Association Between Polycystic Ovary Syndrome and Pregnancy Outcomes in GDM: A Secondary Analysis of the DiGest Trial.

Abstract

Polycystic ovary syndrome (PCOS) is a risk factor for gestational diabetes (GDM) due to shared pathophysiological associations with insulin resistance and adiposity, and may increase the risk of suboptimal perinatal outcomes in GDM. It is unclear if this excess risk upon outcomes is attributable to PCOS, more severe hyperglycaemia, higher maternal BMI or reduced efficacy of dietary interventions. To assess associations of PCOS, dietary intervention and gestational weight loss with maternal and neonatal outcomes in women with GDM. A secondary analysis from the DiGest double-blind randomized controlled trial. Pregnant women with GDM and BMI ≥25 kg/m² from eight UK centres (N =425; 50 with PCOS and 375 without PCOS). Reduced-energy intervention diet (1,200 kcal/day) or standard-energy control diet (2,000 kcal/day) from enrolment (29wks) until delivery. Pregnancy outcomes, including maternal weight and continuous glucose metrics, physical and dietary data and infant birthweight and jaundice, were compared between women with and without PCOS using univariate tests, and multivariable regression models were applied for adjusted analysis. Women with GDM and PCOS had similar baseline characteristics, glycaemia, BMI and pregnancy outcomes compared to women with GDM alone, but their infants had higher rates of neonatal jaundice (24.4% vs. 8.9%, p=0.002). Outcomes across the dietary interventions were similar in women with and without PCOS. In women with GDM, PCOS was not associated with increased risks for most suboptimal pregnancy outcomes or reduced efficacy of a dietary intervention in this cohort where BMI and glycaemia were comparable.