ENDOCRINE-METABOLIC FEATURES IN WOMEN WITH POLYCYSTIC-OVARY-SYNDROME DURING PREGNANCY

To elucidate the mechanism of metabolic adaptation of women with polyc ystic ovary syndrome (PCOS) during pregnancy, the endocrine-metabolic features of a group of PCOS patients with or without gestational diabe tes were studied longitudinally during the three trimesters of gestati on. Oral glucose tolerance test (OGTT, 100 g) and hyperinsulinaemic-eu glycaemic clamp were performed throughout the study. Plasma concentrat ions of insulin and glucose were determined by radioimmunoassay and gl ucose oxidase technique, respectively. Five of 13 PCOS patients develo ped gestational diabetes (GD) at the third trimester (PCOS-GD), while the other eight patients did not develop any alteration of glucose met abolism (PCOS-nGD). Both fasting glucose and insulin plasma concentrat ions did not change significantly during pregnancy and no difference w as seen between the two groups. On the contrary PCOS-GD group early ex hibited higher values of area under the curve (AUC) for glucose and in sulin response to OGTT with respect to those found in PCOS-nGD group, This difference was already significant in the first gestational trime ster, Moreover insulin sensitivity value (M) was significantly lower i n the first trimester of gestation in PCOS-GD as compared with that fo und in PCOS-nGD group. However, as gestation proceeded, M value decrea sed in PCOS-nDG group and the difference from PCOS patients developing gestational diabetes was not sustained into the second and third trim esters, Both groups had similar body mass index values and AUC insulin increase from first to third trimester of gestation. It is concluded that early alteration of insulin sensitivity and secretion constitue s pecific risk factors in PCOS patients for the development of abnormali ties of glucose tolerance.