Ashrafi Mahnaz, Sheikhan Fatemeh, Arabipoor Arezoo, Hosseini Roya, Nourbakhsh Fereshteh, Zolfaghari Zahra
Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran; Department of Obstetrics and Gynecology, School of Medicine, Tehran University of Medical Science, Tehran, Iran.
Department of Endocrinology and Female Infertility at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
Eur J Obstet Gynecol Reprod Biol. 2014 Oct;181:195-9. doi: 10.1016/j.ejogrb.2014.07.043. Epub 2014 Aug 7.
To compare the incidence of gestational diabetes mellitus (GDM) in Iranian infertile women with polycystic ovary syndrome (PCOS) and women without PCOS after pregnancies resulting from either assisted reproductive technology (ART) or spontaneous as well as to determine the risk factors of GDM in PCOS women.
In a cross-sectional study, we evaluated medical records of 234 spontaneous pregnant women without PCOS in Akbarabadi Women's Hospital affiliated to Tehran University of Medical Science, Tehran, Iran, along with 234 pregnant women with PCOS and 234 pregnant non-PCOS women with ART conception who were treated at Royan institute, Tehran, Iran, at the same period of time, 2012 to February 2013. Exclusion criteria were as following: maternal age ≥40, family history of diabetes in first-degree relatives, pre-pregnancy diabetes and history of gestational diabetes, history of stillbirth, recurrent miscarriage, birth weight baby ≥4kg (macrosomia), parity >4, Cushing's syndrome, congenital adrenal hyperplasia and overt hypothyroidism. The GDM diagnosis was according to American Diabetes Association (ADA) criteria. Incidence and the risk factors for GDM were evaluated.
The incidence rates of GDM were 44.4%, 29.9% and 7.3% for PCOS ART, non-PCOS ART and non-PCOS spontaneous pregnant women, respectively. Multivariable logistic regression was used for determining risk factors of GDM in PCOS women with adjusted odds ratios for age, parity and hypothyroidism, the results revealed the most important and significant predictors for development of GDM in PCOS women as follow: menstrual irregularity (OR=4.2; 95% CI=1.7-10.6), serum triglycerides level ≥150mg/dL (OR=1.9; 95% CI=1.07-3.6) and pregestational metformin use (OR=0.4; 95% CI=0.2-0.7).
Pregnant Iranian women with a history of infertility and PCOS are at increased risk for developing GDM. It is recommendable to perform screening test for GDM in PCOS women with ART treatment, irregular menses and high serum triglycerides level in the early stage of pregnancy. Pregestational use of metformin can be effective in reducing the occurrence of GDM.
比较伊朗多囊卵巢综合征（PCOS）不孕女性与非PCOS不孕女性在接受辅助生殖技术（ART）或自然受孕后的妊娠糖尿病（GDM）发病率，并确定PCOS女性发生GDM的危险因素。
在一项横断面研究中，我们评估了伊朗德黑兰医科大学附属阿克巴拉巴迪妇女医院234例自然受孕的非PCOS孕妇的病历，以及同期在伊朗德黑兰罗扬研究所接受治疗的234例PCOS孕妇和234例接受ART受孕的非PCOS孕妇的病历，时间为2012年至2013年2月。排除标准如下：产妇年龄≥40岁、一级亲属糖尿病家族史、孕前糖尿病和妊娠糖尿病史、死产史、复发性流产史、出生体重≥4kg（巨大儿）、产次>4、库欣综合征、先天性肾上腺皮质增生和明显甲状腺功能减退。GDM诊断依据美国糖尿病协会（ADA）标准。评估GDM的发病率及危险因素。
PCOS ART组、非PCOS ART组和非PCOS自然受孕组的GDM发病率分别为44.4%、29.9%和7.3%。采用多变量逻辑回归分析确定PCOS女性发生GDM的危险因素，并对年龄、产次和甲状腺功能减退进行调整比值比分析，结果显示PCOS女性发生GDM的最重要且显著的预测因素如下：月经不规律（OR=4.2；95%CI=1.7-10.6）、血清甘油三酯水平≥150mg/dL（OR=1.9；95%CI=1.07-3.6）和孕前使用二甲双胍（OR=0.4；95%CI=0.2-0.7）。
有不孕史和PCOS的伊朗孕妇发生GDM的风险增加。建议对接受ART治疗、月经不规律和血清甘油三酯水平高的PCOS孕妇在妊娠早期进行GDM筛查。孕前使用二甲双胍可有效降低GDM的发生。
