Risk Factors for Gestatıonal Diabetes in Women with Polycystic Ovarian Syndrome

We aimed to compare the pre-gestational metabolic states of the women who were previously diagnosed with policystic ovarian syndrome and had gestational diabetes mellitus in the subsequent pregnancy and who did not have gestational diabetes mellitus in subsequent pregnancy and to determine the independent variables that predict the gestational diabetes mellitus risk for policystic ovarian syndrome patients in the subsequent pregnancy. Between the dates 2007 and 2012, the patients who were diagnosed with policystic ovarian syndrome in our outpatient gynecology clinic were searched retrospectively. Then these patients were called for pregnancy states. All of these patients have pregnancy spontaneously. The patients’ pre-gestational mean age, body mass index, metabolic and hormonal profiles and pregnancy outcomes were compared between policystic ovarian syndrome cases who developed gestational diabetes mellitus or not. We found some differences in pregestational metabolic states between the policystic ovarian syndrome patients who developed gestational diabetes mellitus in pregnancy or not. The mean age, body mass index, very low density lipoprotein, triglyceride, fasting insulin, fasting c-peptide levels, 1st and 2nd hour glucose levels in 75 gr oral glucose tolerance test, homeostatsis model assessment –insulin resistance measures and neonates’ birth weights were higher in gestational diabetes mellitus group than non-gestational diabetes mellitus group. But high density lipoprotein was lower in gestational diabetes mellitus group than non- gestational diabetes mellitus group. There were no differences between the mean levels Creactive protein, hormonal profile, mean fasting glucose, low density lipoprotein cholesterol, total cholesterol levels and mode of delivery. Glucose intolerance was significantly higher in the gestational diabetes mellitus group (%74,07 vs %6,66). With the multipl logistic regression analysis we found the body mass index as the strongest independent predictor of gestational diabetes mellitus in policystic ovarian syndrome patients (OR: 2,831, %95 CI: 1,234-6,495). The second independent predictor was the high 2nd hour glucose level in oral glucose tolerance test (OR: 1,119, %95 CI: 1,026-1,221). The pre-gestational metabolic variables including the age, body mass index, lipid profile, and glucose metabolism are significantly different in the gestational diabetes mellitus group than the non-gestational diabetes mellitus group. The obesity and glucose intolerance are the independent predictors of gestational diabetes mellitus in policystic ovarian syndrome cases

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1. American Diabetes Association. Clinical Practice Recommendations 2001. Diabetes Care. 2001;24(Suppl. 1):S1-133.

2. Hadden DR. Screening for abnormalities of carbohydrate metabolism in pregnancy. Diabetes Care. 1980;3(3):440-6.

3. Hadden DR. Geographic, ethnic and racial variation in the incidence of gestational diabetes mellitus. Diabetes. 1985,34(Suppl 2):8-12.

4. Jovanovic L, Pettitt D. Gestational diabetes mellitus. JAMA, 2001;286(20):2516-8.

5. Damm P, Kuhl C, Bertelsen A, Molsted-Pedersen L. Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus. Am J Obstet Gynecol. 1992;167(3):607-16.

6. Cunningham GF, leveno KJ, Bloom SL, Hauth JC, Gilstrap LC, Wenstrom KD. Williams Obstetrics, 22nd edition. MC Graw-Hill, New York, 2005;1170-5.

7. Dabelea D. The predisposition to obesity and diabetes in offspring of diabetic mothers. Diabetes Care. 2007;30(Suppl. 2):S169-74.

8. Damm P. Future risk of diabetes in mother and child after gestational diabetes mellitus. Int J Gynaecol Obstet. 2009;104(Suppl. 1):S25-6.

9. Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25(10):1862-8.

10. Ryan EA, O’Sullivan MJ, Skyler JS. Insulin action during pregnancy: Studies with the euglycemic clamp technique. Diabetes. 1985;34(4):380-9.

11. Buchanan TA, Metzger BE, Freinkel N, Bergman RN. Insulin sensitivity and B-cell responsiveness to glucose during late pregnancy in lean and moderately obese women with normal glucose tolerance or mild gestational diabetes. Am J Obstet Gynecol. 1990;162(4):1008-14.

12. Catalano PM, Tyzbir ED, Roman NM, Amini SB, Sims EAH. Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women. Am J Obstet Gynecol. 1991;165(6 Pt 1):1667-72.

13. Ryan EA, Imes S, Liu D, McManus R, Finegood DT, Polonsky KS, Sturis J. Defects in insulin secretion and action in women with a history of gestational diabetes. Diabetes. 1995;44(5):506-12.

14. Metzger BE. Summary and recommendations of the third international workshop-conference on gestational diabetes. Diabetes. 1991;40(Suppl 2):197-201.

15. Holte J, Gennarelli G, Wide L, Lithell H, Berne C. High prevalence of polycystic ovaries and associated clinical, endocrine, and metabolic features in women with previous gestational diabetes mellitus. J Clin Endocrinol Metab. 1998;83(4):1143-50.

16. Speroff L, Fritz MA. Clinical Gynecologic Endocrinology and Infertility, 7th edition. Lippincott Williams & Wilkins, Philadelphia, 2005;465-89.

17. Plehwe WE, Maitland JE, Williams PF, Shearman RP, Turtle JR. Familial hyperinsulinemia complicated by extreme insulin resistance during pregnancy: a probable postreceptor defect. J Clin Endocrinol Metab. 1985;61(1):68-77.

18. Lanzone A, Caruso A, Di Simone N, De Carolis S, Fulghesu AM, Mancuso S. Polycystic ovary disease. A risk factor for gestational diabetes? J Reprod Med. 1995,40(4):312-6.

19. Wortsman J, de Angeles S, Futterweit W, Singh KB, Kaufmann RC. Gestational diabetes and neonatal macrosomia in the polycystic ovary syndrome. J Reprod Med. 1991;36(9):659-61.

20. Revised 2003 consensus on diagnostic criteria and long-term health risksrelated to polycystic ovary syndrome Rotterdam ESHRE/ASRM-SponsoredPCOS Consensus Workshop Group Fertil Steril. 2004;81(1):19-25.

21. American Diabetes Association. Standards of medical care in diabetes-2007. Diabetes Care. 2007;30 Suppl 1:S4-S41.

22. Fallucca F, Dalfrà MG, Sciullo E, Masin M, Buongiorno AM, Napoli A, Fedele D, Lapolla A. Polymorphisms of insulin receptor substrate 1 and beta3-adrenergic receptor genes in gestational diabetes and normal pregnancy. Metabolism. 2006;55(11):1451-6.

23. Mikola M, Hiilesmaa U, Halttunen M, Suhonen L, Tiitinen A. Obstetric Outcome in women with polycystic ovarian syndrome. Hum Reprod. 2001;16(2):226-9.

24. Lo J C, Feigenbaum SL, Escobar GJ, Yang J, Crites YM, Ferrara A. Increased Prevalence Of Gestational Diabetes Mellitus Among Women With Diagnosed Polycystic Ovary Syndrome. Diabetes Care. 2006;29(8):1915-7.

25. Kashanian M, Fazy Z, Pirak A. Evaluation of the relationship between gestational diabetes and a history of polycystic ovarian syndrome. Diabetes Res Clin Pract. 2008;80(2):289-92.

26. Bjercke S, Dale PO, Tanbo T, Storeng R, Ertzeid G, Abyholm T. Impact of insulin resistance on pregnancy complications and outcome in women with polycystic ovary syndrome. Gynecol Obstet Invest. 2002;54(2):94-8.

27. Anttila L, Karjala K, Penttila RA, Ruutiainen K, Ekblad U, Polycystic ovaries in women with gestational diabetes. Obstet Gynecol. 1998;92(1):13-6.

28. Glueck CJ, Wang P, Kobayashi S, Phillips H, Sieve-Smith L. Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome. Fertil Steril. 2002;77(3):520-5.

29. de Wilde MA, Goverde AJ, Veltman-Verhulst SM, Eijkemans MJ, Franx A, Fauser BC, Koster MP. Insulin action in women with polycystic ovary syndrome and its relation to gestational diabetes. Hum Reprod. 2015;30(6):1447-53.

30. Ashrafi M, Sheikhan F, Arabipoor A, Hosseini R, Nourbakhsh F, Zolfaghari Z. Gestational diabetes mellitus risk factors in women with polycystic ovary syndrome (PCOS). Eur J Obstet Gynecol Reprod Biol. 2014,181:195-9.

31. Vollenhoven B, Claric S, Kovacs G, Burger H, Healy D. Prevalence of gestational diabetes mellitus in polycystic ovarian syndrome (PCOS) patients pregnant after ovulation induction with gonadotrophins, Aust N Z J Obstet Gynaecol. 2000;40(1):54-8.

32. Weerakiet S, Srisombut C, Rojanasakul A, Panburana P, Thakkinstian A, Herabutya Y. Prevalence of gestational diabetes mellitus and pregnancy outcomes in Asian women with polycystic ovary syndrome. Gynecol Endocrinol. 2004 Sep;19(3):134-40.