Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz.
Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.
Endokrynol Pol. 2022;73(1):1-7. doi: 10.5603/EP.a2021.0095. Epub 2021 Dec 2.
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 the 1st trimester. We compared surrogate IR indices in 1st-trimester pregnant women and in women with PCOS (Rotterdam consensus criteria).
We performed a 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 the prevalence of GDM according to the International Association of Diabetes and Pregnancy Study Groups (IADSPG) and World Health Organization (WHO) (1999) criteria.
Despite having a 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 vs. 2.64 ± 2.04, p = 0.002), while only the Matsuda index demonstrated less IR in pregnant women (p = 0.003). The correlation between IR indices in pregnant women showed marked variability, ranging from r = 0.334 (HOMA-IR vs. Belfiore index) to r = -1.0 (HOMA-IR vs. QUICKI, p < 0.001). This was accompanied by a 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).
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 a high prevalence of early GDM. It remains to be established whether GDM screening should be performed in the 1st trimester.
妊娠和多囊卵巢综合征（PCOS）都构成胰岛素抵抗状态，与葡萄糖耐量降低的发生率增加有关。有些女性在妊娠早期（甚至第 1 个月）就表现出明显的胰岛素抵抗（IR）并发展为妊娠期糖尿病（GDM）。我们比较了第 1 个月妊娠妇女和多囊卵巢综合征（PCOS）患者（鹿特丹共识标准）的替代 IR 指标。
我们对 106 名健康的妊娠第 1 个月孕妇（妊娠 9.9 ± 2.6 周）和 418 名 PCOS 患者进行了 75g 口服葡萄糖耐量试验（OGTT）和胰岛素测量。我们评估了 IR（HOMA-IR、QUICKI、Matsuda、 Belfiore 和 Stumvoll 指数）以及根据国际糖尿病与妊娠研究协会（IADPSG）和世界卫生组织（WHO）（1999 年）标准诊断的 GDM 患病率。
尽管孕妇的 BMI 略低（p = 0.027），但与 PCOS 患者相比，孕妇的 IR 要么相似（QUICKI、Belfiore 指数、Stumvoll0-120min），要么更大（例如，HOMA-IR 为 3.85 ± 6.11 vs. 2.64 ± 2.04，p = 0.002），而仅 Matsuda 指数显示孕妇的 IR 较低（p = 0.003）。孕妇的 IR 指数之间的相关性变化很大，范围从 r = 0.334（HOMA-IR 与 Belfiore 指数）到 r = -1.0（HOMA-IR 与 QUICKI，p < 0.001）。这伴随着 GDM 的高患病率（IADPSG 和 WHO 标准分别为 14.2%和 9.4%）。根据 IADPSG 标准诊断为 GDM 的女性比无 GDM 的孕妇具有更大的 IR。根据 WHO（1999 年）标准诊断为 GDM 的女性，仅在 OGTT 衍生的 IR 指数（Belfiore、Matsuda 和 Stumvoll0-120 指数）中可见这些差异。
根据 IR 指数的选择，健康的妊娠第 1 个月孕妇表现出与 PCOS 患者相似或更大的 IR，并且伴随着早期 GDM 的高患病率。尚不确定是否应在第 1 个月进行 GDM 筛查。
