Diabetic Tendency in Polycystic Ovary Syndrome

Frederick R. Jelovsek MD

Both gestational diabetes and polycystic ovary syndrome are disorders that are associated with developing non-insulin-dependent diabetes later in life. All pregnancies show some degree of resistance to insulin but about 5-8% have an exaggerated response in which glucose metabolism is clearly abnormal and it is labelled sectional diabetes. Over 20% of patients who have gestational diabetes will develop non-insulin-dependent diabetes in later life.

Polycystic ovaries are a sign of anovulation and are often associated with changes of obesity, hypertension, diabetes and excessive hair growth (hirsutism). On ultrasound, the ovaries of these women often show bead-like, little cysts along the periphery of the ovary. Experts remind us that this is not actually one disease but actually a sign of a cascade of disorders encompassing atherosclerosis, obesity, hyperlipidemia, hypertension and androgen excess. There is still a lot to learn about this condition.

A recent study, Antilla L, et al.:Polycystic ovaries in women with gestational diabetes. Obstet Gynecol 1998;92:13- 6, looked at how often women with gestational diabetes have findings consistent with polycystic ovaries after they finished their pregnancy and any breast feeding. They looked at 30 women with gestational diabetes and 31 women without gestational diabetes 6-16 months after delivery. The control women were matched for age and prepregnancy body mass index. They found that 45% of the women with gestational diabetes had ultrasound findings consistent with polycystic ovaries whereas only 7% of the women without gestational diabetes had those findings.

The much higher incidence of polycystic ovaries in women who had gestational diabetes during pregnancy leads us to several conclusions:

• Women who are diagnosed with polycystic ovarian disease and subsequently get pregnant, should have routine glucose testing performed in pregnancy, perhaps more than once.
• Women who have gestational diabetes in pregnancy should be tested after pregnancy for polycystic ovaries, as well as have lipid profiles, serial blood pressures and periodic glucose tolerance tests to see if (and when) they develop non-insulin dependent diabetes.
• Physicians must do a better job in counselling women who have gestational diabetes about the post-pregnancy and lifelong medical problems they are at risk for.