Overweight, obesity and hyperandrogenemia are associated with gestational diabetes mellitus: A follow‐up cohort study

Abstract

Introduction The aim of the study was to determine the association of body mass index (BMI), self‐reported symptoms or diagnosis of polycystic ovary syndrome (PCOS), and hyperandrogenemia with the occurrence of gestational diabetes mellitus (GDM) through reproductive life. Material and methods A cohort of women born in 1966 were investigated at ages 14, 31 and 46. Women with self‐reported PCOS symptoms (presence of both oligo‐amenorrhea and hirsutism) at age 31 or with formally diagnosed polycystic ovaries (PCO)/PCOS by age 46 formed the group of self‐reported PCOS (srPCOS, n = 222) and were compared with women without self‐reported PCOS symptoms or diagnosis (n = 1357). We investigated also the association of hyperandrogenism (hirsutism or biochemical hyperandrogenism) at age 31 with the occurrence of GDM throughout reproductive life. Results Self‐reported PCOS alone was not a risk factor for GDM, but combined with overweight at age 31 (odds ratio [OR] 2.43, 95% confidence interval [CI] 1.22‐4.86) or 46 (OR 3.04, 95% CI 1.58‐5.83) srPCOS was associated with GDM when compared with normal weight controls. The association disappeared when comparing overweight srPCOS women with overweight controls. However, hyperandrogenemia at age 31, but not hirsutism, was associated with GDM even after adjustment for BMI. Conclusions The increased risk of GDM in women with srPCOS was mostly attributed to overweight or obesity. Importantly, normal weight women with srPCOS did not seem to be at increased risk for developing GDM. However, hyperandrogenemia was associated with GDM even after adjustment for BMI. These findings strengthen the importance of weight management in reproductive‐age women and suggest a noteworthy role of hyperandrogenemia in the pathophysiology of GDM.

Maternal Overweight vs. Polycystic Ovary Syndrome: Disentangling Their Impact on Insulin Action in Pregnancy—A Prospective Study

“…Our data support these findings since in the present study, the status of PCOS was not associated with the development of GDM, however, the limitation of few GDM cases needs to be considered for the interpretation of these results. Similarly, one recent cohort-study could mainly link GDM to obesity, overweight, and hyperandrogenemia rather to PCOS, further supporting the findings of our study [ 19 ]. On the other hand, several large register-based studies could link PCOS to the development of GDM during pregnancy [ 2 , 3 , 20 ].…”

Hyperandrogenemia in Early Adulthood Is an Independent Risk Factor for Abnormal Glucose Metabolism in Middle Age

“…The present results indicate that high T levels at age 31 years measured by LC-MS (LC-MS/MS), are associated with AGM in later life; compared with women in the lowest quartile at age 31 years, women in the highest T quartile at age 31 years had almost twice the risk for AGM at age 46 years. In line with this, our group has previously shown, in the same cohort, a positive association between elevated T and FAI levels at age 31 years with gestational diabetes ( 39 ). So far, previous studies have explored the relationship between sex steroid hormone levels and T2DM with conflicting results ( 4 , 9 , 21-27 ).…”

Challenges in diagnosis and understanding of natural history of polycystic ovary syndrome

“…61 Many of the studies are based on hospital registers and this may also explain some discrepancy from population-based data where BMI seems to play more significant role, especially for GDM. 62 Some of the data also points towards hyperandrogenic phenotypes being at higher risk especially for miscarriage and pre-eclampsia whereas ART does not seem to promote the risk. 61 It has been suggested that androgens may promote androgen resistance in PCOS endometrium, thus contributing to higher miscarriage rate and shallow placentation thus suggesting impaired luteal phase among affected women.…”