PCOS Impact on Pregnancy Outcomes in Gestational Diabetes: DiGest Study Analysis
Overview
This secondary analysis of the DiGest trial evaluated pregnancy outcomes in women with gestational diabetes mellitus (GDM) with and without polycystic ovary syndrome (PCOS). Women with PCOS had similar glycemia, BMI, and most pregnancy outcomes compared to those without PCOS, but their infants showed a higher incidence of neonatal jaundice. Dietary interventions were equally effective regardless of PCOS status.
Background
Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by insulin resistance, affecting up to 18% of women worldwide and increasing risks of metabolic complications. Pregnancy in women with PCOS is associated with higher risks of gestational diabetes mellitus (GDM) and adverse perinatal outcomes such as gestational hypertension and preterm birth. The coexistence of PCOS and GDM may compound risks, but previous studies have yielded inconsistent results, often without adjusting for confounders like BMI and glycemia. This analysis aimed to clarify the impact of PCOS on pregnancy outcomes and dietary intervention efficacy in women with GDM.
Data Highlights
Parameter
PCOS (n=50)
No PCOS (n=375)
P Value
Neonatal Jaundice Rate
24.4%
8.9%
0.002
Baseline BMI
Comparable
Comparable
NS
Glycemia
Comparable
Comparable
NS
Pregnancy Outcomes (Overall)
Similar
Similar
NS
Key Findings
Women with GDM and PCOS had similar baseline characteristics, including BMI and glycemic control, compared to women with GDM alone.
Most maternal and neonatal pregnancy outcomes did not differ significantly between women with and without PCOS.
Infants born to women with PCOS had a significantly higher rate of neonatal jaundice (24.4% vs 8.9%, P = .002).
The efficacy of reduced-energy dietary intervention (1200 kcal/day) versus standard-energy diet was similar regardless of PCOS status.
PCOS was not associated with increased risks of suboptimal pregnancy outcomes after adjusting for BMI and glycemia.
Clinical Implications
Clinicians managing pregnant women with GDM can consider that the presence of PCOS does not necessarily confer additional risk for most adverse pregnancy outcomes when BMI and glycemic control are comparable. Dietary interventions aimed at gestational weight management appear equally effective in women with or without PCOS. However, heightened vigilance for neonatal jaundice may be warranted in infants born to mothers with PCOS.
Conclusion
In this cohort of women with GDM and comparable BMI and glycemia, PCOS was not linked to increased adverse pregnancy outcomes or reduced dietary intervention efficacy, though neonatal jaundice incidence was higher. These findings support tailored management focusing on metabolic control rather than PCOS status alone.
References
DiGest Study Group 2024 -- Link Between Polycystic Ovary Syndrome and Pregnancy Outcomes in Gestational Diabetes Mellitus
