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Predictors of Gestational Diabetes Mellitus in Chinese Women with Polycystic Ovary Syndrome: A Cross-Sectional Study

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Abstract

Aims: This study aims to explore the independent predictors of gestational diabetes mellitus (GDM) in Chinese women with polycystic ovary syndrome (PCOS). Methods: This cross-sectional study analyzed primigravid women with PCOS and classified them as those with and without GDM. Independent risk factors and model performance were analyzed using multivariate logistic regression and the area under the curve (AUC) of receiver operating characteristic (ROC), respectively. Results: Maternal body mass index, waist circumference, waist-to-hip ratio (WHR), fasting glucose, insulin, sex hormone-binding globulin (SHBG), homeostasis model assessment-insulin resistance (HOMA-IR) before pregnancy, gestation weight gain before 24 weeks and the incidence of family history of diabetes were different in the 2 groups. Logistic regression analysis showed that pre-pregnancy WHR, SHBG, HOMA-IR and gestation weight gain before 24 weeks were the independent predictors of GDM. ROC curve analysis confirmed that gestation weight gain before 24 weeks (AUC 0.767, 95% CI 0.688-0.841), pre-pregnant WHR (AUC 0.725, 95% CI 0.649-0.802), HOMA-IR (AUC 0.711, 95% CI 0.632-0.790) and SHBG levels (AUC 0.709, 95% CI 0.625-0.793) were the strong risk factors. Conclusions: In Chinese women with PCOS, factors of gestation weight gain before 24 weeks, pre-pregnant WHR, HOMA-IR and SHBG levels are strongly associated with subsequent development of GDM.

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Most cited references 23

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The prevalence and features of the polycystic ovary syndrome in an unselected population.

Notwithstanding the potential public health impact of the polycystic ovary syndrome (PCOS), estimates regarding its prevalence are limited and unclear. Between July 1998 and October 1999, 400 unselected consecutive premenopausal women (18-45 yr of age) seeking a preemployment physical at the University of Alabama at Birmingham were studied (223 Black, 166 White, and 11 of other races). Evaluation included a history and physical examination, a modified Ferriman-Gallwey hirsutism score, and serum screening for hyperandrogenemia, hyperprolactinemia, and 21-hydroxylase-deficient nonclassical adrenal hyperplasia. PCOS was diagnosed by the presence of the following: 1) oligoovulation, 2) hyperandrogenemia and/or hirsutism (modified Ferriman-Gallwey score > or = 6), and 3) the exclusion of related disorders. Confirmed PCOS was established in those individuals whose evaluation was complete and indicative of PCOS, and possible PCOS was established when the hormonal evaluation was not complete or was unavailable, but the clinical phenotype was otherwise suggestive of the disorder. The individual probability of PCOS in women with possible PCOS was assigned a weight based on the findings in similar subjects whose evaluation was complete, and the total number of PCOS cases arising from these individuals was calculated (i.e. individual probability of PCOS x total number of subjects in the group). The cumulative prevalence of PCOS in our population was 6.6% (26.5 of 400), including 15 subjects among the 347 women completing their evaluation and a calculated prevalence of 11.5 subjects among the remainder. The prevalence rates of PCOS for Black and White women were 8.0 and 4.8%, respectively, not significantly different. These data from a large representative unselected population support the concept that PCOS is the most common endocrine abnormality of reproductive-aged women in the United States.
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Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome

(2004)
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Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis.

The objective of this study is to assess and quantify the risk for gestational diabetes mellitus (GDM) according to prepregnancy maternal body mass index (BMI). The design is a systematic review of observational studies published in the last 30 years. Four electronic databases were searched for publications (1977-2007). BMI was elected as the only measure of obesity, and all diagnostic criteria for GDM were accepted. Studies with selective screening for GDM were excluded. There were no language restrictions. The methodological quality of primary studies was assessed. Some 1745 citations were screened, and 70 studies (two unpublished) involving 671 945 women were included (59 cohorts and 11 case-controls). Most studies were of high or medium quality. Compared with women with a normal BMI, the unadjusted pooled odds ratio (OR) of an underweight woman developing GDM was 0.75 (95% confidence interval [CI] 0.69 to 0.82). The OR for overweight, moderately obese and morbidly obese women were 1.97 (95% CI 1.77 to 2.19), 3.01 (95% CI 2.34 to 3.87) and 5.55 (95% CI 4.27 to 7.21) respectively. For every 1 kg m(-2) increase in BMI, the prevalence of GDM increased by 0.92% (95% CI 0.73 to 1.10). The risk of GDM is positively associated with prepregnancy BMI. This information is important when counselling women planning a pregnancy.

Author and article information

Affiliations
aCenter for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, bCenter for Reproductive Medicine, cCenter for Prenatal Diagnosis, and dDepartment for Gynecology and Obstetrics, Jinan Maternity and Child Care Hospital, and eNational Research Center for Assisted Reproductive Technology and Reproductive Genetics, The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, PR China
Journal
GOI
Gynecol Obstet Invest
10.1159/issn.0378-7346
Gynecologic and Obstetric Investigation
Gynecol Obstet Invest
S. Karger AG (Basel, Switzerland karger@123456karger.com http://www.karger.com )
0378-7346
1423-002X
May 2016
14 October 2015
: 81
: 3
: 220-224
© 2015 S. Karger AG, Basel

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Figures: 1, Tables: 2, References: 27, Pages: 5
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