1. Assisted Reproductive Technology:
Predictive Factors for Gestational Diabetes Mellitus
Kouhkan A 1,2, Khamseh M.E 1, Moini A3,4,5, Pirjani R 4, Ebrahim Valojerdi A 1, Arabipoor A 3, Hosseini R 3,6, * , Baradaran H1*
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Department of Gynecology and Obstetrics, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
*Corresponding author Hamid Reza Baradaran (Ph.D.) and Roya Hosseini (M.D) Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran. Postal address: Firouzeh St., South Vali- Asr Ave., Vali- Asr Sq., Tehran, Iran. Postal code: Tel , Mob: ; Fax s address:
Objectives
Well-known predictors for development of diabetes in spontaneous pregnancy are maternal age, obesity, and family history of diabetes. To date, studies concerning ART outcomes were unable to establish GDM risk factors during ART procedures. It remains unclear which ART characteristic(s) is able to predict GDM in these subjects. Present study was performed to evaluate predictive factors for gestational diabetes mellitus (GDM) in singleton pregnancy following assisted conception.
In addition, the regression analysis revealed that previous OHSS risk (OR 2.40, 95% CI ) and history of PCOS (OR 2.76, 95% CI ) were other most important predictors of GDM.
Conclusions
The route of progesterone administration, previous OHSS risk and history of PCOS seem to be putative risk factors for GDM in women conceived by ART.These findings could be considered in patients' consultation before ART and after achieving pregnancy.
Methods
This nested case-control study was performed during October 2016 to June Pregnant women who conceived following ART procedures referred to infertility clinic were selected and categorized into GDM and non-GDM based on ADA/IAPDSG criteria. The study variables including age, educational status, and first-degree family history of chronic diseases, systolic and diastolic blood pressure, previous obstetric and perinatal outcomes, infertility history, and ART cycle characteristics were collected from medical records. Prediction model to develop GDM was employed by binary logistic regression analysis after adjustment for age and body mass index, family history of diabetes, and gravidity.
Results
In total, 270 women with singleton pregnancies (consisted of 135 GDM and 135 non-GDM women) conceived were studied. According to the final model, significant predictors of GDM were history of polycystic ovarian syndrome (PCOS), previous ovarian hyper-stimulation syndrome (OHSS) risk and progesterone injections. Administration of injectable progesterone during the first weeks of pregnancy was associated with an approximately two-fold increased risk of developing GDM [odds ratio (OR) 2.28, 95% confidence interval (CI) ) ] compared to vaginal progesterone.
Keywords
Gestational diabetes mellitus; assisted reproductive technology; predictive factors