Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

Open Access 01-12-2020 | Metformin | Research article

Impact of comorbid polycystic ovarian syndrome and gestational diabetes mellitus on pregnancy outcomes: a retrospective cohort study

Authors: Varun Manoharan, Vincent W. Wong

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

Abstract

Background

Gestational diabetes mellitus (GDM) and polycystic ovarian syndrome (PCOS) have been associated with adverse maternal and neonatal outcomes, but the evidence on the impact of coexistent PCOS and GDM is rather limited and inconclusive. We investigated the impact of comorbid PCOS on pregnancy outcomes among women with GDM.

Methods

This retrospective cohort study included women diagnosed with GDM on 75 g oral glucose tolerance test on routine antenatal screening tests at Liverpool Hospital between February 2015 and January 2019. Women were then grouped into those with and without PCOS based on the Rotterdam criteria. The demographic details, clinical data and pregnancy outcomes were compared between the two groups.

Results

Among the 1545 women with GDM included in the study, there were 326 women with PCOS. Women with GDM and PCOS (GDM+PCOS+) were younger (29.5 years vs 31.5 years, p < 0.001), more likely to be primigravidae (31.9% vs 20%, p < 0.001), as well as of Caucasian descent (37.4% vs 21.7%, p < 0.001). PCOS was an independent risk factor for the development of preeclampsia on regression analysis (OR 2.06, p = 0.021). Women with PCOS and GDM had a higher body mass index (31.5 kg/m2 vs 27.7 kg/m2, p < 0.001), significant gestational weight gain (12.6 kg vs 11.5 kg, p = 0.016), and more frequent use of pharmacotherapies to manage their GDM (57.7% vs 45.2%, p < 0.001). There was no statistically significant difference in the rates of adverse neonatal outcomes in both the groups.

Conclusion

Among women with GDM, PCOS was an independent risk factor for the development of preeclampsia and significant gestational weight gain, warranting vigilant monitoring of blood pressure, blood glucose levels and body weight, and implementing timely interventions to improve obstetric and neonatal outcomes.
Appendix
Available only for authorised users
Literature
1.
March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25:544–51.PubMedCrossRef
2.
Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8:41.PubMedPubMedCentralCrossRef
3.
Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81:19–25.
4.
Gambineri A, Patton L, Altieri P, Pagotto U, Pizzi C, Manzoli L, et al. Polycystic ovary syndrome is a risk factor for type 2 diabetes: results from a long-term prospective study. Diabetes. 2012;61(9):2369–74.PubMedPubMedCentralCrossRef
5.
Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999;22:141–6.PubMedCrossRef
6.
Legro RS, Gnatuk CL, Kunselman AR, Dunaif A. Changes in glucose tolerance over time in women with polycystic ovary syndrome: a controlled study. J Clin Endocrinol Metab. 2005;90:3236–42.PubMedCrossRef
7.
Mikola M, Hiilesmaa V, Halttunen M, Suhonen L, Tiitinen A. Obstetric outcome in women with polycystic ovarian syndrome. Hum Reprod. 2001;16(2):226–9.PubMedCrossRef
8.
Rees DA, Jenkins-Jones S, Morgan CL. Contemporary reproductive outcomes for patients with polycystic ovary syndrome: a retrospective observational study. J Clin Endocrinol Metab. 2016;101:1664–72.PubMedPubMedCentralCrossRef
9.
Mustaniemi S, Vääräsmäki M, Eriksson JG, Gissler M, Laivuori H, Ijäs H, et al. Polycystic ovary syndrome and risk factors for gestational diabetes. Endocrine Connect. 2018;7(7):859–69.CrossRef
10.
Turhan NO, Seckin NC, Aybar F, Inegol I. Assessment of glucose tolerance and pregnancy outcome of polycystic ovary patients. Int J Gynaecol Obstet. 2003;81:163–8.PubMedCrossRef
11.
Haakova L, Cibula D, Rezabek K, Hill M, Fanta M, Zivny J. Pregnancy outcome in women with PCOS and in controls matched by age and weight. Hum Reprod. 2003;18:1438–41.PubMedCrossRef
12.
Barbour LA, McCurdy CE, Herandez TL, Kirwan JP, Catalano PM, Friedman JE. Cellular mechanisms for insulin resistance in Normal pregnancy and gestational diabetes. Diab Care. 2007;30(2):S112–9.CrossRef
13.
Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocrine Rev. 1997;18(6):774–800.
14.
Harlev A, Witnitzer A. New insights into glucose pathophysiology in gestational diabetes and insulin resistance. Curr Diab Rep. 2010;10(3):242–7.PubMedCrossRef
15.
HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcome (HAPO) study: associations with neonatal anthropometrics. Diabetes. 2009;58:453–9.CrossRef
16.
von Katterfeld B, Li J, McNamara B, Langridge AT. Maternal and neonatal outcomes associated with gestational diabetes in women from culturally and linguistically diverse backgrounds in Western Australia. Diabet Med. 2012;29:372–7.CrossRef
17.
Doherty DA, Newnham JP, Bower C. Implications of polycystic ovary syndrome for pregnancy and for the health of offspring. Obstet Gynecol. 2015;125(6):1397–406.PubMedCrossRef
18.
Kollmann M, Klaritsch P, Martins WP. Maternal and neonatal outcomes in pregnant women with PCOS: comparison of different diagnostic definitions. Hum Reprod. 2015;30(10):2396–403.PubMedCrossRef
19.
Foroozanfard F, Moosaavi SGA, Mansouri F, Bazarganipour F. Obstetric and neonatal outcome in PCOS with gestational diabetes mellitus. J Fam Reprod Health. 2014;8(1):7–12.
20.
Alshammari A, Hanley A, Ni A, Tomlinson G, Feig DS. Does the presence of polycystic ovary syndrome increase the risk of obstetrical complications in women with gestational diabetes? J Metrnal-Fetal Neon Med. 2010;23(6):545–9.
21.
Palomba S, de Wilde MA, Falbo A, Koster MPH, Sala GBL, Fauser BCJM. Pregnancy complications in women with polycystic ovary syndrome. Hum Reprod Update. 2015;21(5):575–92.PubMedCrossRef
22.
Mahomed K, Williams MA, Woelk GB. Risk factors for pre-Eclampsia among Zimbabwean women - maternal arm circumference and other anthropometric measures of obesity. Paediatr Perinat Epidemiol. 1998;12:253–62.PubMedCrossRef
23.
Nankervis A, McIntyre HD, Moses R, Ross GP, Callway L, Porter C, et al. ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia. NSW: Australasian Diabetes in Pregnancy Society; 2014.
24.
Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world- a growing challenge. N Engl J Med. 2007;356:213–5.PubMedCrossRef
25.
Hauger MS, Gibbons L, Vik T, Belizan JM. Prepregnancy weight status and the risk of adverse pregnancy outcome. Acta Obstet Gynecol Scand. 2008;87:953–9.PubMedCrossRef
26.
27.
Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update. 2006;12(6):673–83.PubMedCrossRef
28.
Mañé L, Flores-Le Roux JA, Benaiges D, Rodríguez M, Marcelo I, Chillarón JJ, et al. Role of first-trimester HbA1c as a predictor of adverse obstetric outcomes in a multiethnic cohort. J Clin Endocrinol Metab. 2018;102(2):390–7.
29.
Joffe GM, Esterlitz JR, Levine RJ, Clemens JD, Ewell MG, Sibai BM, et al. The relationship between abnormal glucose tolerance and hypertensive disorders of pregnancy in healthy nulliparous women. Calcium for preeclampsia prevention (CPEP) study group. Am J Obstet Gynaecol. 1998;179(4):1032–7.CrossRef
30.
Joham AE, Palomba S, Hart R. Polycystic ovary syndrome, obesity, and pregnancy. Semin Reprod Med. 2016;34(2):93–101.PubMedCrossRef
31.
32.
Randon PA, MacMahon MJ, Meyer WR. Impaired glucose tolerance in pregnant women with polycystic ovary syndrome. Obstet Gynecol. 1999;94:194–7.
33.
Yu H, Chen H, Rao D, Gong J. Association between polycystic ovary syndrome and the risk of pregnancy complications: a PRISMA-compliant systematic review and meta-analysis. Medicine. 2016;95(51):e4863.PubMedPubMedCentralCrossRef
34.
Balani J, Hyer SL, Rodin DA, Shehata H. Pregnancy outcomes in women with gestational diabetes treated with metformin or insulin: a case-control study. Diabet Med. 2009;26:798–802.PubMedCrossRef
35.
Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. MiG trial investigators. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358:2003–15.PubMedCrossRef
Metadata
Title
Impact of comorbid polycystic ovarian syndrome and gestational diabetes mellitus on pregnancy outcomes: a retrospective cohort study
Authors
Varun Manoharan
Vincent W. Wong
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-03175-5

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue

Research article

“I have to provide for another life emotionally, physically and financially”: understanding pregnancy, motherhood and the future aspirations of adolescent mothers in KwaZulu-Natal South, Africa

Research article

Postnatal depression and its association with adverse infant health outcomes in low- and middle-income countries: a systematic review and meta-analysis

Research article

Enhancing patient mobility following cesarean-delivery – the efficacy of an improved postpartum protocol assessed with pedometers

Research article

Prevalence and risk factors for caesarean delivery following labor induction at a tertiary hospital in North Tanzania: a retrospective cohort study (2000–2015)

Research article

Factors associated with macrosomia, hypoglycaemia and low Apgar score among Fijian women with gestational diabetes mellitus

Research article

Increasing utilisation of perinatal services: estimating the impact of community health worker program in Neno, Malawi