Polycystic ovary syndrome and risk factors for gestational diabetes

Sanna Mustaniemi,Mika Gissler,Hilkka Ijäs,Aini Bloigu,Marja Vääräsmäki,Johan G Eriksson,Hannele Laivuori,Laure Morin-Papunen,Eero Kajantie

doi:10.1530/ec-18-0076

Abstract

ObjectiveTo study the roles of self-reported symptoms and/or prior diagnosis of polycystic ovary syndrome (PCOS) and other potential risk factors for gestational diabetes mellitus (GDM) and to clarify whether the screening of GDM in early pregnancy is beneficial for all women with PCOS.DesignThe FinnGeDi multicentre case-control study including 1146 women with singleton pregnancies diagnosed with GDM and 1066 non-diabetic pregnant women. There were 174 women with PCOS (symptoms and/or diagnosis self-reported by a questionnaire) and 1767 women without PCOS (data missing for 271).MethodsThe study population (N = 1941) was divided into four subgroups: GDM + PCOS (N = 105), GDM + non-PCOS (N = 909), non-GDM + PCOS (N = 69), and controls (N = 858). The participants’ characteristics and their parents’ medical histories were compared.ResultsThe prevalence of PCOS was 10.4% among GDM women and 7.4% among non-diabetics (odds ratios (OR) 1.44, 95% CI: 1.05–1.97), but PCOS was not an independent risk for GDM after adjustments for participants’ age and pre-pregnancy BMI (OR 1.07, 95% CI: 0.74–1.54). In a multivariate logistic regression analysis, the most significant parameters associated with GDM were overweight, obesity, age ≥35 years, participant’s mother’s history of GDM, either parent’s history of type 2 diabetes (T2D) and participant’s own preterm birth.ConclusionsThe increased risk of GDM in women with PCOS was related to obesity and increased maternal age rather than to PCOS itself, suggesting that routine early screening of GDM in PCOS women without other risk factors should be reconsidered. Instead, family history of GDM/T2D and own preterm birth were independent risk factors for GDM.

Highlights

Gestational diabetes mellitus (GDM) and polycystic ovary syndrome (PCOS) are the most common endocrine disorders in women of reproductive age
In a multivariate logistic regression analysis, the most significant parameters associated with GDM were overweight, obesity, age ≥35 years, participant’s mother’s history of GDM, either parent’s history of type 2 diabetes (T2D) and participant’s own preterm birth
The increased risk of GDM in women with PCOS was related to obesity and increased maternal age rather than to PCOS itself, suggesting that routine early screening of GDM in PCOS women without other risk factors should be reconsidered

Summary

Introduction

Gestational diabetes mellitus (GDM) and polycystic ovary syndrome (PCOS) are the most common endocrine disorders in women of reproductive age. The prevalence of GDM varies from 9% to 25% and the prevalence of PCOS varies from 5% to 15%, depending on the study populations and the diagnostic criteria applied [1, 2, 3, 4, 5] Both disorders are associated with insulin resistance and overweight/obesity [6, 7]. Two studies including participants matched for BMI and age did not report increased risk for GDM in women with PCOS [21, 22]. Despite these inconsistent data, in Finland, PCOS is considered an independent indication for an early oral glucose tolerance test (OGTT) during pregnancy, regardless of BMI, according to the 2008 National Current Care Guidelines [23].

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