Insulinresistenz und Inzidenz eines Gestationsdiabetes bei Kinderwunschpatientinnen mit und ohne PCO-Syndrom

Zusammenfassung

Jahren kinderlos. Ein Gestationsdiabetes wurde bei 25 Schwangeren (25,8 %) diagnostiziert (n = 11 [19,6 %] PCO+, n = 14 [34,1 %] PCO-); 9 PCO+- bzw. 14 PCO-Patientinnen davon zeigten im OGTT vor Konzeption eine Insulinresistenz. Bei den PCO-Patientinnen war eine positive Assoziation zwischen BMI und Insulinresistenz nachweisbar (p = 0,010), bei den PCO+ dagegen nicht. Schlussfolgerungen: Bei (insulinresistenten) Kinderwunschpatientinnen mit und ohne PCO-Syndrom ist das Risiko eines Gestationsdiabetes mit 20 bzw. 34 % hoch. Bereits präkonzeptionell sollte daher eine Insulinresistenz nachgewiesen werden, um Risikopatientinnen frühzeitig identifizieren zu können.

Abstract

Purpose: Polycystic ovary (PCO) syndrome is one of the main causes of sterility. Anovulation and hyperandrogenemia as well as insulin resistance are common findings in PCO syndrome. The aim of our study was to compare the incidence of gestational diabetes in sterile women with PCO syndrome (PCO+) with that of women at high risk of gestational diabetes without PCO syndrome (PCO-). Material and Methods: An oral glucose tolerance test (OGTT) was performed in 97 women who had not yet conceived (56 PCO+, 41 PCO-). During the test, blood samples were taken at 30 minute intervals up to 120 minutes and the insulin resistance was determined (as defined by Matsuda and DeFronzo). The women were subsequently followed up during pregnancy, and in early pregnancy another OGTT was performed with samples taken at 60 and 120 minutes after the administration of 75 g of oral glucose to diagnose or exclude gestational diabetes. Results: During follow-up 104 pregnancies and 78 deliveries with 92 children (which included ten twins and two sets of triplets) as well as 26 abortions (26.8 %) were documented, 19 (19.6 %) women remained childless. Gestational diabetes was diagnosed in 25 pregnant women (n = 11 [19.6 %] PCO+; n = 14 [34.1 %] PCO-); 9 (PCO+) and 14 (PCO-) of these patients had been found to be insulin resistant prior to conception. BMI was found to be positively correlated to insulin resistance in PCO- patients (p = 0.010) but not in PCO+ patients. Conclusion: In sterile, especially insulin resistant, PCO+ and PCO- women, the risk of gestational diabetes is high with an incidence of 20 % and 34 %, respectively. Therefore testing for insulin resistance should be carried out before conception, i.e., before ART (artificial reproductive technique), to identify patients at risk for gestational diabetes in later pregnancies.

Schlüsselwörter

OGTT - PCO‐Syndrom - Gestationsdiabetes - Insulinresistenz

Key words

OGTT - PCO syndrome - gestational diabetes - insulin resistance

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