Abstract:
BACKGROUND: Polycystic ovary syndrome (PCOS) is closely linked with insulin resistance and type 2 diabetes mellitus. OBJECTIVE: To determine the prevalence of PCOS in cohort of Sri Lankans with previous gestational diabetes mellitus (GDM). METHOD: Case-control cross-sectional analytical study. One hundred and thirty women with previous GDM and 67 controls were studied. Their history, anthropometry, fasting blood sugar, lipids, plasma testosterone, fasting insulin and transvaginal ultrasound scan for ovarian volume and polycystic (PCO) morphology were recorded. RESULTS: Diabetics- (n=130) Mean post partum duration was 61.7 weeks and age 34.7 5.11 years. 58.5 percent had PCO with ovarian volume of 10.8 cm3 vs. non-PCO volume of 2.9 cm3 (p = 0.002). Within group PCO vs. non-PCO had oligomenorrhoea (18.4 percent vs. 5.6 percent, p=0.02), acanthosis nigricans (54.7 percent vs. 31.8 percent, p=0.007), hirsuitism (13.2 percent vs. 3.7 percent) and previous subfertility (26.7 percent vs. 14.8 percent). Within group PCO vs. non PCO - plasma testosterone, fasting insulin, triglyceride and LDL cholesterol were higher; insulin sensitivity and SHBG lower among PCO, but not statistically significant. HDL cholesterol was significantly lower in PCO group. Although BMI and BP were similar, waist-hip ratio (WHR) was significantly higher (p=0.02) in PCO subjects. Controls- (n=67) Mean post partum duration 70.7 weeks, current age 31.7 4.9 years. BMI >25 kg/m2 in 11(16.4 percent), WHR >0.85 in 34 (50.7 percent). Seven had menstrual irregularity, four hirsuitism, two acne, five acanthosis nigricans and seven previous subfertility. Nine (13.4 percent) had polycystic ovaries with a mean ovarian volume of 4.9 ñ 4.5 cm3 GDM vs. Controls- PCO prevalence: 58.5 percent vs. 13.4 percent (p=0.0000), PCOS prevalence: 40 percent vs. 2.9 percent (p= 0.0000) CONCLUSIONS: PCO/PCOS is significantly more prevalent among Sri Lankan gestational diabetic women than among controls; but substantially less than the prevalence of' PCO amongst white Europeans with previous gestational diabetes.
