The prevalence of polycystic ovaries in women with a history of gestational diabetes

OBJECTIVE Women with a history of gestational diabetes mellitus (GDM) and w omen with polycystic ovary syndrome (PCOS) both demonstrate abnormalities i n insulin action and secretion, and both are at increased risk of developin g type 2 diabetes. To determine whether these similarities reflect a common pathophysiological basis, we examined the prevalence of ultrasound-based p olycystic ovarian morphology in a large multiethnic group of women with a h istory of GDM and a group of women who had normal glucose tolerance during pregnancy. PATIENTS AND DESIGN We studied 91 women with previous GDM (48 European, 20 South Asian, 10 Afro-Caribbean and 13 of other or mixed ethnicity) and 73 n ormoglycaemic control women (56 European, one South Asian, 14 Afro-Caribbea n and two of other or mixed ethnicity), a median (interquartile range) of 2 0 (11-36) and 29 (17-49) months postpartum, respectively. A detailed histor y was taken, and the prevalence of PCO morphology on ultrasound scan was as sessed. Fasting lipids, insulin, glucose status, gonadotrophins and testost erone were measured. Estimates of beta-cell function (%B) and insulin sensi tivity (%S) were derived using the HOMA algorithm. RESULTS Women with previous GDM had higher fasting glucose (5.4 (4.8-6.0) v s. 4.7 (4.4-5.0) mmol/l, P < 0.0001) and features reminiscent of syndrome X : higher BMI (26.4 (22.8-31.4) vs. 23.8 (21.0-27.5) kg/m(2), P = 0.002), wa ist/hip ratio (0.82 (0.79-0.88) vs. 0.77 (0.73-0.81), P < 0.0001), fasting insulin (165 (68-299) vs. 54 (24-156) pmol/l, P < 0.0001), triglycerides (1 .1 (0.8-1.6) vs. 0.8 (0.6-1.1) mmol/l, P < 0.0001) and lower insulin sensit ivity (%S) (27 (16-62) vs. 86 (34-139)%, P < 0.0001) compared to control wo men. The prevalence of PCO was higher in the previous GDM group than in the control subjects (47/91 (52%) vs. 20/73 (27%), chi(2) = 9.86, P = 0.002 ov erall, odds ratio 2.7, P = 0.007 by logistic regression allowing for ethnic ity). There was no difference in any metabolic parameter between the post-G DM PCO group and the post-GDM normal ovaries group, but irregular cycles we re more prevalent in the PCO group (22/47 (47%) vs. 9/44 (21%), chi(2) = 7. 03, P = 0.008). CONCLUSIONS We found a higher prevalence of polycystic ovarian morphology i n women with a history of gestational diabetes. Among the women with previo us gestational diabetes, irregular cycles were more prevalent in the PCO gr oup than in the women with normal ovarian morphology, but no other differen ces in endocrine or metabolic parameters were detected. These findings conf irm an association between PCO and gestational diabetes and suggest that wo men with gestational diabetes display metabolic abnormalities irrespective of ovarian morphology.