Abstract
Background A hyperglycemic metabolic status with insulin resistance can have a negative effect
on fertility and pregnancy outcomes. The aim of this retrospective study was to investigate
disorders of glucose and insulin metabolism in women wanting to conceive who conceived
spontaneously prior to planned assisted reproduction (ART). Associated risk factors
of patients in terms of live births and miscarriages were also analyzed.
Method Out of total study population of 589 pregnancies, the pregnancies of 129 women wishing
to have children who conceived spontaneously prior to planned ART were analyzed in
more detail. A 75 g OGTT (OGTT: oral glucose tolerance test) was carried out prior
to conception and after determination of pregnancy, including glucose measurement
and testing of insulin resistance. If anomalies or risk factors for gestational diabetes
(GDM) were detected, patients received metformin therapy prior to conception (off-label
use). The course and outcome of pregnancies in the defined cohort were recorded.
Results The rate of spontaneous conception before planned ART after treatment for disorders
of glucose/insulin metabolism was 21.9% (n = 129/589). 66.7% of the 129 pregnancies
resulted in a live birth, 32 patients had a miscarriage. 76.0% of patients were treated
with metformin (off-label use) for polycystic ovary syndrome (PCOS), positive risk
profile for GDM, or abnormal glucose/insulin metabolism prior to conception. 55.8%
of the cohort developed GDM. The insulin requirements of patients with GDM differed
significantly depending on their metformin intake. 24.6% of GDM patients receiving
metformin treatment developed GDM requiring insulin treatment compared to 53.8% who
did not receive metformin medication. The PCOS rate in the study population who had
live births was significantly higher (57.0%) than in the group who had miscarriages
(31.3%). There were no significant differences with regard to rate of live births
and rate of miscarriages with/without metformin treatment and GDM and metformin intake.
Conclusion The high rate of spontaneous conceptions in the cohort of women wishing to conceive
emphasizes the importance of optimizing glucose/insulin metabolism prior to conception.
The high rate of GDM in a cohort of pregnant women with a history of sterility also
emphasizes the importance of expanding diagnostic testing for sterility to include
the investigation of glucose metabolism and testing for insulin resistance. It is
possible that PCOS patients in particular could benefit from treatment with metformin
prior to conception, and this could explain the high rate of live births in this patient
cohort.
Key words gestational diabetes - early-onset gestational diabetes - ART - metformin
