The Prevalence of Gestational Diabetes Mellitus in Polycystic Ovary Disease-A Systematic Review, Meta-Analysis, and Exploration of Associated Risk Factors

Polycystic ovary syndrome (PCOS) is a common condition in reproductive-age women. Women with PCOS are at higher risk of pregnancy complications, including gestational diabetes (GDM). The prevalence of PCOS and GDM varies according to the diagnostic criteria used. The mechanism for the occurrence of GDM in women with PCOS is still unclear. Materials and Methods: A systematic search of the electronic database was done using keywords like PCOS and GDM to include studies between April 2008 and March 2023 where uniform diagnostic criteria were used. After assessing the risk of bias, studies with a high risk (of bias) were excluded, and a meta-analysis was conducted using relative risks and confidence intervals. Results and Discussion: Out of 1896 search results, 95 were selected for full-text review. The quality of the studies was scrutinized and a total of 28 studies were included as they fulfilled the inclusion criteria. The incidence of GDM in women with PCOS was found to be 10.55% (2.9-54.9%) from pooled data involving 1,280,245 women. The prevalence of PCOS in women diagnosed with GDM, based on pooled data from 36,351 women across retrospective studies, was found to be 2.47% (ranging from 1.5% to 50.1%). Selection predominantly included cohort studies, most commonly from China. The meta-analysis found that the risk of GDM is higher in women with PCOS than in those without PCOS (HR: 1.59, 95% CI: 1.27-1.91, p < 0.001). Family history of diabetes, ethnicity, high pre-pregnancy BMI, insulin resistance, gestational weight gain, use of assisted reproductive techniques, and multifetal gestation were found to be associated with GDM in women with PCOS. Conclusion: The prevalence of GDM in patients with PCOS is high, but the causality is complex. The newer predictive models are promising in clarifying the causative relationships, yet use various parameters with different cut-offs. There is a need for the development of universally acceptable parameters for the early prediction of GDM in women with PCOS.