Comparison of metabolic profile and parameters of glu-cose homeostasis between PCOS patients and controls in early pregnancy

Ziele: Das Ziel dieser prospektiven longitudinalen Studie war die Erhebung von Unterschie-den im metabolischen Profil und Glukosestoffwechsel zwischen Frauen mit polyzystischem Ovarsyndrom (PCOS) und gesunden Kontrollen in der Frühschwangerschaft und Beurteilung der Beziehung dieser Unterschiede zum Schwangerschafts-Outcome, insbesondere Schwan-gerschaftsdiabetes. Weiterhin wurde die heterogene Gruppe der PCOS Patientinnen nach verschiedenen Diagnosekriterien in Subgruppen unterteilt, um gruppenspezifische Unter-schiede zu erheben. Methoden: 31 Schwangere mit PCOS und 36 gesunde Probandinnen wurden zu 3 Untersu-chungen in den Schwangerschaftswochen 12+0 bis 22+6 (V1), 24+0 bis 28+6 (V2) und 3 bis 12 Monate nach Entbindung eingeladen. An jedem Termin wurden eine metabolische Cha-rakterisierung und Routinelaboruntersuchung durchgeführt. Nach der Nüchternabnahme von Glukose, Insulin und C-Peptid erhielten die Patientinnen 75 g Glukose (75 g-2h oraler Glu-kosetoleranztest, OGTT). Glukose, Insulin und C-Peptid wurden erneut nach 30, 60, 90 und 120 Minuten abgenommen. Zur Beurteilung von Insulinsensitivität, Insulinsekretion und -Zell Funktion in der Frühschwangerschaft wurden mehrere Indizes basierend auf den Werten des V1 OGTT errechnet und verglichen. Das Schwangerschafts-Outcome wurde im Rahmen des 3. Besuchs erhoben. Ergebnisse: Das demographische Profil der PCOS Patientinnen und Kontrollen war ver-gleichbar. Nur der Ferriman-Gallwey-Index, ein Merkmal für Hyperandrogenämie, war sig-nifikant höher (4,55 (5,47) vs. 1,49 (2,16), p=0,009). Auch der Konzeptionsmodus unter-schied sich, wobei 92,3% der PCOS Patientinnen und 0% der Kontrollen mithilfe assistierter Reproduktion schwanger wurden (p<0,001). Die metabolischen Nüchternlaborwerte (Gluco-se, Insulin, C-peptid, Lipide, Sexualhormonbindendes Globulin SHBG) waren auch ver-gleichbar außer das SHBG welches in der PCOS Gruppe signifikant niedriger war (359,80 (122,41) vs. 414,07 (93,78), p=0,015). Die Insulinsensitivität unterschied sich nicht signi-fikant, jedoch zeigten PCOS Patientinnen eine tendenziell höhere Insulinresistenz. Die Insu-linsekretion unterschied sich ebenfalls nicht signifikant außer der Gesamtinsulinsekretion, die in der PCOS-Gruppe höher war (50,98 (28,18) vs. 38,92 (27,41), p=0,042). Der Dispo-sition Index war in der PCOS Gruppe niedriger, das Ergebnis erreichte jedoch keine statisti-sche Signifikanz. Das Schwangerschafts-Outcome war über alle Gruppen vergleichbar. Diskussion: Das metabolische Profil und Parameter des Glukosestoffwechsels zeigten fast keine statistisch signifikanten Unterschiede über alle Gruppen, jedoch konnte eine tendenzi-ell höhere Insulinresistenz und erhöhte kompensatorische Insulinsekretion sowie eine ernied-rigte -Zell Funktion in der PCOS Gruppe festgestellt werden. Weitere Studien mit größerer Fallzahl sind zur weiteren detaillierten Beurteilung dieser Ergebnisse erforderlich.Aims: The aim of this prospective longitudinal study was to assess whether women with the polycystic ovary syndrome (PCOS) show differences in metabolic profile and parameters of glucose homeostasis compared to healthy controls in early pregnancy and to relate those dif-ferences to pregnancy outcome, especially gestational diabetes mellitus (GDM). Further-more, the heterogenic group of PCOS patients was divided into subgroups according to dif-ferent diagnostic criteria to assess group-specific differences. Methods: 31 Pregnant PCOS women and 36 healthy controls were invited to participate in 3 metabolic assessments between weeks 12+0 and 22+6 (V1), weeks 24+0 and 28+6 (V2) and 3-12 months after delivery (V3). At each visit, all participants received a metabolic charac-terization as well as a routine laboratory assessment. After collecting plasma samples of glu-cose, insulin and C-peptide in the fasting state, the participants received a 75 g oral glucose load (75g 2h oral glucose tolerance test, OGTT). Further samples of glucose, insulin and C-peptide were taken at 30, 60, 90 and 120 minutes. To assess insulin sensitivity and secretion as well as -cell function in early pregnancy, several indices based on the OGTT data of V1 were calculated and compared. The pregnancy outcome was assessed at visit 3. Results: The demographic profile of PCOS patients and controls was comparable. Only the Ferriman-Gallwey-Index, a marker for hyperandrogenemia, was significantly different with 4.55 (5.47) vs. 1.49 (2.16), p=0.009, as well as the conception mode with 83.9% of PCOS patients vs. 0% of controls (p<0.001) having conceived after assisted reproduction therapy (ART). Baseline laboratory parameters of metabolic profile (glucose, insulin, C-peptide, lipids, SHBG) were also comparable except for SHBG which was significantly lower (359.80 (122.41) vs. 414.07 (93.78), p=0.015) in the PCOS group. Parameters of insulin sensitivity did not differ significantly, however, PCOS subjects showed a tendency towards higher insu-lin resistance. Parameters of insulin secretion did also not differ except for the total insulin secretion which was higher in the PCOS group (50.98 (28.18) vs. 38.92 (27.41), p=0.042). The oral disposition index was lower in PCOS patients; however, this result did not reach statistical significance. The Pregnancy outcome was comparable across all groups. Conclusions: The metabolic profile and parameters of glucose homeostasis showed almost no statistically significant difference across all study groups; however, there were trends to-wards a decreased insulin sensitivity and elevated compensatory insulin secretion as well as reduced -cell function within the PCOS groups. Further studies with more participants should be conducted to assess those findings in detail.eingereicht von Tina StoppAbweichender Titel laut Übersetzung der Verfasserin/des VerfassersMedizinische Universität Wien, Diplomarb., 2019(VLID)326091

Pregnancy after bariatric surgery: a narrative literature review and discussion of impact on pregnancy management and outcome

Abstract Bariatric surgery (BS) is regarded to be the most effective treatment of obesity with long lasting beneficial effects including weight loss and improvement of metabolic disorders. A considerable number of women undergoing BS are at childbearing age. Although the surgery mediated weight loss has a positive effect on pregnancy outcome, the procedures might be associated with adverse outcomes as well, for example micronutrient deficiencies, iron or B12 deficiency anemia, dumping syndrome, surgical complications such as internal hernias, and small for gestational age (SGA) offspring, possibly due to maternal undernutrition. Also, there is no international consensus concerning the ideal time to conception after BS. Hence, the present narrative review intents to summarize the available literature concerning the most common challenges which arise before and during pregnancy after BS, such as fertility related considerations, vitamin and nutritional deficiencies and their adequate compensation through supplementation, altered glucose metabolism and its implications for gestational diabetes screening, the symptoms and treatment of dumping syndrome, surgical complications and the impact of BS on pregnancy outcome. The impact of different bariatric procedures on pregnancy and fetal outcome will also be discussed, as well as general considerations concerning the monitoring and management of pregnancies after BS. Whereas BS leads to the mitigation of many obesity-related pregnancy complications, such as gestational diabetes mellitus (GDM), pregnancy induced hypertension and fetal macrosomia; those procedures pose new risks which might lead to adverse outcomes for mothers and offspring, for example nutritional deficiencies, anemia, altered maternal glucose metabolism and small for gestational age children

To Predict the Requirement of Pharmacotherapy by OGTT Glucose Levels in Women with GDM Classified by the IADPSG Criteria

The aim of this study was to assess the association between OGTT glucose levels and requirement of pharmacotherapy in GDM patients classified by the IADPSG criteria. This study included 203 GDM patients (108 managed with lifestyle modification and 95 requiring pharmacotherapy). Clinical risk factors and OGTT glucose concentrations at 0 (G0), 60 (G60), and 120 min (G120) were collected. OGTT glucose levels were significantly associated with the later requirement of pharmacotherapy (ROC-AUC: 71.1, 95% CI: 63.8–78.3). Also, the combination of clinical risk factors (age, BMI, parity, and pharmacotherapy in previous gestation) showed an acceptable predictive accuracy (ROC-AUC: 72.1, 95% CI: 65.0–79.2), which was further improved when glycemic parameters were added (ROC-AUC: 77.5, 95% CI: 71.5–83.9). Random forest analysis revealed the highest variable importance for G0, G60, and age. OGTT glucose measures in addition to clinical risk factors showed promising properties for risk stratification in GDM patients classified by the recently established IADPSG criteria

Correction: Increasing Live Birth Rate by Preimplantation Genetic Screening of Pooled Polar Bodies Using Array Comparative Genomic Hybridization.

[This corrects the article DOI: 10.1371/journal.pone.0128317.]

Novel Indices of Glucose Homeostasis Derived from Principal Component Analysis: Application for Metabolic Assessment in Pregnancy

Aims. This study is aimed at assessing the association of previously developed indices of glucose homeostasis derived from principal component analysis (PCA) with parameters of insulin action, secretion, and beta cell function during pregnancy. Methods. In this prospective longitudinal study, an oral glucose tolerance test was performed in sixty-seven pregnant women at two prepartum (12+0 to 22+6 and 24+0 to 28+6) and one postpartum (2 to 11 months) visits. Three principal component scores (PCS) were calculated based on measurements of glucose, insulin, C-peptide, age, and BMI to assess their association with fasting and dynamic indices of insulin action, secretion, and β-cell function. Results. PCS1 was positively associated with fasting and dynamic parameters of insulin sensitivity (Matsuda index: r=0.93, p<0.001), whereas a strong negative association was observed for early, late, and total insulin response. PCS2 was associated with higher mean glucose but negatively related to parameters of insulin secretion. PCS3 was significantly associated with fasting indices of insulin sensitivity. PCS1 to 3 assessed at early pregnancy were also associated with development of GDM, whereby random forest analysis revealed the highest variable importance for PCS1. PCS1 to 3 were significantly related to the oral disposition index explaining 49.0% of its variance. Conclusions. PCS1 to 3 behaved similarly as compared to previous observations in nonpregnant women and were furthermore associated with the development of GDM. These findings support our hypothesis that PCS1 to 3 could be used as novel indices of glucose disposal during pregnancy

Characteristics of the total study population.

<p>The data are expressed as the mean ± standard deviation as well as the median (IQR) and counts (%).</p><p>* p-value based on the Wilcoxon rank sum test.</p><p>Characteristics of the total study population.</p

Uni- and multivariable analyses of 299 subjects with transfers resulting in live births.

<p>*Adjusted odds ratios (AORs) for a fully adjusted logistic regression model.</p><p>Uni- and multivariable analyses of 299 subjects with transfers resulting in live births.</p

Increasing Live Birth Rate by Preimplantation Genetic Screening of Pooled Polar Bodies Using Array Comparative Genomic Hybridization - Fig 2

<p>(A) Number of chromosomal aberrations in aneuploid oocytes. In total, the polar bodies of 530 oocytes were tested by aCGH, and 359 were found to have a chromosomal aberration. Approximately 65% of aneuploid oocytes had two or more aneuploidies. (B) Distribution of chromosome errors in aneuploid oocytes. All chromosomes were found to be involved in aneuploidies. Aneuploidy of chromosome 4 was observed in only 10% of oocytes, while chromosome 19 aberrations were most frequently detected in up to 30% of oocytes.</p