCOS in 91 women with previous GDM compared to 73 normoglycemic control women (52 vs. 27%, P = 0.002), and Anttila et al.26 reported a 44% prevalence of PCOS in women with GDM, with no differences in BMI before pregnancy or in weight gain during pregnancy compared to controls. They suggested a screening program for GDM for these patients.

Mikola et al.27 retrospectively evaluated 99 pregnancies in women with PCOS compared with an unselected control population. The average BMI and the nulliparity rate were higher in the PCOS group, as was the multiple pregnancy rate (9.1 vs. 1.1%). GDM developed in 20% of the patients with PCOS but only in 8.9% of the controls (P < 0.001). A BMI > 25 was the best predictor of GDM (adjusted OR = 5.1, 95% CI 3.2-8.3), and PCOS was an additional independent predictor (adjusted OR = 1.9, 95% CI 1.0-3.5).

Koivunen et al.28 found that compared with 48 control women, 33 women with previous GDM more often had significantly abnormal oral glucose tolerance tests (OGTT), higher prevalences of polycystic ovaries (39.4 vs. 16.7%, P = 0.03), higher serum concentrations of cortisol, dehydroepiandrosterone and dehydroepiandrosterone sulfate, and a greater area under the glucose curve.

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