Department of Clinical Sciences, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden.
Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
BJOG. 2022 Jun;129(7):1112-1121. doi: 10.1111/1471-0528.17042. Epub 2021 Dec 27.
To explore mechanisms that modulate gestational weight gain (GWG) in women with polycystic ovary syndrome (PCOS) and healthy controls.
Sub-sample of randomised controlled trials (PCOS) combined with a prospective cohort (controls).
Eleven Norwegian, Swedish, and Icelandic hospitals.
Pregnant women with PCOS treated with metformin (PCOS-M, n = 36) or placebo (PCOS-P, n = 37), and healthy pregnant women (HC, n = 15).
Serum levels of the appetite regulating hormones leptin, ghrelin, allopregnanolone, and soluble leptin receptor (sOB-R) were determined in the first and third trimesters.
Excessive GWG (eGWG) relative to body mass index according to Institute of Medicine (IOM) guideline. Serum leptin/sOB-R ratio, or free-leptin-index (FLI), as biomarker of leptin sensitivity. Serum ghrelin and allopregnanolone levels.
The overall prevalence of eGWG was 44% (38/86). Women with eGWG had higher first and third trimester FLI (P < 0.001), and lower third trimester allopregnanolone levels (P = 0.003) versus women with non-eGWG. The prevalence of eGWG was lower in PCOS-M versus PCOS-P (28% versus 62%, odds ratio = 0.4, 95% CI 0.2-0.8, P = 0.005). FLI decreased during pregnancy in PCOS-M (P = 0.01), but remained unaltered in PCOS-P and HC. Ghrelin and allopregnanolone levels were comparable in PCOS-M, PCOS-P and HC throughout pregnancy.
Excessive GWG is associated with enhanced leptin resistance, and attenuated physiological increase in serum allopregnanolone levels during pregnancy. Metformin reduces the risk for eGWG and improves leptin sensitivity in pregnant women with PCOS.
Metformin counteracts excessive weight gain and leptin resistance in pregnant women with polycystic ovary syndrome.
探索调节多囊卵巢综合征（PCOS）女性和健康对照者妊娠体重增加（GWG）的机制。
随机对照试验（PCOS）的亚样本与前瞻性队列（对照组）相结合。
挪威、瑞典和冰岛的 11 家医院。
接受二甲双胍（PCOS-M，n=36）或安慰剂（PCOS-P，n=37）治疗的 PCOS 孕妇和健康孕妇（HC，n=15）。
在第一和第三个三个月测定食欲调节激素瘦素、胃饥饿素、别孕烯醇酮和可溶性瘦素受体（sOB-R）的血清水平。
根据美国医学研究所（IOM）指南，体重指数相对于体重指数的过度 GWG（eGWG）。血清瘦素/sOB-R 比值或游离瘦素指数（FLI）作为瘦素敏感性的生物标志物。血清胃饥饿素和别孕烯醇酮水平。
eGWG 的总体患病率为 44%（38/86）。与非 eGWG 妇女相比，eGWG 妇女的第一和第三个三个月的 FLI 更高（P<0.001），第三个三个月的别孕烯醇酮水平更低（P=0.003）。与 PCOS-P 相比，PCOS-M 中 eGWG 的患病率较低（28%对 62%，比值比 0.4，95%CI 0.2-0.8，P=0.005）。PCOS-M 中 FLI 在妊娠期间下降（P=0.01），但在 PCOS-P 和 HC 中则保持不变。整个妊娠期间，PCOS-M、PCOS-P 和 HC 中的胃饥饿素和别孕烯醇酮水平相似。
过度 GWG 与瘦素抵抗增强和妊娠期间血清别孕烯醇酮水平的生理增加减弱有关。二甲双胍可降低 PCOS 孕妇发生 eGWG 的风险，并改善其瘦素敏感性。
二甲双胍可对抗多囊卵巢综合征孕妇体重过度增加和瘦素抵抗。
