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Preconception IGT linked to adverse pregnancy outcomes in PCOS
Women with polycystic ovary syndrome and preconception impaired glucose tolerance have increased risks for adverse pregnancy outcomes, including gestational diabetes, pregnancy loss and large for gestational age, compared with those with PCOS and isolated impaired fasting glucose or normoglycemia, study data show.
Zi-Jiang Chen, MD, PhD, of the Center for Reproductive Medicine at Shandong Provincial Hospital in Jinan, China, and colleagues evaluated data from the FREFRO-PCOS study on 1,508 women with PCOS to determine the effect of preconception IGT on pregnancy outcomes.
At baseline, 20.2% of participants were diagnosed with IGT, 17.6% with isolated IFG and 62.2% with normoglycemia.
Conception rates were highest among participants with isolated IFG (72.9%), followed by those with normoglycemia (65.4%) and those with IGT (60.6%). Participants with isolated IFG had a higher conception rate compared with participants with IGT (OR = 0.57; 95% CI, 0.4-0.85) and participants with normoglycemia (OR = 1.43; 95% CI, 1.05-1.95); the rates remained higher even after adjustment for age, BMI, duration of infertility, total testosterone level and treatment groups. Participants with normoglycemia had higher rates of twin pregnancies among clinical pregnancies compared with participants with IGT (OR = 0.59; 95% CI, 0.4-0.85), even after adjustment (OR = 0.65; 95% CI, 0.44-0.95).
Participants with IGT had a higher rate of pregnancy loss (OR = 1.85; 95% CI, 1.12-3.13) and a lower rate of live birth (OR = 0.54; 95% CI, 0.33-0.9) compared with participants with normoglycemia; however, the differences were no longer significant after adjustment for age, BMI, duration of infertility, total testosterone level and treatment groups. Compared with participants with normoglycemia, participants with IGT had higher risk for gestational diabetes (OR = 3.13; 95% CI, 1.23-7.69) and large for gestational age (OR = 2.13; 95% CI, 1.19-3.85) even after adjustment for age, BMI, duration of infertility, total testosterone level and treatment groups. Preeclampsia developed in 1.4% of participants with normoglycemia, 4.2% with isolated IFG and 0% with IGT.
The rates of pregnancy loss (OR = 2.17; 95% CI, 1.11-4.17) and large for gestational age (OR = 2.94; 95% CI, 1.33-6.25) were higher and the rate of live birth was lower (OR = 0.5; 95% CI, 0.26-0.97) in participants with IGT compared with participants with isolated IFG.
The risk for gestational diabetes was higher among participants with isolated IFG compared with participants with normoglycemia (OR = 3.08; 95% CI, 1.19-8.01) even after adjustment (OR = 3.1; 95% CI, 1.19-8.05).
The risk for gestational diabetes in twin pregnancies was higher among participants with IGT compared with participants with normoglycemia (OR = 7.69; 95% CI, 2.78-20) and participants with isolated IGF (OR = 4; 95% CI, 1.19-14.29).
“We found preconception IGT and isolated IFG had a similar risk of gestational diabetes in singleton pregnancies, which was higher than that in women with normoglycemia even after adjusting for age, BMI and other confounders,” the researchers wrote. “In twin pregnancies, the risk of gestational diabetes was dramatically increased in women with preconception IGT compared with women with isolated IFG or normoglycemia. The underlying mechanism is unclear.” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.