Objective: To assess the endocrine and metabolic disorders and adverse obstetric outcomes in metabolically obese normal weight (MONW) women with polycystic ovary syndrome (PCOS).
Design: prospective cross sectional and case control study.
Main outcome measures: insulin resistance/hyperinsulinemia (IR/HI), adipocytokines, pregnancy and neonatal complications.
Material and Methods: The study included 109 pregnant women with PCOS (PPCOS). They were divided into 2 groups. Group 1: 62 included metabolically obese normal weight (MONW) women and group 2 included 47 metabolically healthy normal weight (MHNW) women. Group 3 included 35 MHNW non-PCOS women as controls. Body mass index (BMI) of cases and controls ranged from ≥18 to≤24kg/m2 Before pregnancy, fasting glucose, insulin, lipid profile, pro-inflammatory and anti-inflammatory adipocytokines, total testosterone (TT),sex hormone binding globulin (SHBG), free androgen index (FAI), Feriman-Gallwey score (FGS) and quantitative insulin checking index (QUICKI) were estimated for the three groups. All women were pregnant after treatment of infertility and pregnancy was singleton. At 24-28 weeks' gestation 50g glucose challenge test was performed and if one hour plasma glucose was >= 140 mg/dl a two hours 75 g oral glucose tolerance test (OGTT) was done. If OGTT was normal these tests were repeated at 32-34 weeks' gestation.
Results: BMI was not different in the three groups but duration of infertility was shorter in group (2). Systolic and diastolic pressures, WC, WHR, and SAD (99.2 +/- 2.4 cm, 0.89 +/- 0.02, 24.4 +/- 1.1cm respectively) were significantly higher in MONW women compared with MHNW women. FGS was significantly higher in PCOS compared with non-PCOS women. Gestational age at delivery and birth weight were significantly lower in MONW compared with MHNW women. Before pregnancy, fasting: insulin and lipid profile were significantly higher in MONW compared with MHNW women. Fasting glucose and high density lipoproteins were significantly lower in MONW compared with MHNW women. QUICKI was <0.330 denoting insulin resistance in MONW women. It was >0.330 denoting normal insulin sensitivity in MHNW women. Anti-inflammatory cytokines (insulin sensitizers) and SHBG were significantly lower in MONW compared with MHNW women. Pro-inflammatory cytokines, inducing insulin resistance,, TT and FAI were significantly higher in MONW compared with MHNW women. TT, FAI and FGS were significantly higher in MHNW PCOS compared with MHNW non-PCOS women. The rate of early pregnancy loss (EPL), preeclampsia (PE), gestational diabetes mellitus (GDM), preterm labor (PTL), preterm rupture of membranes (PROM), pyelonephritis, caesarian section (CS) and neonatal complications were significantly higher in MONW compared with MHNW women. The rate of EPL was significantly higher in MONW women compared with MHNW women. EPL was significantly higher in MHNW PPCOS compared with MHNW non-PCOS pregnant women.
Conclusion: Incidence of EPL and late pregnancy complications as GDM, GH, PE, PTL, PROM, urinary tract infection, CS and neonatal complications were significantly higher in MONW PPCOS compared with MHNW pregnant women with and without PCOS. Adverse pregnancy outcomes may be related to IR/HI and not to PCOS per se. Incidence of EPL in MHNW PPCOS was significantly higher compared with MHNW pregnant women without PCOS. EPL may be related to PCOS per se due to hyperandrogenemia. Abnormal synthesis and release of adipoctytokines from excessive visceral adipose tissue in MONW women induced IR/HI that were responsible for the metabolic disorders and increased adverse pregnancy outcomes in MONW PPCOS.
Keywords: Polycystic ovary syndrome, Adipocytokines, Insulin resistance/ Hyperinsulism, Adverse pregnancy outcomes