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Nilsen GØ, Simpson MR, Hanem LGE, Løvvik T, Ødegård R, Stokkeland LMT, Andersen M, Juliusson PB, Vanky E. Anthropometrics of neonates born to mothers with PCOS with metformin or placebo exposure in utero. Acta Obstet Gynecol Scand 2024; 103:176-187. [PMID: 37488743 PMCID: PMC10755130 DOI: 10.1111/aogs.14637] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Fetal growth may be affected by both maternal polycystic ovary syndrome (PCOS) and metformin therapy. Here, we explore the effect of intrauterine metformin exposure on birth anthropometrics of infants born to women with PCOS. We also investigated whether the effect of metformin on birth anthropometrics is modified by maternal pre-pregnancy body mass index, PCOS hyperandrogenic phenotype, serum androgen levels, preconception use of metformin and offspring sex. Additionally, we assessed newborn anthropometrics in relation to a national reference population. MATERIAL AND METHODS Individual data from three randomized controlled triasl were pooled. The randomized controlled trials investigated the effects of metformin in pregnant women with PCOS. In all, 397 and 403 were randomized to the metformin and placebo groups, respectively. A Scandinavian growth reference was used to calculate sex and gestational age adjusted z-scores. Linear regression models were used to estimate the effect of metformin on offspring z-scores of head circumference, birth length, birthweight, placental weight, body mass index, ponderal index and birthweight:placental weight ratio. S-testosterone, s-androstenedione, and s-sex-hormone binding globulin from four timepoints in pregnancy were analyzed. RESULTS Compared with the PCOS-placebo group, newborns in the PCOS-metformin group had larger head circumference (head circumference z-score: mean difference = 0.25, 95% CI = 0.11- 0.40). This effect of metformin on head circumference z-score was particularly observed among offspring of overweight/obese mothers and mothers with hyperandrogenic PCOS-phenotype. We observed no difference in other anthropometric measures between the metformin and placebo groups or any clear interaction between maternal androgen levels and metformin. Newborns in the PCOS-placebo group were shorter than in the reference population (birth length z-score: mean = -0.04, 95% CI = -0.05 to -0.03), but head circumference and birthweight were similar. CONCLUSIONS Larger head circumference was observed at birth in metformin-exposed offspring of mothers with PCOS. PCOS-offspring were also shorter, with a similar birthweight to the reference population, indirectly indicating higher weight-to-height ratio at birth.
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Affiliation(s)
- Guro Ørndal Nilsen
- Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Melanie Rae Simpson
- Department of Public Health and NursingNorwegian University of Science and TechnologyTrondheimNorway
| | - Liv Guro Engen Hanem
- Children's Clinic, St. Olav's HospitalTrondheim University HospitalTrondheimNorway
| | - Tone Shetelig Løvvik
- Department of Clinical and Molecular MedicineFaculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Obstetrics and Gynecology, St. Olav's HospitalTrondheim University HospitalTrondheimNorway
| | - Rønnaug Ødegård
- Department of Clinical and Molecular MedicineFaculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Center for Obesity Research, St. Olav's HospitalTrondheim University HospitalTrondheimNorway
| | - Live Marie T. Stokkeland
- Department of Clinical and Molecular MedicineFaculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Center of Molecular Inflammation Research (CEMIR)Norwegian University of Science and Technology (NTNU)TrondheimNorway
| | | | - Petur Benedikt Juliusson
- Department of Health Registry Research and DevelopmentNational Institute of Public HealthBergenNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Eszter Vanky
- Department of Clinical and Molecular MedicineFaculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Obstetrics and Gynecology, St. Olav's HospitalTrondheim University HospitalTrondheimNorway
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Palm CVB, Dreyer AF, Boye H, Jørgensen JS, Wu C, Højsager FD, Jensen TK, Glintborg D, Andersen MS. Higher free testosterone in the third trimester was associated with lower abdominal circumference at birth in boys: Odense child cohort. BJOG 2024; 131:36-45. [PMID: 37443462 DOI: 10.1111/1471-0528.17595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To investigate associations between maternal testosterone status and offspring birth anthropometrics. DESIGN Population-based prospective cohort study. SETTING University Hospital. POPULATION 1486 mother-child dyads from Odense Child Cohort. METHODS Maternal blood samples were collected at gestational weeks 27-30 and free testosterone (FT) levels were calculated using the Vermeulen equation from total testosterone (TT) analysed by mass spectrometry and sex hormone binding globulin. Associations between FT or TT levels and birth anthropometrics were analysed with multiple linear regression models according to offspring sex with adjustment for maternal age, parity, smoking and educational level. Analyses were repeated with polycystic ovary syndrome as exposure for offspring birth anthropometrics. MAIN OUTCOME MEASURES Offspring birth weight (BW), birth length, abdominal and head circumferences. RESULTS Maternal mean (SD) age was 30.2 (4.5) years and pre-pregnancy body mass index was 23.5 (5.3) kg/m2 . In boys (n = 787), higher FT was associated with lower birth weight (adjusted doubling constant = -65.53, P = 0.010), shorter birth length (adjusted doubling constant = -0.43, P < 0.001), and lower abdominal circumference (adjusted doubling constant = -0.39, P < 0.001); Higher TT was associated with lower abdominal circumference (adjusted doubling constant = -0.25, P = 0.028). In girls, no associations were found between maternal FT or TT and offspring anthropometrics. CONCLUSIONS Higher maternal free testosterone exposure was linked to reduced birth weight, length and abdominal circumference in boys, whereas girls were not susceptible to maternal testosterone exposure.
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Affiliation(s)
- Camilla V B Palm
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anja F Dreyer
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Henriette Boye
- Odense Child Cohort, Hans Christian Andersen Hospital for Children and Adolescents, Odense University Hospital, Odense, Denmark
- OPEN Patient data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - Jan S Jørgensen
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Chunsen Wu
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Frederik D Højsager
- Odense Child Cohort, Hans Christian Andersen Hospital for Children and Adolescents, Odense University Hospital, Odense, Denmark
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Tina K Jensen
- Odense Child Cohort, Hans Christian Andersen Hospital for Children and Adolescents, Odense University Hospital, Odense, Denmark
- OPEN Patient data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Marianne S Andersen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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S J, S N, S SK, Haripriya G, Sheriff D, S JC, Mohammad H, K P. Anthropometric Measurements in Newborns: A Comparative Study of Infants Born to Mothers With and Without Polycystic Ovary Syndrome. Cureus 2023; 15:e48012. [PMID: 38034170 PMCID: PMC10687346 DOI: 10.7759/cureus.48012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Objective Fetal growth can be affected by maternal PCOS and may have an impact on offspring and childhood growth. The current findings across studies are divergent and controversial. This study aims to determine whether maternal PCOS can affect the physical measurements of newborns and to establish the differences in birth weight, length, head, and chest circumference between newborns of mothers with polycystic ovarian syndrome and those of mothers without polycystic ovarian syndrome. Methods In this study, we examined the gestational age, birth weight, length, head circumference, chest circumference, and ponderal index of 75 infants born to mothers with polycystic ovary syndrome (PCOS) and compared them to those of 94 infants born to mothers without PCOS. Result Compared with the other groups, the PCOS group does not show significant differences in anthropometric indices compared to the control group. Infants born to normal and PCOS mothers birth weight were categorized as SGA (small for gestational age) if birth weight was less than the 5th percentile. LGA is large for gestational age if birth weight is greater than the 90th percentile. Other appropriate for gestational age if infant birth weight is between> 5th and < 90th percentile. Significant differences in anthropometric indices like birth weight, head circumference, and Ponderal index were observed in SGA and LGA newborns of normal and PCOS mothers. Conclusion The study findings indicate that neonates born to mothers with PCOS have higher rates of SGA and LGA newborns, and differences in anthropometric indices (birth weight, head circumference, and Ponderal index) were observed between SGA and LGA newborns of PCOS mothers.
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Affiliation(s)
- Jayakumari S
- Anatomy, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Nirupa S
- Obstetrics and Gynaecology, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Shivaranjani K S
- Obstetrics and Gynecology, Sri Lalithambigai Medical College & Hospital, Chennai, IND
| | - Geetha Haripriya
- Obstetrics and Gynecology, Prashanth Fertility Research Centre, Chennai, IND
| | | | - Janaki C S
- Anatomy, Bharath Medical College and Hospital, Chennai, IND
| | | | - Prabhu K
- Anatomy, Sree Balaji Medical College and Hospital, Chennai, IND
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Ryu KJ, Wi WY, Nam S, Jeong HG, Cho GJ, Park H, Kim T. Maternal Polycystic Ovary Syndrome and the Risk of Early Childhood Obesity in Female Offspring: A Nationwide Population-Based Study. J Korean Med Sci 2023; 38:e111. [PMID: 37038646 PMCID: PMC10086379 DOI: 10.3346/jkms.2023.38.e111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/02/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND To investigate the relationship between polycystic ovary syndrome (PCOS) in Korean women and childhood growth and obesity of their offspring. METHODS This longitudinal case-control study using the Korean National Health Insurance claims database and the National Health Screening Program for Infants and Children database included women who delivered singletons between January 2007 and December 2008. Offspring's body mass index (BMI) measurements taken between 42 and 80 months of age were compared according to a maternal history of PCOS. RESULTS Among a total of 131,805 participants, 1,213 women had a history of PCOS and 130,592 women did not. Female offspring aged 66-80 months born to women with PCOS had significantly higher BMI than those born to women without PCOS; there was no significant difference in that of male offspring regardless of maternal PCOS. In the generalized estimating equation and multivariable logistic regression analyses, the female offspring born to women with PCOS had a significantly higher risk of obesity during the age of 42-54 and 66-80 months (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.09-2.21 and OR, 1.5; 95% CI, 1.05-2.15, respectively), than those born to women without PCOS, after adjusting for several confounding factors. CONCLUSION Maternal PCOS is independently associated with an increased incidence of childhood obesity in female offspring among Korean women. Women with PCOS should consider the risk of early childhood obesity in their daughters, even if they maintain a healthy weight themselves.
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Affiliation(s)
- Ki-Jin Ryu
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Won Young Wi
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seunghyun Nam
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hye Gyeong Jeong
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Hyuntae Park
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Prenatal Androgen Exposure and Traits of Autism Spectrum Disorder in the Offspring: Odense Child Cohort. J Autism Dev Disord 2023; 53:1053-1065. [PMID: 35124780 DOI: 10.1007/s10803-022-05446-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
Fetal androgen exposure may be associated with autism spectrum disorder (ASD). We studied 1777 mother-child pairs in the prospective Odense Child Cohort. Prenatal androgen exposure was assessed by maternal 3rd trimester testosterone concentrations, maternal polycystic ovary syndrome (PCOS), and 3 months offspring anogenital distance. ASD traits were assessed at age 3 years with the ASD-symptom scale of the Child Behavior Checklist for ages 1½-5 years. Maternal testosterone was positively associated with traits of ASD in boys (p < 0.05). Maternal PCOS was associated with increased offspring ASD traits (p = 0.046), but became non-significant after excluding parental psychiatric diagnosis. Offspring anogenital distance was not linked to ASD traits. Higher prevalence of ASD in boys could be linked to higher susceptibility to fetal androgen exposure.
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Wei SQ, Bilodeau-Bertrand M, Auger N. Association of PCOS with offspring morbidity: a longitudinal cohort study. Hum Reprod 2022; 37:2135-2142. [PMID: 35830879 DOI: 10.1093/humrep/deac154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/15/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Do children whose mothers have polycystic ovary syndrome (PCOS) have an increased risk of morbidity? SUMMARY ANSWER Maternal PCOS is associated with an increased risk of infection, allergy and other childhood morbidity. WHAT IS KNOWN ALREADY PCOS is associated with higher rates of gestational diabetes, pre-eclampsia and preterm delivery, but the long-term impact on child health is poorly understood. STUDY DESIGN, SIZE, DURATION We conducted a retrospective longitudinal cohort study of 1 038 375 children in Quebec between 2006 and 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS We included 7160 children whose mothers had PCOS and 1 031 215 unexposed children. Outcomes included child hospitalization for infectious, allergic, malignant and other diseases before 13 years of age. We estimated hazard ratios (HRs) and 95% CI for the association of PCOS with childhood morbidity in adjusted Cox proportional hazards regression models. MAIN RESULTS AND THE ROLE OF CHANCE Children exposed to PCOS were hospitalized at a rate of 68.9 (95% CI 66.2-71.8) per 1000 person-years, whereas unexposed children were hospitalized at a rate of 45.3 (95% CI 45.1-45.5) per 1000 person-years. Compared with no exposure, maternal PCOS was associated with 1.32 times the risk of any childhood hospitalization (95% CI 1.26-1.40), 1.31 times the risk of infectious disease hospitalization (95% CI 1.25-1.38) and 1.47 times the risk of allergy-related hospitalization (95% CI 1.31-1.66). Risk of hospitalization was also elevated for childhood metabolic (HR 1.59, 95% CI 1.16-2.18), gastrointestinal (HR 1.72, 95% CI 1.53-1.92), central nervous system (HR 1.74, 95% CI 1.46-2.07) and otologic disorders (HR 1.34, 95% CI 1.26-1.43). Subgroup analyses suggested that there was little difference in the association of PCOS with hospitalization among boys (HR 1.31, 95% CI 1.24-1.39) and girls (HR 1.34, 95% CI 1.26-1.43). LIMITATIONS, REASONS FOR CAUTION We analyzed severe childhood morbidity requiring hospitalization, not mild diseases treated in ambulatory clinics. We lacked data on ethnicity, education and physical activity, and cannot rule out residual confounding. WIDER IMPLICATIONS OF THE FINDINGS Our findings suggest that maternal PCOS is associated with an increased risk of childhood morbidity. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grant PJT-162300 from the Canadian Institutes of Health Research. N.A. acknowledges a career award from the Fonds de recherche du Québec-Santé (296785). The authors declare no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Shu Qin Wei
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Canada.,Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Canada
| | - Marianne Bilodeau-Bertrand
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Canada
| | - Nathalie Auger
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.,Department of Social and Preventive Medicine, School of Public Health, University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada
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7
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Elevated blood pressure in pregnant women with gestational diabetes according to the WHO criteria: importance of overweight. J Hypertens 2022; 40:1614-1623. [PMID: 35792096 DOI: 10.1097/hjh.0000000000003196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hypertension before and during early pregnancy has been associated with an increased risk of gestational diabetes mellitus (GDM) in retrospective analyses. We aimed to investigate the prospective blood pressure trackings in a population-based cohort of pregnant women, who were stratified according to their metabolic status in early third trimester. METHODS We recorded blood pressure longitudinally during pregnancy in 1230 women from the Odense Child Cohort, Denmark. Fasting glucose and insulin were measured at gestational weeks 28-30. Metabolic status was evaluated according to the WHO 2013 threshold for GDM (GDM-WHO: fasting plasma glucose ≥5.1 mmol/l), insulin and homeostatic model assessment of insulin resistance (HOMA-IR). Relationships between metabolic status in third trimester and blood pressure trajectories were evaluated with adjusted linear mixed models. Trajectory was defined as blood pressure records in pregnancy per 4 weeks interval. RESULTS Prevalence of GDM-WHO was 40% (498/1230). GDM-WHO was associated with 1.46 (0.22-2.70) mmHg higher SBP and 1.04 (0.07-2.01) mmHg higher DBP trajectories in the overall cohort. The associations were driven by differences in the overweight group, with 3.14 (1.05-5.25) mmHg higher SBP and 1.94 (0.42-3.47) mmHg higher DBP per 4 weeks in women with GDM-WHO compared with women without GDM-WHO. GDM-WHO was not associated with blood pressure in women with normal weight. Blood pressure trajectories were elevated across quartiles of insulin resistance. CONCLUSION GDM-WHO is associated with higher blood pressure in pregnancy, and there appears to be a stronger effect in overweight women.
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Zhang F, Ying L, Zhang Q, Wang F, Qu F. Association between maternal polycystic ovary syndrome and early childhood growth: a continuous observation from 3 months to 6 years of age. J Assist Reprod Genet 2022; 39:461-471. [PMID: 35048272 PMCID: PMC8956758 DOI: 10.1007/s10815-021-02378-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate whether maternal PCOS could impact growth and development in offspring at an early age through continuous observation from age 3 months to 6 years. METHODS This prospective study was conducted in 198 children born to mothers with PCOS and 227 children born to healthy mothers in Ningbo (Zhejiang Province, China) between October 2012 and July 2015. Measurements of offspring height, weight, head circumference, and teething were examined by trained professionals through age 6 years. Height, weight, and body mass index (BMI) were analysed using repeated measures analysis of variance between the PCOS and control groups. RESULTS Offspring born to women with PCOS showed significantly higher BMI at age 12, 18, and 30 months and 5 years (P = 0.040, P = 0.000, P = 0.000, and P = 0.023, respectively). Female offspring born to women with PCOS showed significantly increased body weight at 3, 8, 12, 18, and 30 months, and 3 and 6 years (P = 0.027, P = 0.008, P = 0.010, P = 0.034, P = 0.047, P = 0.040, and P = 0.035, respectively) and significantly higher BMI at 3, 8, 12, 18, and 30 months (P = 0.009, P = 0.016, P = 0.029, P = 0.000, and P = 0.000, respectively). After adjusting for maternal, paternal, and pregnancy confounders, PCOS status presented significant associations with weight at age 3, 8, and 12 months and 3 years (P = 0.005, P = 0.004, P = 0.021, P = 0.035 respectively), and with BMI at age 3 and 8 months (P = 0.011 and P = 0.014) in female offspring. CONCLUSIONS Maternal PCOS is associated with an increased risk of developing obesity in female offspring.
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Affiliation(s)
- Fangfang Zhang
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006 People’s Republic of China
| | - Liying Ying
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006 People’s Republic of China ,Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang 315100 People’s Republic of China
| | - Qing Zhang
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006 People’s Republic of China
| | - Fangfang Wang
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006 People’s Republic of China
| | - Fan Qu
- grid.13402.340000 0004 1759 700XWomen’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, 310006 People’s Republic of China
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Dalgaard CM, Andersen MS, Jensen RC, Larsen PV, Find LG, Boye H, Jensen TK, Bilenberg N, Glintborg D. Maternal polycystic ovary syndrome and attention deficit hyperactivity disorder in offspring at 3 years of age: Odense Child Cohort. Acta Obstet Gynecol Scand 2021; 100:2053-2065. [PMID: 34490610 DOI: 10.1111/aogs.14259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/07/2021] [Accepted: 08/22/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous data suggested a link between maternal polycystic ovary syndrome (PCOS) and offspring attention deficit hyperactivity disorder (ADHD), which could be mediated by higher prenatal androgen exposure. MATERIAL AND METHODS The study was part of the prospective Odense Child Cohort and included 1776 pregnant women, 165 (9%) with PCOS and 1607 (91%) controls. ADHD symptoms at 3 years of age were defined using the parent-reported questionnaire Child Behavior Checklist/1.5-5 (scores >90th centile of Danish national standard). Maternal blood samples were collected in the third trimester measuring total testosterone by mass spectrometry, sex hormone-binding globulin, and calculated free testosterone. Offspring anogenital distance was measured at 3 months of age. Regression models were performed with presence of ADHD symptoms as the dependent variable and adjusted for maternal age, body mass index, parity, smoking status, educational level, and parental psychiatric diagnoses. RESULTS ADHD symptoms were present in 105/937 (11%) boys and 72/839 (9%) girls. In boys, maternal PCOS was positively associated with ADHD symptoms (unadjusted odds ratio [OR] 1.91, 95% CI 1.07-3.43, p = 0.03, adjusted OR 2.20, 95% CI 1.20-4.02, p = 0.01), whereas maternal PCOS was not associated with ADHD symptoms in girls. Maternal total testosterone, free testosterone, and offspring anogenital distance were not associated with higher risk of ADHD symptoms in the offspring. CONCLUSIONS Higher risk of ADHD in boys born of mothers with PCOS were not associated with maternal third-trimester testosterone levels or offspring anogenital distance.
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Affiliation(s)
- Cilia M Dalgaard
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Marianne S Andersen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Richard C Jensen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Pia V Larsen
- Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Laura G Find
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Henriette Boye
- Odense Child Cohort, Hans Christian Andersen Hospital for Children, Odense University Hospital, Odense, Denmark.,OPEN Patient Data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - Tina K Jensen
- Odense Child Cohort, Hans Christian Andersen Hospital for Children, Odense University Hospital, Odense, Denmark.,OPEN Patient Data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark.,Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Odense University Hospital, Odense, Denmark
| | - Niels Bilenberg
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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10
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Glintborg D, Jensen RC, Schmedes AV, Brandslund I, Kyhl HB, Jensen TK, Andersen MS. Anogenital distance in children born of mothers with polycystic ovary syndrome: the Odense Child Cohort. Hum Reprod 2020; 34:2061-2070. [PMID: 31560039 DOI: 10.1093/humrep/dez122] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/18/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Are higher testosterone levels during pregnancy in women with polycystic ovary syndrome (PCOS) associated with longer offspring anogenital distance (AGD)? SUMMARY ANSWER AGD was similar in 3-month-old children born of mothers with PCOS compared to controls. WHAT IS KNOWN ALREADY AGD is considered a marker of prenatal androgenization. STUDY DESIGN, SIZE, DURATION Maternal testosterone levels were measured by mass spectrometry at Gestational Week 28 in 1127 women. Maternal diagnosis of PCOS before pregnancy was defined according to Rotterdam criteria. Offspring measures included AGD from anus to posterior fourchette (AGDaf) and clitoris (AGDac) in girls and to scrotum (AGDas) and penis (AGDap) and penile width in boys and body composition (weight and BMI SD scores) at age 3 months. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was part of the prospective study, Odense Child Cohort (OCC), and included mothers with PCOS (n = 139) and controls (n = 1422). The control population included women with regular menstrual cycles (<35 days) before conception and no signs of androgen excess (hirsutism and/or acne). MAIN RESULTS AND THE ROLE OF CHANCE AGD measures were comparable in offspring of women with PCOS compared to controls (all P > 0.2) despite significantly higher maternal levels of total testosterone (mean: 2.4 versus 2.0 nmol/l) and free testosterone (mean: 0.005 versus 0.004 nmol/l) in women with PCOS versus controls (both P < 0.001). In women with PCOS, maternal testosterone was an independent positive predictor of offspring AGDas and AGDap in boys. Maternal testosterone levels did not predict AGD in girls born of mothers with PCOS or in boys or girls born of women in the control group. LIMITATIONS, REASONS FOR CAUTION The diagnosis of PCOS was based on retrospective information and questionnaires during pregnancy. Women participating in OCC were more ethnically homogenous, leaner, more educated and less likely to smoke compared to the background population. Our study findings, therefore, need to be reproduced in prospective study cohorts with PCOS, in more obese study populations and in women of other ethnicities. WIDER IMPLICATIONS OF THE FINDINGS Our finding of the same AGD in girls born of mothers with PCOS compared to controls expands previous results of studies reporting longer AGD in adult women with PCOS. Our results suggest that longer AGD in adult women with PCOS could be the result of increased testosterone levels in puberty, perhaps in combination with weight gain. STUDY FUNDING/COMPETING INTEREST(S) Financial grants for the study were provided by the Danish Foundation for Scientific Innovation and Technology (09-067180), Ronald McDonald Children Foundation, Odense University Hospital, the Region of Southern Denmark, the Municipality of Odense, the Mental Health Service of the Region of Southern Denmark, The Danish Council for Strategic Research, Program Commission on Health, Food and Welfare (2101-08-0058), Odense Patient data Explorative Network, Novo Nordisk Foundation (grant no. NNF15OC00017734), the Danish Council for Independent Research and the Foundation for research collaboration between Rigshospitalet and Odense University Hospital and the Health Foundation (Helsefonden). There is no conflict of interest of any author that could be perceived as prejudicing the impartiality of the research reported.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University, Odense, Denmark
| | - Richard Christian Jensen
- Department of Endocrinology and Metabolism, Odense University, Odense, Denmark.,Department of Environmental Medicine, Odense University Hospital, Odense, Denmark
| | | | - Ivan Brandslund
- Department of Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, SDU, Odense, Denmark
| | - Henriette Boye Kyhl
- Odense Child Cohort, Hans Christian Andersen Hospital for Children and Adolescents, Odense University Hospital, Odense, Denmark.,Odense Patient data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - Tina Kold Jensen
- Department of Environmental Medicine, Odense University Hospital, Odense, Denmark.,Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Mild maternal sleep-disordered breathing during pregnancy and offspring growth and adiposity in the first 3 years of life. Sci Rep 2020; 10:13979. [PMID: 32814798 PMCID: PMC7438510 DOI: 10.1038/s41598-020-70911-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/06/2020] [Indexed: 01/06/2023] Open
Abstract
Sleep-disordered breathing (SDB) during pregnancy has been linked to adverse fetal outcomes. Since the intrauterine milieu plays a critical role in childhood growth, we explored the interactions between maternal SDB and offspring growth and adiposity patterns during infancy. Fifty-eight healthy women with uncomplicated pregnancies underwent an objective sleep study and laboratory evaluation during the third trimester, their offspring underwent a 3-year growth surveillance. The 14 (24.1%) women with SDB had a higher body mass index (BMI) (P = 0.003), elevated C-reactive protein levels (P = 0.003), and decreased HDL-cholesterol levels (P = 0.009) than the women without SDB. A general linear model evaluated the interactions between maternal SDB and offspring growth and adiposity measurements after controlling for gestational age and maternal and paternal BMIs. The offspring of mothers with SDB had a significantly smaller head circumference at birth (P = 0.004), with a distinctive pattern of catchup growth by the end of the first year of life (P = 0.018). Their growth pattern was distinguished by compromised birth weight-to-length, rapid catch-up growth, and an increase in both weight-to-length and triceps thickness by the age of three (P < 0.001 and P = 0.001, respectively). Our findings suggest that maternal SDB during pregnancy affects head circumference growth and adiposity acquisition from birth through infancy.
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Andersen MS, Jensen RC, Schmedes AV, Brandslund I, Kyhl HB, Jensen TK, Glintborg D. Third trimester cortisol status is associated with offspring sex and polycystic ovary syndrome status: Odense Child Cohort. Fertil Steril 2019; 112:764-772. [DOI: 10.1016/j.fertnstert.2019.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/06/2019] [Accepted: 05/07/2019] [Indexed: 12/15/2022]
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Vanky E, Engen Hanem LG, Abbott DH. Children born to women with polycystic ovary syndrome-short- and long-term impacts on health and development. Fertil Steril 2019; 111:1065-1075. [PMID: 31056313 DOI: 10.1016/j.fertnstert.2019.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 12/30/2022]
Abstract
Maternal PCOS status may negatively influence offspring infant and childhood growth, cardiometabolic health, reproductive health, and neurodevelopment. Current findings across studies are divergent, often because of small numbers of subjects, as well as heterogeneous selection criteria, ethnicities, and definitions of control groups. Coexisting maternal obesity, pregnancy complications, and comorbidity make it difficult to identify the contribution of maternal PCOS. Large, prospective, international, multiethnic studies with standardized investigation protocols and questionnaires on PCOS offspring health and development are needed.
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Affiliation(s)
- Eszter Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Gynecology and Obstetrics, St. Olav's Hospital, Trondheim, Norway.
| | - Liv Guro Engen Hanem
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - David H Abbott
- Department of Obstetrics and Gynecology and Wisconsin National Primate Research Center, University of Wisconsin, Madison, Wisconsin
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Palm CVB, Glintborg D, Kyhl HB, McIntyre HD, Jensen RC, Jensen TK, Jensen DM, Andersen M. Polycystic ovary syndrome and hyperglycaemia in pregnancy. A narrative review and results from a prospective Danish cohort study. Diabetes Res Clin Pract 2018; 145:167-177. [PMID: 29689322 DOI: 10.1016/j.diabres.2018.04.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/17/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insulin resistance is common in polycystic ovary syndrome (PCOS). PCOS may be associated with increased risk of gestational diabetes mellitus (GDM). OBJECTIVES To (1) review literature regarding PCOS and hyperglycaemia in pregnancy and (2) present original data from Odense Child Cohort (OCC) regarding GDM in PCOS. METHODS Literature search including original studies from 2000-18. OCC included 2548 pregnant women, 9.5% (n = 241) had PCOS. Fasting plasma glucose was measured in 1519 and 659 oral glucose tolerance tests were performed (with risk factor for GDM, n = 384, without risk factors, n = 275), applying two different GDM criteria. RESULTS 30 studies were eligible using 12 different sets of diagnostic criteria for GDM. Ten studies included n > 50, control group, assessment of GDM and BMI. Results were not uniform, but supported that higher BMI, higher age, Asian ethnicity, and fertility treatment increased the risk of GDM in PCOS. In OCC, women with PCOS and controls had similar prevalences of GDM independent of different sets of criteria for GDM. CONCLUSION PCOS may not be an individual risk factor for GDM. Pregnancies in PCOS are characterized by factors known to increase risk of GDM, especially high BMI and fertility treatment.
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Affiliation(s)
- Camilla Viola Buskbjerg Palm
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark; Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Henriette Boye Kyhl
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Odense Patient Data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - H David McIntyre
- Mater Research, University of Queensland, Brisbane, Australia; Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | | | - Tina Kold Jensen
- Odense Patient Data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Dorte Møller Jensen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark; Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Marianne Andersen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.
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15
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Glintborg D, Jensen RC, Bentsen K, Schmedes AV, Brandslund I, Kyhl HB, Bilenberg N, Andersen MS. Testosterone Levels in Third Trimester in Polycystic Ovary Syndrome: Odense Child Cohort. J Clin Endocrinol Metab 2018; 103:3819-3827. [PMID: 30060213 DOI: 10.1210/jc.2018-00889] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/24/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism. In pregnancy, testosterone levels may be higher in women with PCOS compared with controls. AIMS To compare total testosterone (TT), free testosterone (FT), and sex hormone-binding globulin (SHBG) levels in third-trimester pregnant women with PCOS and controls and to establish reference ranges for TT, FT, and SHBG in PCOS and controls. METHODS The study was part of the prospective study, Odense Child Cohort. PCOS was diagnosed by questionnaires and/or patient records. Fasting blood samples were collected at gestational week 28 and plasma TT was measured by liquid chromatography-tandem mass spectrometry in women with PCOS (n = 145) and in women without PCOS (controls, n = 1341). RESULTS Levels of TT (mean, 2.4 vs 2.0 nmol/L) and FT (mean, 0.005 vs 0.004 nmol/L) were higher, whereas SHBG levels (mean, 447 vs 477 nmol/L) were lower in women with PCOS vs controls (all P < 0.001). Reference intervals for TT, FT, and SHBG in women with PCOS and controls were overlapping, and partitioning of reference intervals was an ambiguous decision. In multiple regression analyses, TT and FT levels were positively associated with PCOS status and BMI and inversely associated with age and parity. Offspring sex did not predict maternal TT and FT. CONCLUSIONS TT and FT levels were higher in third-trimester pregnant women with PCOS compared with controls. Separate reference interval for FT in women with PCOS should be considered.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University, Odense C, Denmark
| | - Richard Christian Jensen
- Department of Endocrinology and Metabolism, Odense University, Odense C, Denmark
- Department of Environmental Medicine, Odense University Hospital, Odense C, Denmark
| | - Kristian Bentsen
- Department of Endocrinology and Metabolism, Odense University, Odense C, Denmark
| | | | - Ivan Brandslund
- Department of Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark (SDU), Odense C, Denmark
| | - Henriette Boye Kyhl
- Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark
- Odense Patient Data Exploratory Network (OPEN), University of Southern Denmark, Odense C, Denmark
| | - Niels Bilenberg
- Child and Adolescent Psychiatric Department, Odense, Mental Health Hospital and University Clinic, Region of Southern Denmark, Odense C, Denmark
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Andersen M, Glintborg D. Diagnosis and follow-up of type 2 diabetes in women with PCOS: a role for OGTT? Eur J Endocrinol 2018; 179:D1-D14. [PMID: 29921567 DOI: 10.1530/eje-18-0237] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022]
Abstract
Polycystic ovary syndrome (PCOS) is common in premenopausal women. The majority of women with PCOS have insulin resistance and the risk of type 2 diabetes mellitus (T2D) is higher in women with PCOS compared to controls. In non-pregnant women with PCOS, glycemic status may be assessed by oral glucose tolerance test (OGTT), fasting plasma glucose (FPG) or HbA1c. OGTT has been reckoned gold standard test for diagnosing T2D, but OGTT is rarely used for diagnostic purpose in other non-pregnant individuals at risk of T2D, apart from PCOS. OGTT has questionable reproducibility, and high sensitivity of the 2-h glucose value is at the expense of relatively low specificity, especially regarding impaired glucose tolerance (IGT). Furthermore, lean women with PCOS are rarely diagnosed with T2D and only few percent of normal-weight women have prediabetes. Glycemic status is necessary at diagnosis and during follow-up of PCOS, especially in women with high risk of T2D (obesity, previous gestational diabetes (GDM)). We suggest that OGTT should be used in the same situations in PCOS as in other patient groups at risk of T2D. OGTT is indicated for diagnosing GDM; however, OGTT during pregnancy may not be indicated in lean women with PCOS without other risk factors for GDM.
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Affiliation(s)
- Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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McIntyre HD, Jensen DM, Jensen RC, Kyhl HB, Jensen TK, Glintborg D, Andersen M. Gestational Diabetes Mellitus: Does One Size Fit All? A Challenge to Uniform Worldwide Diagnostic Thresholds. Diabetes Care 2018; 41:1339-1342. [PMID: 29559508 DOI: 10.2337/dc17-2393] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To define the prevalence and pregnancy outcomes related to elevated fasting venous plasma glucose (FVPG) in a Danish pregnancy cohort. RESEARCH DESIGN AND METHODS This was an observational cohort study including 1,516 women without gestational diabetes mellitus (GDM) by Danish criteria. FVPG measured at 28 weeks' gestation was related to pregnancy outcomes. RESULTS With use of the World Health Organization (WHO) 2013 threshold of FVPG ≥5.1 mmol/L, 40.1% of the cohort qualified as having GDM. There was no evidence of excess fetal growth, hypertension in pregnancy, or cesarean delivery in women with FVPG <5.6 mmol/L. CONCLUSIONS The WHO 2013 FVPG threshold for GDM is unsuitable for Denmark. It inappropriately labels as having GDM an unmanageably large number of women who are at low absolute risk of pregnancy complications.
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Affiliation(s)
- H David McIntyre
- Mater Research and Mater Clinical Unit, The University of Queensland, South Brisbane, Queensland, Australia .,Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | - Dorte M Jensen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Richard C Jensen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Department of Environmental Medicine, Odense University Hospital, Odense, Denmark.,Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Henriette B Kyhl
- Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Odense Patient data Explorative Network, Odense, Denmark
| | - Tina K Jensen
- Department of Environmental Medicine, Odense University Hospital, Odense, Denmark.,Odense Patient data Explorative Network, Odense, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Hanem LGE, Stridsklev S, Júlíusson PB, Salvesen Ø, Roelants M, Carlsen SM, Ødegård R, Vanky E. Metformin Use in PCOS Pregnancies Increases the Risk of Offspring Overweight at 4 Years of Age: Follow-Up of Two RCTs. J Clin Endocrinol Metab 2018; 103:1612-1621. [PMID: 29490031 DOI: 10.1210/jc.2017-02419] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/26/2018] [Indexed: 12/30/2022]
Abstract
CONTEXT Metformin is used in pregnancy in women with gestational diabetes mellitus, polycystic ovary syndrome (PCOS), and obesity. Metformin passes the placenta. OBJECTIVE To explore the effects of metformin use in PCOS pregnancies on offspring growth to 4 years of age. DESIGN Follow-up study of two randomized, double-blind, placebo-controlled trials. SETTING Secondary care centers. Eleven public hospitals in Norway. PARTICIPANTS One hundred eighty-two children of mothers with PCOS who participated in two randomized controlled trials. INTERVENTION Metformin 1700 or 2000 mg/d or placebo from first trimester to delivery in the original studies. No intervention in the current study. MAIN OUTCOME MEASURES Height, weight, body mass index (BMI), and overweight/obesity at 4 years of age and head circumference at 1 year of age, converted to z scores. RESULTS The difference in height z score means between the groups at 4 years of age was nonsignificant (0.07 [95% confidence interval (CI): -0.22 to 0.36]; P = 0.651). At 4 years of age, the metformin group had higher weight z score than the placebo group [difference in means: 0.38 (0.07 to 0.69); P = 0.017] and higher BMI z score [difference in means: 0.45 (0.11 to 0.78); P = 0.010]. There were more overweight/obese children in the metformin group [26 (32%)] than in the placebo group [14 (18%)] at 4 years of age [odds ratio: 2.17 (1.04 to 4.61); P = 0.038]. The difference in mean head circumference z score at 1 year of age was 0.27 (-0.04 to 0.58; P = 0.093). CONCLUSION Metformin-exposed children had higher BMI and increased prevalence of overweight/obesity at 4 years of age.
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Affiliation(s)
- Liv Guro Engen Hanem
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solhild Stridsklev
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Pétur B Júlíusson
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Øyvind Salvesen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mathieu Roelants
- Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium
| | - Sven M Carlsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Rønnaug Ødegård
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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