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Submitted: 2021-08-04
Accepted: 2021-09-20
Published online: 2021-11-04
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High prevalence of early (1st trimester) gestational diabetes mellitus in Polish women is accompanied by insulin resistance similar to women with polycystic ovary syndrome (PCOS)

Krzysztof Lewandowski12, Monika Głuchowska3, Karolina Garnysz45, Wojciech Horzelski6, Mariusz Grzesiak45, Andrzej Lewiński12
DOI: 10.5603/EP.a2021.0095
Affiliations
  1. Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
  2. Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital - Research Institute, Lodz, Poland
  3. Department of Pathology of Pregnancy, 1st Chair of Gynaecology and Obstetrics, Medical University of Lodz, Lodz, Poland
  4. Department of Perinatology, Obstetrics and Gynaecology, Polish Mother’s Memorial Hospital - Research Institute, Lodz, Poland
  5. Department of Gynaecology and Obstetrics, 2nd Chair of Gynaecology and Obstetrics, Medical University of Lodz, Lodz, Poland
  6. Faculty of Mathematics and Computer Science, University of Lodz, Banacha 22, 90-238 Lodz, Poland

open access

Ahead of print
Original Paper
Submitted: 2021-08-04
Accepted: 2021-09-20
Published online: 2021-11-04

Abstract

Aims: Both pregnancy and polycystic ovary syndrome (PCOS) constitute insulin-resistant states that are associated with an increased prevalence of glucose intolerance. Some women demonstrate significant insulin resistance (IR) and develop gestational diabetes (GDM) even in 1st trimester. We compared surrogate IR indices in 1st trimester pregnant women and in women with PCOS (Rotterdam consensus criteria). Subjects & Methods: We performed 75 g Oral Glucose Tolerance Test (OGTT) with insulin measurements in 106 healthy 1st trimester pregnant women at 9.9±2.6 weeks of gestation and in 418 women with PCOS. We assessed IR (HOMA-IR, QUICKI, Matsuda, Belfiore and Stumvoll indices) as well as prevalence of GDM according to the IADPSG and WHO (1999) criteria. Results: Despite slightly lower BMI (p=0.027) pregnant women had either similar (QUICKI, Belfiore index, Stumvoll0-120 min) or greater IR than women with PCOS (e.g. HOMA-IR 3.85±6.11 versus 2.64±2.04, p=0.002), while only Matsuda index demonstrated less IR in pregnant women (p=0.003). Correlation between IR indices in pregnant women showed marked variability ranging from r=0.334 (HOMA-IR versus Belfiore index) to r=-1.0 (HOMA-IR versus QUICKI, p<0.001). This was accompanied by high prevalence of GDM (14.2% and 9.4%, IADPSG and WHO criteria, respectively). Women with GDM diagnosed according to IADPSG criteria demonstrated greater IR than pregnant women without GDM. In women with GDM diagnosed according to WHO (1999) criteria these differences were visible only for OGTT-derived IR indices (Belfiore, Matsuda and Stumvoll0-120 index). Conclusions: Depending on the choice of IR indices healthy 1st trimester pregnant women demonstrate either similar, or greater IR than women with PCOS and this is accompanied by high prevalence of early GDM. It remains to be established whether GDM screening should be performed in the 1st trimester.

Abstract

Aims: Both pregnancy and polycystic ovary syndrome (PCOS) constitute insulin-resistant states that are associated with an increased prevalence of glucose intolerance. Some women demonstrate significant insulin resistance (IR) and develop gestational diabetes (GDM) even in 1st trimester. We compared surrogate IR indices in 1st trimester pregnant women and in women with PCOS (Rotterdam consensus criteria). Subjects & Methods: We performed 75 g Oral Glucose Tolerance Test (OGTT) with insulin measurements in 106 healthy 1st trimester pregnant women at 9.9±2.6 weeks of gestation and in 418 women with PCOS. We assessed IR (HOMA-IR, QUICKI, Matsuda, Belfiore and Stumvoll indices) as well as prevalence of GDM according to the IADPSG and WHO (1999) criteria. Results: Despite slightly lower BMI (p=0.027) pregnant women had either similar (QUICKI, Belfiore index, Stumvoll0-120 min) or greater IR than women with PCOS (e.g. HOMA-IR 3.85±6.11 versus 2.64±2.04, p=0.002), while only Matsuda index demonstrated less IR in pregnant women (p=0.003). Correlation between IR indices in pregnant women showed marked variability ranging from r=0.334 (HOMA-IR versus Belfiore index) to r=-1.0 (HOMA-IR versus QUICKI, p<0.001). This was accompanied by high prevalence of GDM (14.2% and 9.4%, IADPSG and WHO criteria, respectively). Women with GDM diagnosed according to IADPSG criteria demonstrated greater IR than pregnant women without GDM. In women with GDM diagnosed according to WHO (1999) criteria these differences were visible only for OGTT-derived IR indices (Belfiore, Matsuda and Stumvoll0-120 index). Conclusions: Depending on the choice of IR indices healthy 1st trimester pregnant women demonstrate either similar, or greater IR than women with PCOS and this is accompanied by high prevalence of early GDM. It remains to be established whether GDM screening should be performed in the 1st trimester.

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Keywords

Gestational Diabetes Mellitus; GDM; insulin resistance; pregnancy; PCOS; polycystic ovary syndrome; HOMA-IR; QUICKI; Belfiore index; Matsuda index; Stumvoll index

About this article
Title

High prevalence of early (1st trimester) gestational diabetes mellitus in Polish women is accompanied by insulin resistance similar to women with polycystic ovary syndrome (PCOS)

Journal

Endokrynologia Polska

Issue

Ahead of print

Article type

Original paper

Published online

2021-11-04

DOI

10.5603/EP.a2021.0095

Keywords

Gestational Diabetes Mellitus
GDM
insulin resistance
pregnancy
PCOS
polycystic ovary syndrome
HOMA-IR
QUICKI
Belfiore index
Matsuda index
Stumvoll index

Authors

Krzysztof Lewandowski
Monika Głuchowska
Karolina Garnysz
Wojciech Horzelski
Mariusz Grzesiak
Andrzej Lewiński

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