Polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM) risk
TL;DR: Systematizing risk factors that could contribute to the development of Gestational diabetes mellitus is systematized, as well as reviewing literature reports and analyses on the occurrence of a potential correlation.
Abstract: Gestational diabetes mellitus (GDM) is a common complication of pregnancy In the course of pregnancy elevated levels of hormones and other proteins having insulin-antagonistic effects lead to higher insulin resistance in peripheral tissues, followed by hyperinsulinemia. Risk factors for the development of GDM have been well-established. However, the debate whether polycystic ovary syndrome (PCOS) may predispose to GDM continues. Patients with PCOS are often affected by obesity dyslipidemia, hyperinsulinemia, and tissue-specific insulin resistance. Obesity occurs in 50% of the cases, while tissue-specific insulin resistance is observed in 20-40% of the affected patients. This paper aims at systematizing risk factors that could contribute to the development of GDM, as well as reviewing literature reports and analyses on the occurrence of a potential correlation.
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TL;DR: The state of art about epidemiology, physiopathology, diagnosis, and management of GDM is described, and the current state in low income countries trying to outline basis for further research is focused on.
Abstract: Gestational diabetes mellitus (GDM) is defined as a glucose intolerance that occurs for the first time or it is first identified during pregnancy. The GDM etiology is multifactorial. It has not completely been established yet and several known risk factors may contribute to its onset. To date, there are no shared guidelines on the management and follow-up, especially regarding the low-income countries. In this paper, we describe the state of art about epidemiology, physiopathology, diagnosis, and management of GDM. Moreover, we focus on the current state in low income countries trying to outline basis for further research.
25 citations
Cites background from "Polycystic ovary syndrome (PCOS) an..."
...It is likely that it is a multifactorial etiology (Baz et al. 2015; Issat et al. 2015)....
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TL;DR: PCO women have significant insulin resistance that is independent of obesity, changes in body composition, and impairment of glucose tolerance, and PCO is associated with a unique disorder of insulin action.
Abstract: Hyperinsulinemia secondary to a poorly characterized disorder of insulin action is a feature of the polycystic ovary syndrome (PCO). However, controversy exists as to whether insulin resistance results from PCO or the obesity that is frequently associated with it. Thus, we determined in vivo insulin action on peripheral glucose utilization (M) and hepatic glucose production (HGP) with the euglycemic glucose-clamp technique in obese ( n = 19) and nonobese ( n = 10) PCO women and age- and body-composition-matched normal ovulatory women ( n = 11 obese and n = 8 nonobese women). None had fasting hyperglycemia. Two obese PCO women had diabetes mellitus, established with an oral glucose tolerance test; no other women had impairment of glucose tolerance. However, the obese PCO women had significantly increased fasting and 2-h glucose levels after an oral glucose load and increased basal HGP compared with their body-composition-matched control group. There were statistically significant interactions between obesity and PCO in fasting glucose levels and basal HGP ( P < .05). Steady-state insulin levels of ∼100 μU/ml were achieved during the clamp. Insulin-stimulated glucose utilization was significantly decreased in both PCO groups whether expressed per kilogram total weight ( P < .001) or per kilogram fat free mass ( P < .001) or when divided by the steady-state plasma insulin (I) level (M/I, P < .001). There was residual HGP in 4 of 15 obese PCO, 0 of 11 obese normal, 2 of 10 nonobese PCO, and 0 of 8 nonobese normal women. The metabolic clearance rate of insulin did not differ in the four groups. We conclude that 1 ) PCO women have significant insulin resistance that is independent of obesity, changes in body composition, and impairment of glucose tolerance, 2 ) PCO and obesity have a synergistic deleterious effect on glucose tolerance, 3 ) hyperinsulinemia in PCO is not the result of decreased insulin clearance, and 4 ) PCO is associated with a unique disorder of insulin action.
1,916 citations
University of California, Los Angeles1, University of Palermo2, Lille University of Science and Technology3, National and Kapodistrian University of Athens4, University of Alcalá5, Icahn School of Medicine at Mount Sinai6, University of Duisburg-Essen7, Pennsylvania State University8, University of Adelaide9, Pfizer10, University of Pittsburgh11
TL;DR: It is the view of the AES Task Force on the Phenotype of PCOS that there should be acceptance of the original 1990 National Institutes of Health criteria with some modifications, taking into consideration the concerns expressed in the proceedings of the 2003 Rotterdam conference.
Abstract: Objective: The Androgen Excess Society (AES) charged a task force to review all available data and recommend an evidence-based definition for polycystic ovary syndrome (PCOS), whether already in use or not, to guide clinical diagnosis and future research. Participants: Participants included expert investigators in the field. Evidence: Based on a systematic review of the published peer-reviewed medical literature, by querying MEDLINE databases, we tried to identify studies evaluating the epidemiology or phenotypic aspects of PCOS. Consensus Process: The task force drafted the initial report, following a consensus process via electronic communication, which was then reviewed and critiqued by the AES Board of Directors. No section was finalized until all members were satisfied with the contents and minority opinions noted. Statements that were not supported by peer-reviewed evidence were not included. Conclusions: Based on the available data, it is the view of the AES Task Force on the Phenotype of PCOS that...
1,877 citations
TL;DR: The Insulin-Related Ovarian Regulatory System: Implications for Therapy and Therapeutic use are summarized.
Abstract: I. Introduction II. Insulin and Insulin Receptor A. Structures of insulin and insulin receptor B. Presence of insulin and insulin receptor in the ovary C. Insulin action and the ovary D. Summary III. IGFs and Their Receptors A. IGF peptides and receptors B. Expression of IGFs and IGF receptors in the ovary C. Role of IGFs in ovulatory function and steroidogenesis D. Summary IV. IGF-Binding Proteins (IGFBPs) and Proteases A. Structural relationships among IGFBPs B. IGFBP expression in the ovary C. IGFBP proteases in the ovary D. IGFBP actions in the ovary E. Role of IGFBPs in follicular development and atresia F. Summary V. Polycystic Ovary Syndrome (PCOS) A. Clinical features B. Theories of pathogenesis C. Insulin resistance in PCOS D. Alterations of IGFs and IGFBPs in PCOS E. Summary VI. The Insulin-Related Ovarian Regulatory System: Implications for Therapy A. Treatment of PCOS B. Therapeutic use of IGF-I and IGF-II C. Use of GH in ovulation induction VII. Summary and Conclusions
814 citations
TL;DR: In conclusion, women with PCOS are at increased risk of pregnancy and neonatal complications and pre-pregnancy, antenatal and intrapartum care should be aimed at reducing these risks.
Abstract: Polycystic ovary syndrome (PCOS) is a common reproductive disorder associated with many characteristic features, including hyperandrogenaemia, insulin resistance and obesity which may have significant implications for pregnancy outcomes and long-term health of the woman. This meta-analysis was conducted to evaluate the risk of pregnancy and neonatal complications in women with PCOS. Electronic databases were searched for the following MeSH headings: PCOS, hyperandrogenism, pregnancy outcome, pregnancy complications, diabetes mellitus, type II. A handsearch of human reproduction and fertility and sterility was also conducted. Studies in which pregnancy outcomes in women with PCOS were compared with controls were considered for inclusion in this meta-analysis. Fifteen of 525 identified studies were included, involving 720 women presenting with PCOS and 4505 controls. Women with PCOS demonstrated a significantly higher risk of developing gestational diabetes [odds ratio (OR) 2.94; 95% confidence interval (CI): 1.70-5.08], pregnancy-induced hypertension (OR 3.67; 95% CI: 1.98-6.81), pre-eclampsia (OR 3.47; 95% CI: 1.95-6.17) and preterm birth (OR 1.75; 95% CI: 1.16-2.62). Their babies had a significantly higher risk of admission to a neonatal intensive care unit (OR 2.31; 95% CI: 1.25-4.26) and a higher perinatal mortality (OR 3.07; 95% CI: 1.03-9.21), unrelated to multiple births. In conclusion, women with PCOS are at increased risk of pregnancy and neonatal complications. Pre-pregnancy, antenatal and intrapartum care should be aimed at reducing these risks.
696 citations
TL;DR: The sequence of the highly polymorphic region near the human insulin gene, which begins 363 base pairs before the start of transcription and extends upstream, indicated that it is generated by variation in the number and arrangement of members of a family of tandemly repeating nucleotides whose structure is related to ACAGGGGTGTGTGGGG.
Abstract: The sequence of the highly polymorphic region near the human insulin gene, which begins 363 base pairs before the start of transcription and extends upstream, indicated that it is generated by variation in the number and arrangement of members of a family of tandemly repeating nucleotides whose structure is related to ACAGGGGTGTGGGG. Another 15-base pair sequence, repeated twice near the human gene, is located ∼325 base pairs on either side of the polymorphic region. One member is in the transcriptional control region.
492 citations