Abstract
BackgroundObesity is common in young women, increasing insulin resistance (IR) and worsening pregnancy complications, including gestational diabetes (GDM). Women with polycystic ovary syndrome (PCOS) are commonly obese, which aggravates the severity of PCOS clinical expression. Relationships between these common insulin-resistant conditions, however, remain unclear.MethodsWe conducted a secondary analysis of the Australian Longitudinal Study on Womenās Health (ALSWH) database, including data from 8009 women aged 18ā36 years across six surveys. We used latent-curve growth modelling to identify distinct body mass index (BMI) trajectories and multinomial logistic regression to explore sociodemographic and health variables characterizing BMI group membership. Logistic regression was used to assess independent risk of GDM.ResultsA total of 662 women (8.29%, 95% CI 7.68ā8.89) reported PCOS. Three distinct BMI trajectories emerged, namely low stable (LSG) (63.8%), defined as an average trajectory remaining at ~25 kg/m2; moderately rising (MRG) (28.8%), a curvilinear trajectory commencing in a healthy BMI and terminating in the overweight range; and high-rising (HRG) (7.4%), a curvilinear trajectory starting and terminating in the obese range. A high BMI in early reproductive life predicted membership in higher trajectories. The HRG BMI trajectory was independently associated with GDM (OR 2.50, 95% CI 1.80ā3.48) and was a stronger correlate than PCOS (OR 1.89, 95% CI 1.41ā2.54), maternal age, socioeconomic status, or parity.ConclusionOur results suggest heterogeneity in BMI change among Australian women of reproductive age, with and without PCOS. Reducing early adult life weight represents an ideal opportunity to intervene at an early stage of reproductive life and decreases the risk of long-term metabolic complications such as GDM.
Highlights
Obesity is common in young women, increasing insulin resistance (IR) and worsening pregnancy complications, including gestational diabetes (GDM)
We show significantly distinct trajectories of weight gain predicted by early adult life body mass index (BMI)
We demonstrate that BMI trajectory is a stronger correlate of GDM than polycystic ovary syndrome (PCOS) or other traditional confounders such as age, socioeconomic status, and parity
Summary
Obesity is common in young women, increasing insulin resistance (IR) and worsening pregnancy complications, including gestational diabetes (GDM). Women with polycystic ovary syndrome (PCOS) are commonly obese, which aggravates the severity of PCOS clinical expression. Relationships between these common insulin-resistant conditions, remain unclear. There is an alarming rise in weight gain and obesity [1], fueled by adverse lifestyle risk factors [2] This increasing trend is especially concerning among women of reproductive age in developed countries like Australia, where up to 44% of women entering pregnancy are overweight or obese [3]. Obesity increases insulin resistance (IR), worsens pregnancy complications such as gestational diabetes (GDM) [4], and exacerbates other common insulin-resistant conditions including polycystic ovary syndrome (PCOS) [5]. While existing studies recognize GDM as a complication of PCOS, with an approximately three-fold risk, most have not adjusted for important confounders, including obesity or body mass index (BMI) [13, 14]
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