PRECONCEPTIONAL AND GESTATIONAL EVALUATION OF INSULIN-SECRETION IN PATIENTS WITH POLYCYSTIC-OVARY-SYNDROME

The relationship between insulinaemia and obesity and glucose toleranc e and the impact of pregnancy as risk factor for carbohydrate abnormal ities were investigated in 91 consecutive patients with polycystic ova ry syndrome (PCOS) aged 26-32 years, Fifteen normoglycaemic patients b ecame pregnant within 6 months of the pregestational study using pharm acological induction of ovulation. Plasma concentrations of insulin an d glucose after an oral glucose tolerance test (OGTT) were determined by immunoradiometric assay and glucose oxidase technique respectively, OGTT patients were classified according to their response as normoins ulinaemic (n = 46) or hyperinsulinaemic (n = 45). Impairment of glucos e metabolism occurred in 12.1% (n = 11, 10 obese and one lean) of all PCOS subjects, Based on insulin secretion, 6.5% of normoinsulinaemic a nd 13.3% of hyperinsulinaemic patients had an impaired glucose toleran ce and 2.3 and 2.2% respectively a noninsulin-dependent diabetes melli tus, Obese patients had higher values for area under the curve for ins ulin response to OGTT (I-AUC values) than lean patients, and the perce ntage above ideal body weight was greater in hyperinsulinaemic than in normoinsulinaemic patients, All hyperinsulinaemic (7/15) subjects who became pregnant developed an impairment of glucose metabolism during pregnancy. It is concluded that the PCOS population was at higher risk of developing carbohydrate abnormalities than the normal population o f a similar reproductive age, Furthermore, those with abnormal insulin secretion at the pregestational stage may, during pregnancy develop a n impaired gestational glucose tolerance or gestational diabetes.