Metabolic and polycystic ovary syndromes in indigenous South Asian women with previous gestational diabetes mellitus

Abstract

Objective To determine the risk of metabolic syndrome (MS) and polycystic ovary syndrome (PCOS) in a cohort of indigenous South Asian women with a recent history of gestational diabetes mellitus (GDM).Design Case-control study.Setting Department of Obstetrics & Gynaecology, University of Colombo, Sri Lanka.Sample Two hundred and seventy-four indigenous Sri Lankan women with previous GDM and 168 ethnically matched controls. Of these, 147 with previous GDM and 67 controls not taking hormonal contraception participated in an in-depth endocrine study.Methods Assessing the prevalence of MS and PCOS based on clinical features, biochemistry and ovarian ultrasound examination at 3 years postpartum. Main outcome measures Prevalence of MS and PCOS.Results Women with previous GDM and controls were studied at a mean (range) of 34.6 (13.4-84.1) and 46.5 (17.5-78) months postpartum, respectively. Those with previous GDM had a larger mean ± 95% confidence interval waist circumference (90.9 ± 1.3 versus 81.2 ± 2.8 cm, P = 0.0004) and were more likely to have hypertension (17.6 versus 7.4%, P = 0.001), glucose intolerance (51.7 versus 10.4%, P = 0.00001), hypertriglyceridaemia (16.3 versus 5.9%, P = 0.02) and a lower level of high-density lipoprotein (70 versus 56.7%, P = 0.04) than the controls. Of the women who had GDM, 72 (49%) had MS, 86 (58.5%) had polycystic ovaries and 59 (40%) had PCOS, significantly more than the control women-4 (6%), 9 (13%) and 2 (3%), respectively (P = 0.00001).Conclusions The prevalence of MS and PCOS in indigenous Sri Lankan women 3 years postpartum is significantly higher in those with previous GDM compared with ethnically matched controls. This confirms an association between GDM and subsequent PCOS and MS.

Diabetes in pregnancy among Sri Lankan women: gestational or pre-gestational?

“…It is noteworthy, that despite no significant difference in the individual risk factors, a past history of GDM was significantly higher among those with early diagnosed GDM. This supports our hypothesis of the high probability for a larger proportion of women in the early diagnosed group of GDM to have had previously undetected chronic diabetes / pre-diabetes as many groups including us have shown that nearly 40-60% of those with previous GDM progress into chronic diabetes and the metabolic syndrome, as early as 3 years post partum (7,17,18,19). It is also interesting that those with clear PGDM in this study had a significantly lower BMI.…”

The Prevalence of Clinical Characteristics of Polycystic Ovary Syndrome among Indigenous Women: A Systematic Search and Review of the Literature

“…39 Studies conducted in the United States identified indigenous women as Native American, 27 American Indian, Alaskan Native, 38 or Pima Indian. 31,32,35 Studies in Sri Lanka identified women as Indigenous South Asian women 33,36 and the study in New Zealand identified women as either Maori or Pacific Islander. 34 None of the studies involving indigenous women in Australia or Sri Lanka included a comparison group of nonindigenous women.…”

“…34 Sample selection methods varied widely. Four studies used retrospective clinical audits of patient records, 27,34,36,38 three studies collected clinical data, 32,35,39 and three used data from community studies. 28,29,33 One study recruited via convenience sampling, 37 while another utilized geographically defined purposive sampling.…”

“…Wijeyaratne et al 36 assessed PCOS prevalence among Indigenous Sri Lankan population, in a case-control study exploring associations between gestational diabetes mellitus (GDM) and subsequent PCOS and MetS. Women with previous GDM (n ¼ 147) and ethnically matched control women (n ¼ 67) were recalled 3 years postpartum and assessed for PCOS characteristics and related metabolic features.…”

“…All thirteen studies included an assessment of the clinical characteristics of PCOS. These included indigenous populations from Australia, [28][29][30]37,39 New Zealand, 34 Sri Lanka, 33,36 and the United States. 27,31,32,35,38 Three of the studies from the United States 27,31,38 and the study from New Zealand 34 included comparison groups of nonindigenous women.…”