title: Insulin action in women with polycystic ovary syndrome and its relation to gestational diabetes.
abstract: OBJECTIVE
  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?
  
  
  CONCLUSIONS
  Women with PCOS who develop GDM already show disturbed insulin action early in pregnancy.
  
  
  BACKGROUND
  Pregnant women with PCOS are at increased risk of developing GDM compared with women without PCOS.
  
  
  METHODS
  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.
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Selection bias cannot be excluded since only women from one centre with a complete blood sampling set were included in this study.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  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.
  
  
  BACKGROUND
  Clinicaltrials.gov, number NCT00821379.
authors.affiliation: Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands m.dewilde-2@umcutrecht.nl.
authors.forename: Marlieke A
authors.initials: MA
authors.lastname: de Wilde
authors.affiliation: Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands.
authors.forename: Angelique J
authors.initials: AJ
authors.lastname: Goverde
authors.affiliation: Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands.
authors.forename: Susanne M
authors.initials: SM
authors.lastname: Veltman-Verhulst
authors.affiliation: Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands.
authors.forename: Marinus J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.affiliation: Department of Obstetrics, University Medical Centre Utrecht, 3584 EA Utrecht, The Netherlands.
authors.forename: Arie
authors.initials: A
authors.lastname: Franx
authors.affiliation: Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands.
authors.forename: Bart C J M
authors.initials: BC
authors.lastname: Fauser
authors.affiliation: Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands Department of Obstetrics, University Medical Centre Utrecht, 3584 EA Utrecht, The Netherlands.
authors.forename: Maria P H
authors.initials: MP
authors.lastname: Koster
mesh_terms: D000328:Adult; D001786:Blood Glucose; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000097:blood*; D005260:Female; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D015999:Multivariate Analysis; D011085:Polycystic Ovary Syndrome / Q000150:complications*; D011247:Pregnancy; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013739:Testosterone / Q000097:blood
chemical_list: D001786:Blood Glucose; D007328:Insulin; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone
keywords: PCOS; gestational diabetes; pregnancy