Preconception predictors of gestational diabetes: a multicentre prospective cohort study on the predominant complication of pregnancy in polycystic ovary syndrome.
OBJECTIVE
Can we develop an adequate preconception prediction model to identify those women with polycystic ovary syndrome (PCOS) who have an increased risk of developing gestational diabetes mellitus (GDM) during subsequent pregnancy?


CONCLUSIONS
The risk of developing GDM in women with PCOS can be adequately predicted prior to conception by a prediction model.


BACKGROUND
Women with PCOS are at increased risk of pregnancy complications, especially GDM. GDM has serious short-term and long-term effects on mother and baby.


METHODS
This study is a part of a multicentre prospective cohort study, which was conducted between April 2008 and April 2012. A total of 326 women with PCOS were included.


METHODS
Women with PCOS and a wish to conceive were included prior to conception and followed until 6 weeks after delivery. Maternal, neonatal and birth complications were reported. A multivariate model was developed to predict the most common pregnancy complication, GDM, by using univariate and multivariate logistic regression of preconception patient characteristics. The area under the curve (AUC) of the receiver-operating characteristic was used to test the performance of the model.


RESULTS
A total of 189 women (58%) achieved an ongoing pregnancy (8% multiples) and delivered a live-born neonate. One or two maternal complications occurred in 62 (33%) pregnant women, mainly GDM (n = 41; 22%) and pregnancy-induced hypertension (n = 14; 7%). In children, one or two complications were observed in 49 (26%) of 206 children born, e.g. premature delivery (n = 23; 12%) and small for gestational age (n = 15; 8%). The preconception prediction model for GDM performed well (AUC 0.87, 95% CI 0.81-0.93). First-degree relatives with type 2 diabetes mellitus, serum levels of fasting glucose, fasting insulin, androstenedione and sex hormone-binding globulin before conception were identified as predictors.


CONCLUSIONS
The prediction model has not yet been externally validated in another group of patients. Also, there were missing data for some of the determinants, which were accounted for by multiple imputation.


CONCLUSIONS
Women with PCOS who achieve a pregnancy have an increased risk of GDM. The prediction model can be used to identify women particularly at risk for GDM who should be monitored closely to enable preventative measures that may reduce the risk of developing GDM and its adverse consequences.


BACKGROUND
No external funding was used for the study. M.A.W., S.M.V.V., A.J.G., A.F. and M.P.H.K. have nothing to disclose. C.B.L has received fees and grant support from the following companies (in alphabetic order): Auxogen, European Society of Human Reproduction and Embryology and MSD. J.S.E.L. has received fees and grant support from the following companies (in alphabetic order): Ferring, Gennovum, Merck-Serono, MSD, Organon, Schering Plough, Sharp & Dome and Serono. M.J.C. 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.


BACKGROUND
NCT00821379 [Clinicaltrials.gov].
Department of Reproductive Medicine and Gynaecology, Division of Woman and Baby, University Medical Centre Utrecht, Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands.
M A
MA
de Wilde
S M
SM
Veltman-Verhulst
A J
AJ
Goverde
C B
CB
Lambalk
J S E
JS
Laven
A
A
Franx
M P H
MP
Koster
M J C
MJ
Eijkemans
B C J M
BC
Fauser
D000328:Adult; D016640:Diabetes, Gestational / Q000209:etiology*; D005260:Female; D006801:Humans; D008962:Models, Theoretical; D011085:Polycystic Ovary Syndrome / Q000150:complications*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors
gestational diabetes; polycystic ovary syndrome; pregnancy complications