多囊卵巢综合征女性的胰岛素作用及其与妊娠期糖尿病的关系。
Insulin action in women with polycystic ovary syndrome and its relation to gestational diabetes.
机构信息
Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands.
出版信息
Hum Reprod. 2015 Jun;30(6):1447-53. doi: 10.1093/humrep/dev072. Epub 2015 Apr 2.
STUDY QUESTION
How does insulin action change during pregnancy in women with polycystic ovary syndrome (PCOS) who develop gestational diabetes (GDM) compared with women with PCOS who do not?
SUMMARY ANSWER
Women with PCOS who develop GDM already show disturbed insulin action early in pregnancy.
WHAT IS KNOWN ALREADY
Pregnant women with PCOS are at increased risk of developing GDM compared with women without PCOS.
STUDY DESIGN, SIZE, DURATION: This study represents a post hoc analysis of a subgroup of pregnant women with PCOS participating in a multicentre prospective cohort study. A total of 72 women were included.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with PCOS and a wish to conceive were included before conception and followed during pregnancy. Insulin, glucose, homeostasis model assessment of insulin resistance (HOMA-IR), sex hormone-binding globulin (SHBG) and testosterone were analysed at three different time points in women who developed GDM and women who did not.
MAIN RESULTS AND THE ROLE OF CHANCE
Seventy-two pregnant women with PCOS were included of which 22 (31%) women developed GDM. Both insulin levels and HOMA-IR were significantly higher at each sampling point in women with PCOS who developed GDM. SHBG levels were significantly lower before conception and in the second trimester compared with women who did not develop GDM. Testosterone concentrations were significantly lower before conception in women who developed GDM. After adjusting for BMI, waist circumference and waist/hip ratio, the differences in insulin, HOMA-IR, SHBG and testosterone levels remained largely the same.
LIMITATIONS, REASONS FOR CAUTION: Selection bias cannot be excluded since only women from one centre with a complete blood sampling set were included in this study.
WIDER IMPLICATIONS OF THE FINDINGS
The knowledge that women with PCOS who develop GDM already have a disturbed insulin action early in pregnancy is likely to be useful in considering the pathophysiology processes underlying this disorder in this specific group of women.
STUDY FUNDING/COMPETING INTERESTS: This study was funded by the Child Health research programme of the University Medical Centre Utrecht. M.A.d.W., A.J.G., S.M.V.-V., A.F. and M.P.H.K. have no conflicts of interest to disclose. M.J.C.E. has received grant support from the following companies (in alphabetic order): Illumina and MSD. B.C.J.M.F. has received fees and grant support from the following companies (in alphabetic order): Ferring, Ova-Science, PregLem SA, Roche and Watson Laboratories. The authors declare complete independence from funders.
TRIAL REGISTRATION NUMBER
Clinicaltrials.gov, number NCT00821379.
研究问题
与未发生妊娠糖尿病（GDM）的多囊卵巢综合征（PCOS）女性相比，发生 GDM 的 PCOS 女性在怀孕期间的胰岛素作用如何变化？
总结答案
发生 GDM 的 PCOS 女性在妊娠早期已经表现出胰岛素作用紊乱。
已知情况
与非 PCOS 女性相比，PCOS 孕妇发生 GDM 的风险增加。
研究设计、大小和持续时间：这是一项多中心前瞻性队列研究中 PCOS 孕妇亚组的事后分析。共纳入 72 名孕妇。
参与者/材料、地点和方法：在受孕前纳入有妊娠意愿的 PCOS 女性，并在整个孕期进行随访。在发生 GDM 和未发生 GDM 的女性中，分别在三个不同时间点分析胰岛素、葡萄糖、稳态模型评估的胰岛素抵抗（HOMA-IR）、性激素结合球蛋白（SHBG）和睾酮。
主要结果和机会作用
纳入了 72 名 PCOS 孕妇，其中 22 名（31%）女性发生了 GDM。发生 GDM 的 PCOS 女性在每个采样点的胰岛素水平和 HOMA-IR 均显著升高。与未发生 GDM 的女性相比，SHBG 水平在受孕前和孕中期显著降低。发生 GDM 的女性在受孕前的睾酮浓度明显降低。在调整 BMI、腰围和腰臀比后，胰岛素、HOMA-IR、SHBG 和睾酮水平的差异基本保持不变。
局限性、谨慎的原因：由于仅纳入了一个中心具有完整血液采样集的女性，因此可能存在选择偏倚。
研究结果的意义
患有 GDM 的 PCOS 女性在妊娠早期已经存在胰岛素作用紊乱的知识，这可能有助于考虑这一特定人群中这种疾病的病理生理过程。
研究资金/利益冲突：本研究由乌得勒支大学医学中心儿童健康研究计划资助。M.A.d.W.、A.J.G.、S.M.V.-V.、A.F.和 M.P.H.K. 没有利益冲突需要披露。M.J.C.E. 从以下公司（按字母顺序）获得了资助支持：Illumina 和 MSD。B.C.J.M.F. 从以下公司（按字母顺序）获得了费用和资助支持：Ferring、Ova-Science、PregLem SA、Roche 和 Watson Laboratories。作者声明完全独立于资助者。
临床试验注册号
Clinicaltrials.gov，编号 NCT00821379。
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