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      Sex hormone binding globulin measurement before conception as a predictor of gestational diabetes in women with polycystic ovarian syndrome

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          Abstract

          Background:

          The objective of this study was to investigate whether the sex hormone binding globulin (SHBG) levels before conception are predictive of gestational diabetes mellitus (GDM) in women with polycystic ovarian syndrome (PCOS).

          Materials and Methods:

          A total of 180 women with PCOS were enrolled and followed up during pregnancy. Diagnosis of GDM was based on a 2-hour, 75 g oral glucose tolerance test (GTT) performed at 24-28 weeks of gestational age. SHBG levels were measured from serum samples that had collected before conception. We examined the incidence of GDM and plotted a receiver operating characteristic (ROC) curve to assess discrimination.

          Results:

          Of the 180 women, 50 (27.8%) were diagnosed with GDM. Those with lower levels of SHBG before conception were more likely to develop GDM than those with higher SHBG (44.4 ± 14.8 nmol/l vs. 63.5 ± 22.7 nmol/l, P < 0.001). The area under the ROC was 77.0% (95% confidence interval [CI] 71.3-78.8). The optimal cut-off value for detecting GDM was a SHBG ≥62.5 nmol/l. For every 1 nmol/l increase in SHBG value, there was a 7% reduction in the risk for development of GDM (Odds ratio 0.93 [95% CI 0.90-0.96], P < 0.001).

          Conclusion:

          In women with PCOS preconception, SHBG levels are strongly associated with development of GDM.

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          Most cited references17

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          Diagnosis and classification of diabetes mellitus.

          (2004)
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            Sex hormone-binding globulin and risk of type 2 diabetes in women and men.

            Circulating sex hormone-binding globulin levels are inversely associated with insulin resistance, but whether these levels can predict the risk of developing type 2 diabetes is uncertain. We performed a nested case-control study of postmenopausal women in the Women's Health Study who were not using hormone therapy (359 with newly diagnosed type 2 diabetes and 359 controls). Plasma levels of sex hormone-binding globulin were measured; two polymorphisms of the gene encoding sex hormone-binding globulin, SHBG, that were robustly associated with the protein levels were genotyped and applied in mendelian randomization analyses. We then conducted a replication study in an independent cohort of men from the Physicians' Health Study II (170 with newly diagnosed type 2 diabetes and 170 controls). Among women, higher plasma levels of sex hormone-binding globulin were prospectively associated with a lower risk of type 2 diabetes: multivariable odds ratios were 1.00 for the first (lowest) quartile of plasma levels, 0.16 (95% confidence interval [CI], 0.08 to 0.33) for the second quartile, 0.04 (95% CI, 0.01 to 0.12) for the third quartile, and 0.09 (95% CI, 0.03 to 0.21) for the fourth (highest) quartile (P<0.001 for trend). These prospective associations were replicated among men (odds ratio for the highest quartile of plasma levels vs. the lowest quartile, 0.10; 95% CI, 0.03 to 0.36; P<0.001 for trend). As compared with homozygotes of the respective wild-type allele, carriers of a variant allele of the SHBG single-nucleotide polymorphism (SNP) rs6259 had 10% higher sex hormone-binding globulin levels (P=0.005), and carriers of an rs6257 variant had 10% lower plasma levels (P=0.004); variants of both SNPs were also associated with a risk of type 2 diabetes in directions corresponding to their associated sex hormone-binding globulin levels. In mendelian randomization analyses, the predicted odds ratio of type 2 diabetes per standard-deviation increase in the plasma level of sex hormone-binding globulin was 0.28 (95% CI, 0.13 to 0.58) among women and 0.29 (95% CI, 0.15 to 0.58) among men, a finding that suggests that sex hormone-binding globulin may have a causal role in the risk of type 2 diabetes. Low circulating levels of sex hormone-binding globulin are a strong predictor of the risk of type 2 diabetes in women and men. The clinical usefulness of both SHBG genotypes and plasma levels in stratification and intervention for the risk of type 2 diabetes warrants further examination. 2009 Massachusetts Medical Society
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              A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome.

              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.
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                Author and article information

                Journal
                J Res Med Sci
                J Res Med Sci
                JRMS
                Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences
                Medknow Publications & Media Pvt Ltd (India )
                1735-1995
                1735-7136
                August 2013
                : 18
                : 8
                : 637-640
                Affiliations
                [1]Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
                Author notes
                Address for correspondence: Dr. Ferdous Mehrabian, Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: mehrabian@ 123456med.mui.ac.ir
                Article
                JRMS-18-637
                3872600
                24379837
                56754571-cb54-4660-8f8e-a72f321b203a
                Copyright: © Journal of Research in Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 March 2013
                : 03 June 2013
                : 04 July 2013
                Categories
                Original Article

                Medicine
                gestational diabetes,polycystic ovary syndrome,rotterdam criteria,shbg
                Medicine
                gestational diabetes, polycystic ovary syndrome, rotterdam criteria, shbg

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