Metabolic Disorders and Pregnancy: Research Review

Metabolic disorders, like diabetes and PCOS, can increase a person’s chance for infertility and miscarriage. When these disorders are properly diagnosed, studies indicate that taking metformin and/or getting blood sugar levels under control could help reduce chances of miscarriage or pregnancy complications. These tests look for signs of metabolic problems.

Polycystic ovarian syndrome (PCOS) is a common endocrine condition, characterized by high levels of androgens and resistance to insulin. People with PCOS are at an increased risk for infertility and pregnancy complications such as gestational diabetes and hypertension. These tests look for signs of insulin resistance and hormonal dysregulation.

Physiology and Published clinical data

Polycystic ovarian syndrome (PCOS), a multifactorial syndrome, is one of the most prevalent endocrine diseases affecting women of reproductive age¹. PCOS is currently diagnosed according to the Rotterdam criterion² determining the disease based on the presence of two out of three of the following symptoms^3-4:

• polycystic ovarian morphology
• clinical (hirsutism, acne)⁵ or biochemical hyperandrogenism (serum hormone measurement)
• oligo/amenorrhea

Although not included in the diagnostic criteria, insulin resistance may be central to the etiology of the syndrome^6-7 and this may be exacerbated by obesity. Women with PCOS commonly present with infertility and are at increased risk for pregnancy complications such as gestational diabetes and hypertension⁸.

Several studies have shown a strong association between AMH levels and PCOS. Serum AMH is a good diagnostic marker for PCOS as high AMH levels (cut off >3.19ng/mL) were correlated with oligo/amenorrhea and the appearance of polycystic ovaries on ultrasound^9-10.

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References

1. March,W.A.; Moore, V.M.;Willson, K.J.; Phillips, D.I.; Norman, R.J.; Davies, M.J. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum. Reprod. 2009, 25, 544–551.
2. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum. Reprod. 2004, 19, 41–47.
3. ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstet Gynecol. 2018 Jun;131(6): e157-e171.
4. Bustin, S.A.; Benes, V.; Garson, J.A.; Hellemans, J.; Huggett, J.; Kubista, M.; Mueller, R.; Nolan, T.; Pfa_, M.W.; Shipley, G.L.; et al. The MIQE guidelines: Minimum information for publication of quantitative real-time PCR experiments. Clin. Chem. 2009, 55, 611–622.
5. Lobo RA, Goebelsmann U, Horton R. Evidence for the importance of peripheral tissue events in the development of hirsutism in polycystic ovary syndrome. J Clin Endocrinol Metab 1983; 57: 393–7. (Level II-2)
6. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997; 18:774–800. (Level III).
7. Wang J, Wu D, Guo H, Li M. Hyperandrogenemia and insulin resistance: The chief culprit of polycystic ovary syndrome. Life Sci. 2019 Oct 8; 236:116940.
8. Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update 2006; 12:673–83.
9. Abbara A, Eng PC, Phylactou M, Clarke SA, Hunjan T, Roberts R, Vimalesvaran S, Christopoulos G, Islam R, Purugganan K, Comninos AN, Trew GH, Salim R, Hramyka A, Owens L, Kelsey T, Dhillo WS. Anti-Müllerian hormone (AMH) in the Diagnosis of Menstrual Disturbance Due to Polycystic Ovarian Syndrome. Front Endocrinol (Lausanne). 2019 Sep 26; 10:656.
10. Ahmed N, Batarfi AA, Bajouh OS, Bakhashab S. Serum Anti-Müllerian Hormone in the Diagnosis of Polycystic Ovary Syndrome in Association with Clinical Symptoms. Diagnostics (Basel). 2019 Oct 1; 9 (4).