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Wang Y, Gao H, Di W, Gu Z. Endocrinological and metabolic characteristics in patients who are non-obese and have polycystic ovary syndrome and different types of a family history of type 2 diabetes mellitus. J Int Med Res 2021; 49:3000605211016672. [PMID: 34024175 PMCID: PMC8142526 DOI: 10.1177/03000605211016672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective We aimed to investigate whether patients with polycystic ovary syndrome (PCOS) and a family history (FH) of type 2 diabetes mellitus (T2DM) are at increased risk of endocrinological and metabolic abnormalities, and whether this risk differs between first-degree and second-degree relatives, and between maternal and paternal transmission. Methods A total of 680 patients with PCOS were enrolled in this retrospective, single-center study. Endocrine and glycolipid metabolism parameters were compared. Results The free androgen index (FAI), and levels of fasting blood glucose (FBG), fasting insulin (FINS), homeostatic model assessment-insulin resistance (HOMA-IR), total cholesterol (TC), and low-density lipoprotein cholesterol were significantly higher, whereas sex hormone binding globulin (SHBG) levels were significantly lower in patients with PCOS and a FH of T2DM. In patients with PCOS with a FH of T2DM in first-degree relatives, age and levels of FBG, FINS, and HOMA-IR were significantly higher than those who had a FH of T2DM in second-degree relatives. A maternal history of T2DM was associated with a higher body mass index, FAI, and TG levels, and lower SHBG levels. Conclusions Patients with PCOS and a FH of T2DM have more severe hyperandrogenism and metabolic disorders, especially in those with maternal transmission.
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Affiliation(s)
- Yuan Wang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Hua Gao
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Wen Di
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.,Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.,State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhuowei Gu
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.,Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
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Managing cardiometabolic risk factors across a woman's lifespan: A lipidologist's perspective. J Clin Lipidol 2021; 15:423-430. [PMID: 33836983 DOI: 10.1016/j.jacl.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022]
Abstract
A recent rise in atherosclerotic cardiovascular disease (ASCVD) mortality in women warrants a heightened focus on the cardiometabolic risk factors that are closely tied to increasing trends in obesity and suboptimal lifestyle. Polycystic ovarian syndrome (PCOS), adverse pregnancy outcomes (APOs) and nonalcoholic fatty liver disease (NAFLD) are often manifestations of cardiometabolic disease that convey cardiovascular risk requiring recognition foremost, as well as a targeted approach to treatment. Similarly, menopause is a time to reflect on a woman's cardiovascular risk as multiple cardiometabolic changes occur during this time. Contraceptives and menopausal replacement therapy (MRT) should be considered along with a woman's individual thrombotic and cardiovascular risk. Clinicians should be attuned to cardiometabolic risk factors throughout a woman's lifespan and familiar with strategies to reduce cardiovascular risk.
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Yilmaz B, Vellanki P, Ata B, Yildiz BO. Diabetes mellitus and insulin resistance in mothers, fathers, sisters, and brothers of women with polycystic ovary syndrome: a systematic review and meta-analysis. Fertil Steril 2018; 110:523-533.e14. [PMID: 29960703 DOI: 10.1016/j.fertnstert.2018.04.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/02/2018] [Accepted: 04/16/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE(S) To analyze whether first-degree relatives (FDR) of patients with polysystic ovary syndrome (PCOS) have an increased risk of insulin resistance and glucose intolerance. DESIGN Systematic review and meta-analysis. SETTING None. PATIENT(S) Parents and siblings of women with and without PCOS. INTERVENTION(S) Search of PubMed database from 1960 to September 2017 with cross-checking of references of relevant articles in English. MAIN OUTCOME MEASURE(S) Prevalence of type 2 diabetes mellitus (T2DM) and impaired glucose tolerance, and levels of fasting insulin, 2-hour insulin levels, and homeostatic model assessment insulin resistance (HOMA IR). RESULT(S) Our search retrieved 4,796 articles of which 19 were included. The prevalence of T2DM was significantly increased in mothers and fathers of PCOS probands (rate ratio [RR] 2.43; 95% confidence interval [CI], 1.58-3.75, and RR 2.27; 95% CI, 1.25-4.12). Moreover, the fasting insulin (in mothers, fathers, and sisters) and HOMA IR (in mothers, fathers, and sisters) levels were statistically significantly higher in parents and siblings of PCOS patients. The sisters (RR 1.34; 95% CI, 0.59-3.03) and brothers (RR 1.51; 95% CI, 0.63-3.62) had a higher prevalence of T2DM than the control subjects, but the difference was not statistically significant. CONCLUSION(S) Our meta-analysis provides quantitative evidence demonstrating clustering of T2DM and insulin resistance in the parents and siblings of PCOS probands. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2016 CRD42016048551.
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Affiliation(s)
- Bulent Yilmaz
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Priyathama Vellanki
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University, Chicago, Illinois
| | - Baris Ata
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, School of Medicine, Koc University, Istanbul, Turkey
| | - Bulent Okan Yildiz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, School of Medicine, Hacettepe University, Ankara, Turkey.
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van der Kemp J, van der Schouw YT, Asselbergs FW, Onland-Moret NC. Women-specific risk factors for heart failure: A genetic approach. Maturitas 2018; 109:104-111. [DOI: 10.1016/j.maturitas.2017.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/22/2017] [Accepted: 12/29/2017] [Indexed: 02/07/2023]
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Yilmaz B, Vellanki P, Ata B, Yildiz BO. Metabolic syndrome, hypertension, and hyperlipidemia in mothers, fathers, sisters, and brothers of women with polycystic ovary syndrome: a systematic review and meta-analysis. Fertil Steril 2018; 109:356-364.e32. [PMID: 29331234 PMCID: PMC5983376 DOI: 10.1016/j.fertnstert.2017.10.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To provide an evidence-based assessment of metabolic syndrome, hypertension, and hyperlipidemia in first-degree relatives of women with polycystic ovary syndrome (PCOS). DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Mothers, fathers, sisters, and brothers of women with and without PCOS. INTERVENTION(S) An electronic-based search with the use of PubMed from 1960 to June 2015 and cross-checked references of relevant articles. MAIN OUTCOME MEASURE(S) Metabolic syndrome, hypertension and dyslipidemia, and surrogate markers, including systolic blood pressure (BP), diastolic BP, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. RESULT(S) Fourteen of 3,346 studies were included in the meta-analysis. Prevalence of the following was significantly increased in relatives of women with PCOS: metabolic syndrome (risk ratio [RR] 1.78 [95% confidence interval 1.37, 2.30] in mothers, 1.43 [1.12, 1.81] in fathers, and 1.50 [1.12, 2.00] in sisters), hypertension (RR 1.93 [1.58, 2.35] in fathers, 2.92 [1.92, 4.45] in sisters), and dyslipidemia (RR 3.86 [2.54, 5.85] in brothers and 1.29 [1.11, 1.50] in fathers). Moreover, systolic BP (mothers, sisters, and brothers), total cholesterol (mothers and sisters), low-density lipoprotein cholesterol (sisters), and triglycerides (mothers and sisters) were significantly higher in first-degree relatives of PCOS probands than in controls. CONCLUSION(S) Our results show evidence of clustering for metabolic syndrome, hypertension, and dyslipidemia in mothers, fathers, sisters, and brothers of women with PCOS. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2016 CRD42016048557.
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Affiliation(s)
- Bulent Yilmaz
- Department of Obstetrics and Gynecology, Izmir Katip Celebi University School of Medicine, Izmir, Turkey
| | - Priyathama Vellanki
- Division of Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, Georgia
| | - Baris Ata
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - Bulent Okan Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey.
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Abstract
PURPOSE OF REVIEW Polycystic ovary syndrome (PCOS) is diagnosed by its characteristic reproductive features. However, PCOS is also associated with metabolic abnormalities, including insulin resistance and β-cell dysfunction. The severity of these abnormalities varies according to the reproductive phenotype, with the so-called NIH or classic phenotype conferring the greatest metabolic risk. The increased risk for type 2 diabetes (T2D) is well established among affected women with the NIH phenotype, but whether PCOS also confers an increased risk for cardiovascular events remains unknown. RECENT FINDINGS Recent studies in daughters of affected women have found evidence for pancreatic β-cell dysfunction prior to menarche. Further, genetic analyses have provided evidence that metabolic abnormalities such as obesity and insulin resistance contribute to the pathogenesis of PCOS. PCOS increases the risk for T2D. However, the risk for cardiovascular disease has not been quantified, and prospective, longitudinal studies are still critically needed.
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Affiliation(s)
- Laura C Torchen
- Division of Endocrinology, Ann & Robert H Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Box 54, Chicago, IL, 60611, USA.
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
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Feichtinger M, Stopp T, Göbl C. [Metabolic and Reproductive Consequences of the Polycystic Ovary Syndrome (PCOS)]. Wien Med Wochenschr 2017; 166:139-42. [PMID: 26819214 DOI: 10.1007/s10354-016-0439-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Polycystic ovarian syndrome represents the most common endocrine disease of women of reproductive age. Symptoms include metabolic, gynecologic and cosmetic features. Genetic factors seem to contribute to the disease, affecting not only women but also male relatives of patients with similar symptoms. Besides, lifestyle factors play a central role impacting clinical PCOS appearance. Following we present an overview of the syndrome, its epidemiology, metabolic and gynecological aspects, gender and genetic factors and its therapy.
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Affiliation(s)
- Michael Feichtinger
- Abteilung für gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinik für Frauenheilkunde, Währinger Gürtel 18-20, 1090, Wien, Österreich.,Wunschbaby Institut Feichtinger, Lainzerstraße 6, 1130, Wien, Österreich
| | - Tina Stopp
- Abteilung für gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinik für Frauenheilkunde, Währinger Gürtel 18-20, 1090, Wien, Österreich.,Wunschbaby Institut Feichtinger, Lainzerstraße 6, 1130, Wien, Österreich
| | - Christian Göbl
- Abteilung für gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinik für Frauenheilkunde, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Vipin VP, Dabadghao P, Shukla M, Kapoor A, Raghuvanshi AS, Ramesh V. Cardiovascular disease risk in first-degree relatives of women with polycystic ovary syndrome. Fertil Steril 2016; 105:1338-1344.e3. [DOI: 10.1016/j.fertnstert.2016.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/15/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
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Torchen LC, Kumar A, Kalra B, Savjani G, Sisk R, Legro RS, Dunaif A. Increased antimüllerian hormone levels and other reproductive endocrine changes in adult male relatives of women with polycystic ovary syndrome. Fertil Steril 2016; 106:50-55. [PMID: 27042970 DOI: 10.1016/j.fertnstert.2016.03.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/01/2016] [Accepted: 03/15/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate for differences in reproductive hormone levels in male relatives of women with polycystic ovary syndrome (PCOS). DESIGN Cross-sectional study. SETTING Academic medical center. PATIENT(S) Sixty-three fathers and 66 brothers of women with PCOS as well as two groups of control men of comparable age to fathers (older control, n = 30) and brothers (younger control, n = 58). INTERVENTION(S) A single early morning fasting blood sample was obtained for the measurement of reproductive hormone levels. MAIN OUTCOME MEASURE(S) Testosterone, LH, FSH, antimüllerian hormone (AMH), inhibin B, estradiol (E2), and estrone (E1) levels were measured. RESULT(S) The AMH, LH, and FSH levels were significantly increased in male relatives compared with their respective control groups. The levels of E2, E1, T, and inhibin B did not differ between the groups. CONCLUSION(S) The AMH, LH, and FSH levels were increased in adult male relatives of women with PCOS, suggesting that they may have altered testicular function and changes in neuroendocrine regulation of gonadotropin secretion. These changes may reflect effects of PCOS susceptibility genes such as the recently mapped chromosome 11p14.1 locus in the region of the FSH B polypeptide gene.
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Affiliation(s)
- Laura C Torchen
- Division of Pediatric Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | | | - Ryan Sisk
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Chicago, Illinois
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Andrea Dunaif
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Chicago, Illinois.
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Louwers YV, Roest-Schalken ME, Kleefstra N, Roeters van Lennep J, van den Berg M, Fauser BCJM, Bilo HJG, Sijbrands EJG, Laven JSE. Excess mortality in mothers of patients with polycystic ovary syndrome. Hum Reprod 2014; 29:1780-6. [DOI: 10.1093/humrep/deu107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Kulshreshtha B, Singh S, Arora A. Family background of Diabetes Mellitus, obesity and hypertension affects the phenotype and first symptom of patients with PCOS. Gynecol Endocrinol 2013; 29:1040-4. [PMID: 24102267 DOI: 10.3109/09513590.2013.829446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The phenotypic variability among PCOS could be due to differences in insulin patterns. Hyperinsulinemia commonly accompanies Diabetes Mellitus (DM), obesity, hypertension and CAD, though, to a variable degree. We speculate that a family history of these diseases could differentially affect the phenotype of PCOS. AIM To study the effect of DM/CAD/HT and obesity on the phenotype of PCOS. METHODS PCOS patients and age matched controls were enquired for a family background of DM, hypertension, CAD and obesity among parents and grandparents. Regression modelling was employed to examine predictors of obesity and first symptom in PCOS patients. RESULTS There were 88 PCOS women and 77 age-matched controls (46 lean, 31 obese). A high prevalence of DM, CAD, obesity and hypertension was observed among parents and grandparents of women with PCOS compared to controls. Hypertension and CAD manifested more in father's side of family. BMI of PCOS subjects was significantly related to parental DM and obesity after correcting for age. First symptom of weight gain was significantly associated with number of parents with DM (p = 0.02) and first symptom of irregular periods was associated with number of parents with hypertension (p = 0.06). CONCLUSION A family background of DM/HT and obesity diseases affects the phenotype of PCOS.
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Dokras A. Cardiovascular disease risk in women with PCOS. Steroids 2013; 78:773-6. [PMID: 23624351 DOI: 10.1016/j.steroids.2013.04.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 03/28/2013] [Accepted: 03/28/2013] [Indexed: 01/07/2023]
Abstract
Cardiac disease is the number one killer in women. Adolescents and reproductive age women with PCOS have an increased prevalence of cardiovascular risk factors. These include obesity, impaired glucose tolerance, diabetes, hypertension, mood disorders and metabolic syndrome. There is sufficient evidence to confirm the presence of subclinical atherosclerosis in women with PCOS compared to age matched controls. There are, however, few prospective studies examining non-fatal and fatal cardiac events in women with well-defined PCOS. Future directions of research should include longitudinal studies in peri- and post-menopausal women with prospectively defined PCOS to better estimate the risk of cardiac morbidity and mortality in this high-risk population. In the meantime, regular screening for risk factors and timely early interventions are critical to reduce the overall risk burden.
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Affiliation(s)
- Anuja Dokras
- Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 800, Philadelphia, PA 19104, USA.
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Bates GW, Legro RS. Longterm management of Polycystic Ovarian Syndrome (PCOS). Mol Cell Endocrinol 2013; 373:91-7. [PMID: 23261983 PMCID: PMC4367484 DOI: 10.1016/j.mce.2012.10.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 10/12/2012] [Accepted: 10/30/2012] [Indexed: 12/15/2022]
Abstract
Polycystic Ovarian Syndrome (PCOS) has been associated with numerous reproductive and metabolic abnormalities. Despite tremendous advances in the management of reproductive dysfunction, insight into the metabolic implications of PCOS is limited by the lack of uniform diagnostic criteria, the heterogeneity of the condition and the presence of confounders including obesity. Obesity clearly has a role in long term health and may best predict both reproductive and metabolic dysfunction as well as negatively affect the response to treatment in women with PCOS. Diabetes, cardiovascular disease and cancer are also at the forefront of any risk assessment or comprehensive treatment strategy for these women. Lifestyle modifications including dietary changes, increased exercise and weight loss are appropriate first line interventions for many women with PCOS. Pharmaceuticals including metformin, lipid lowering agents and oral contraceptives should be tailored to the individual's risk profile and treatment goals.
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Affiliation(s)
- Gordon W Bates
- University of Alabama at Birmingham, Obstetrics and Gynecology, 10390 Women and Infants Center, Birmingham, AL 35249-7333, United States.
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Wang ET, Cirillo PM, Kao CN, Cohn BA, Cedars MI. Birth weight and childhood growth in daughters of women with irregular menstrual cycles. Gynecol Endocrinol 2013; 29:615-8. [PMID: 23656394 PMCID: PMC4346350 DOI: 10.3109/09513590.2013.788638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Menstrual irregularity has been associated with insulin resistance, type 2 diabetes mellitus and markers of metabolic dysfunction. This study aimed to determine whether irregular menstrual cycles (MCs) in reproductive-age women are associated with the weight of their daughters at birth and growth up to age five. We studied 4863 pregnant women with menstrual history data in a prospective cohort, recruited from the Kaiser Health Plan (1959-1966). Serial measures of their daughters' weight and height were abstracted from medical records. We used analysis of covariance, stratified by maternal body mass index, to explore the association between maternal MC and infant birth weight (BW). We included 4774 daughters in a repeated measures analysis to compare the effect of maternal MC on childhood weight through age five. Daughters of non-obese women with irregular MC had a statistically significant lower BW compared to daughters of women with regular MC; this difference was notably amplified among obese women. The daughters' weights were not statistically different when growth was assessed from birth to five years. We conclude that daughters of obese women with irregular MC, in particular, had significantly lower BW compared to daughters of women with regular MC, which did not persist over five years of follow-up.
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Affiliation(s)
- Erica T Wang
- Cedars Sinai Medical Center, 8635 W, 3rd Street 160W, Los Angeles, CA 90048, USA.
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Sasidevi A, Vellanki P, Kunselman AR, Raja-Khan N, Dunaif A, Legro RS. Familial aggregation of circulating C-reactive protein in polycystic ovary syndrome. Hum Reprod 2012; 28:770-6. [PMID: 23257395 DOI: 10.1093/humrep/des416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
STUDY QUESTION What is the heritability of C-reactive protein (CRP) levels in women with polycystic ovary syndrome (PCOS) and their first-degree relatives? SUMMARY ANSWER Women with PCOS and their siblings are more likely to have elevated CRP levels when both of their parents have elevated CRP. This PCOS family-based study indicates that CRP levels are likely a heritable trait. WHAT IS KNOWN ALREADY Previous studies have established that an elevated blood level of CRP is variably present in women with PCOS, and may be present independent of metabolic status. STUDY DESIGN, SIZE AND DURATION A familial based phenotyping study consisting of 81 families comprised of PCOS patients and their first-degree relatives for 305 subjects. PARTICIPANTS/MATERIALS, SETTING AND METHODS Study conducted at an academic health center. An elevated CRP level was defined as >28.6 nmol/l. To account for familial clustering, generalized estimating equations with a logit link were used to model the association between elevated CRP levels in patients with PCOS and their siblings with their parental group (A = neither parent with elevated CRP; B = one parent with elevated CRP; C= both parents with elevated CRP), adjusting for gender, age and BMI of the offspring. We did additional heritability analyses by using a variance component estimation method for CRP levels, adjusting for sex, age and BMI. MAIN RESULTS AND THE ROLE OF CHANCE We observed elevated CRP levels in 94% of the offspring in group C, 45% in group B and 10% in group A after adjusting for age, gender and BMI of the offspring. The median BMI of the offspring in group A, B and C were 30.0, 28.7 and 31.2 kg/m², respectively. Heritability estimates of CRP levels ranged from 0.75 to 0.83 and remained significant after excluding for type 2 diabetes mellitus. Our small sample size increases the possibility of a type 1 error. LIMITATIONS, REASONS FOR CAUTION This is a single report in an adequately powered but limited sample size study identifying the strong heritability of CRP levels. Replication in other large family cohorts is necessary. WIDER IMPLICATION OF THE FINDINGS These findings support the concept that there is an increased cardiovascular disease risk profile in families of women with PCOS. STUDY FUNDING/COMPETING INTEREST This research was supported by National Institutes of Health grants U54HD-034449 and P50 HD044405 (A.D.). Priyathama Vellanki is supported in part by NIH/NIDDK Training Grant T32 DK007169.
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Affiliation(s)
- Arunachalam Sasidevi
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
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Duleba AJ, Dokras A. Is PCOS an inflammatory process? Fertil Steril 2012; 97:7-12. [PMID: 22192135 DOI: 10.1016/j.fertnstert.2011.11.023] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/17/2011] [Accepted: 11/17/2011] [Indexed: 11/18/2022]
Abstract
PRO--PCOS is associated with low-grade systemic inflammation as evidenced by elevation of multiple markers of inflammation such as C-reactive protein, interleukin-18, monocyte chemoattractant protein-1 and white blood cell count as well as endothelial dysfunction and increased oxidative stress. CON--Current studies examining the evidence for low grade inflammation in PCOS are small, heterogeneous for the diagnosis, confounded by degree of adiposity and do not consistently demonstrate a clinically relevant increase in the above mentioned biomarkers.
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Affiliation(s)
- Antoni J Duleba
- Department of Obstetrics and Gynecology, University of California Davis, Sacramento, California 95817, USA.
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Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 2011; 97:28-38.e25. [PMID: 22153789 DOI: 10.1016/j.fertnstert.2011.09.024] [Citation(s) in RCA: 1018] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 09/13/2011] [Indexed: 12/11/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females, with a high prevalence. The etiology of this heterogeneous condition remains obscure, and its phenotype expression varies. Two widely cited previous ESHRE/ASRM sponsored PCOS consensus workshops focused on diagnosis (published in 2004) and infertility management (published in 2008), respectively. The present third PCOS consensus report summarizes current knowledge and identifies knowledge gaps regarding various women's health aspects of PCOS. Relevant topics addressed-all dealt with in a systematic fashion-include adolescence, hirsutism and acne, contraception, menstrual cycle abnormalities, quality of life, ethnicity, pregnancy complications, long-term metabolic and cardiovascular health, and finally cancer risk. Additional, comprehensive background information is provided separately in an extended online publication.
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