Polycystic ovary syndrome Ppt Powerpoint Presentation slides CJ Glueck Medical Slideshow Polycystic Ovary Syndrome

Polycystic ovary syndrome

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METFORMIN IN PCOS PROTECTS AGAINST 1ST TRIMESTER MISCARRIAGE PROMOTES OVULATION REDUCES GESTATIONAL DIABETES AND FETAL MACROSOMIA PROBABLY REDUCES PRE-ECLAMPSIA-ECLAMPSIA-HELLP IS NOT TERATOGENIC IS ASSOCIATED WITH NORMAL INFANT GROWTH AND DEVELOPMENT

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Pregnancy Outcomes in 125 Women with PCOS Previously without metformin 301 pregnancies With metformin 148 pregnancies, 155 fetuses McNemar S=148.4, p<0.0001

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Pregnancy Outcomes in 178 Women with PCOS Previously without metformin 197 pregnancies With metformin 88 pregnancies, 91 fetuses McNemar S=64.1, p<0.0001

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Metformin reduces miscarriage in PCOS by reducing hypofibrinolytic plasminogen activator inhibitor activity, an independent determinant of miscarriage, which is closely correlated with insulin, insulin resistance, and triglycerides. This is particularly important in PCOS where 4G4G PAI-1 homozygosity is much more common than in normal women

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Pregnancy Outcomes on Metformin in 144 Women with PCOS

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Pregnancy Outcomes on Metformin in 300 Women with PCOS

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Prevalence of GDM GDM PREVALENCE DOUBLED IN KAISER COLORADO FROM 1994-2002 (2.1%?4.1%), NATIONALLY 3-8%. >50% OF WOMEN WITH GDM DEVELOP TYPE II DM WITHIN 5 YRS ASSOCIATED WITH BIRTH DEFECTS AND ABNORMALITIES IN CHILDHOOD GROWTH AND GLUCOSE REGULATION

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CROSS-GENERATIONAL CYCLE OF GDM MATERNAL GDM BEGETS OFFSPRING’S TYPE II DM AND OBESITY.

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Recognized risk factors for GD include body mass index >25 kg/m 2, first degree family history of type 2 DM, age ? 25 years, multiparity, previous GD, and previous macrosomic infants (>9 lbs. or 4000 grams). Additional risk factors for GD include pre-conception impaired fasting glucose levels (110-125 mg/dL), pre-conception impaired glucose tolerance (2 hour post oral glucose load glucose levels 140-199 mg/dL), polycystic ovary syndrome (PCOS), and ethnic group (American Indian or Alaska Native; African American; Asian; Hispanic; Pacific Islander).

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Gestational Diabetes in 40 Women with PCOS Previously without metformin In 52 livebirth pregnancies With metformin In 40 livebirth pregnancies GD 13% GD 31% X2 =4.3, p=0.039 McNemar S=8.3, p=0.039

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GD in 121 Women with PCOS 140 Livebirth Pregnancies on Metformin GD in 251 Livebirth Pregnancies From Community Controls GD 7% GD 16% X2 =6.2, p=0.013 GD IN PCOS ON METFORMIN VS COMMUNITY CONTROLS

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GD in 251 Livebirth Pregnancies From Community Controls GD 16% GD 17% GD in 203 Women with PCOS 211 Livebirth Pregnancies on Metformin X2 =0.11, p=0.75 GD IN WOMEN WITH PCOS ON METFORMIN VS COMMUNITY CONTROLS

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Pregnancy increases requirements for insulin secretion, increasing insulin resistance and demands on pancreatic ß-cells, promoting development of gestational diabetes (GD), particularly in women with pre-existing insulin resistance, commonly in women with polycystic ovary syndrome (PCOS). Preliminary studies suggest that metformin may have unique potential to prevent development of GD. We postulate that interventions which reduce insulin resistance and lower requirements for endogenous insulin secretion can preserve beta cell function and prevent development of type 2 DM.

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Pre-conception Insulin Resistance Physical inactivity ? PCOS ? Obesity ? Race ? Increased demand on beta cells for insulin secretion Hyperinsulinemia ? Maternal weight gain ? Neonatal macrosomia ? 1st trimester miscarriage ? Pregnancy induced HTN ? Pre-eclampsia ? High PAI-Fx ? Insulin resistance of pregnancy ? Pregnancy increases requirements for insulin secretion Reduction in beta cell reserve ? Glucose intolerance ? Gestational diabetes ? Type 2 diabetes

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Insulin sensitizing drugs (Metformin) Reduces demand on beta cells for insulin secretion Protects beta cell reserve Overcomes insulin resistance Euglycemia maintained • Decreases gestational diabetes • Primary prevention of type 2 diabetes

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Major and minor birth defects, 142 live births to 125 women with PCOS: 1 tethered spinal cord, 1 hamstring tendon contracture. Birth defects in 1.4%, national average ~4.5%

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METFORMIN IN PCOS PROMOTES OVULATION PROTECTS AGAINST 1ST TRIMESTER MISCARRIAGE REDUCES GESTATIONAL DIABETES AND MACROSOMIA PROBABLY REDUCES PRE-ECLAMPSIA-ECLAMPSIA-HELLP IS NOT TERATOGENIC IS ASSOCIATED WITH NORMAL INFANT GROWTH AND DEVELOPMENT

	glueckch@healthall.com 1 Years ago. Category: Obstetrics and Gynecology

Tags:	Obstetrics and Gynecology

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