HIGH PREVALENCE OF POLYCYSTIC OVARIES AND ASSOCIATED CLINICAL, ENDOCRINE, AND METABOLIC FEATURES IN WOMEN WITH PREVIOUS GESTATIONAL DIABETES-MELLITUS

The prevalence of polycystic ovaries, according to ultrasonography, an d associated clinical, endocrine, and metabolic features were investig ated in women with previous gestational diabetes mellitus (GDM). Thirt y-four women with GDM 3-5 yr before the investigation and 36 controls with uncomplicated pregnancies, selected for similar age, parity, and date of delivery, were investigated. The women with previous GDM showe d a higher prevalence of polycystic ovaries [14 of 34 (41%) us. 1 of 3 6 (3%); P < 0.0001],hirsutism (P < 0.01), irregular menstrual cycles ( P < 0.01), and a higher body mass index (BMI; P < 0.001) than the cont rols. Five women (15%) with previous GDM had developed manifest diabet es (excluded in comparisons of metabolic variables). After dividing th e women with previous GDM into subgroups according to ovarian appearan ce, the 2 subgroups showed similar glucose tolerance and prevalence of diabetes, whereas the women with polycystic ovaries were younger (mea n +/- SD, 33.3 +/- 1.4 us. 38.2 +/- 1.1; P < 0.01), had higher truncal -abdominal/femoral fat ratio according to skin folds (P < 0.05), had h igher concentrations of androstenedione (P < 0.01) and testosterone (P < 0.01), and had a higher LH/FSH ratio (P < 0.01), lower levels of GH (P < 0.01), higher levels of triglycerides (P < 0.05) and cholesterol (P < 0.05) in very low density lipoprotein, all independent of age an d BMI, and had a higher prevalence of pregnancy-induced hypertension ( 50% us. 15%; P < 0.05) during the index pregnancy compared with the wo men with normal ovaries. The group of women with GDM showed a lower ea rly insulin release after glucose (iv glucose tolerance test) for thei r degree of insulin resistance (euglycemic hyperinsulinemic clamp) com pared with controls (P < 0.05). In the two subgroups, insulin sensitiv ity was lower in the polycystic ovaries group, independent of BMI (P < 0.05), than in the group with normal ovaries. In conclusion, ultrason ographic, clinical and endocrine signs of polycystic ovary syndrome we re much increased in women with a history of GDM. Compared with the wo men with normal ovaries and previous GDM, those with polycystic ovarie s formed a distinct subgroup that may be more prone to develop various features of the insulin resistance syndrome. Both groups showed a sim ilarly disturbed balance between beta-cell activity and insulin sensit ivity, but in women with polycystic ovaries, insulin resistance may be the dominant component.