Polycystic ovary syndrome (PCOS) increases the risk of subsequent gestational diabetes mellitus (GDM): A novel therapeutic perspective

Association of serum N,N,N-trimethyl-5-aminovaleric acid, trimethylamine N-oxide, and trimethyllysine levels with gestational diabetes mellitus

OBJECTIVE

To investigate the association of serum N,N,N-trimethyl-5-aminovaleric acid (TMAVA), trimethylamine N-oxide (TMAO), and trimethyllysine (TML) levels with gestational diabetes mellitus (GDM).

METHODS

Seventy pregnant women from the Hunan Provincial Maternal and Child Health Care Hospital (March 2021 to October 2023) were enrolled in this study. Forty GDM patients with GDM were included in the GDM group (GDM), and 30 healthy controls were included (Con). Participants were further categorized into adverse and good outcome groups based on pregnancy outcomes. Serum TMAVA, TMAO, and TML levels were quantified using ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Correlations between biomarker levels and clinical indicators were assessed using Pearson and Spearman analyses. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate risk factors and predictive value.

RESULTS

Serum TMAVA, TMAO, and TML levels were significantly higher in the GDM group. TMAVA levels were positively correlated with fasting plasma glucose (FPG), fasting insulin (FINS), creatinine (Cr), TMAO, and TML. TMAO and TML positively correlated with FPG, 2-h postprandial glucose (2h PG), FINS, Cr, and uric acid (UA) levels, while TMAO negatively correlated with triglyceride (TG). Combined TMAVA, TMAO, and TML predicted GDM with an area under the curve (AUC) of 0.940 (95% CI: 0.883-0.997). Elevated TMAVA levels were associated with adverse pregnancy outcomes in GDM, with an AUC of 0.757 (95% CI: 0.612-0.902).

CONCLUSIONS

Elevated serum levels of TMAVA, TMAO, and TML were significantly associated with the occurrence of GDM and adverse pregnancy outcomes. The combined detection of these three biomarkers demonstrated superior accuracy in predicting GDM. Among them, TMAVA demonstrated the highest predictive efficiency for adverse pregnancy outcomes in women with GDM. These findings provide new biomarkers for early screening and risk assessment of GDM, offering promising applications in clinical practice.

Obstetric and perinatal outcomes in singleton pregnancies following medicated, stimulated and natural, frozen embryo transfer cycles: an updated systematic review and meta-analysis

Frozen embryo transfer (FET) has been associated with higher risks of hypertensive disorders of pregnancy (HDP), large for gestational age and high birth weight. This systematic review and meta-analysis evaluates obstetric and perinatal outcomes in medicated, stimulated and natural FET cycles. A literature search was performed using MEDLINE, EMBASE, CINAHL and the Cochrane Library database; 152,590 FET cycles were analysed from 31 included studies. Risk ratios (RR) and 95% confidence intervals (CI) were calculated using fixed and random effects models determined by the heterogeneity (I2). There was significantly higher risk of obstetric and perinatal complications, including HDP (RR 1.84, CI:1.48-2.29, I2 87%) and low birth weight (LBW) (RR 1.25, CI:1.12-1.39, I2 57%) following medicated compared to natural FET cycles. A higher risk of HDP (RR 1.50, CI:1.33-1.64, I2 32%) and macrosomia (RR 1.28, CI:1.17-1.40, I2 37%) was noted following medicated compared to stimulated cycles. Natural demonstrated lower risk of HDP (RR 0.77, CI:0.60-0.99, I2 32%), gestational diabetes (RR 0.78, CI:0.68-0.89, I2 43%), LBW (RR 0.78, CI:0.64-0.95, I2 48%) and small for gestational age (RR 0.83, CI:0.70-0.98, I2 12%) than stimulated cycles. These findings indicate that medicated FET cycles convey greater risks of obstetric and perinatal complications than natural or stimulated cycles.

Long Noncoding RNA NONHSAT233728.1 Promotes ROS Accumulation and Granulosa Cell Apoptosis by Regulating the MAPK/ERK1/2 Signaling Pathway

Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine disorders in women of reproductive age. However, the underlying molecular mechanism remains unclear. In this study, we employed RNA sequencing analysis to identify differentially expressed protein-coding genes and long noncoding RNA (lncRNA) expression profiles in granulosa cells from women with and without PCOS. It was established that the level of NONHSAT233728.1 was diminished in women with PCOS. The present study demonstrated the role of NONHSAT233728.1 in granulosa cells from patients with PCOS and further investigated the potential mechanism of NONHSAT233728.1 in the KGN cell line. Additionally, the knockdown of NONHSAT233728.1 has been observed to promote cell apoptosis, inhibit cell proliferation, promote mitochondrial dysfunction, and inflammation. Western blot analyses confirmed that phospho-extracellular regulated protein kinases (ERK)1/2 were decreased following lnc-NONHSAT233728.1 knockdown. Consequently, we propose that ROS accumulation activates the endogenous mitochondrial apoptosis pathway, leading to granulosa cell apoptosis via the MEK/ERK1/2 pathway, which contributes to follicular atresia. We observed a negative correlation between NONHSAT233728.1 and both LH levels and the LH/FSH ratio. These findings indicate that lncRNA NONHSAT233728.1 is linked to the pathogenesis of PCOS and offer new insights into its underlying mechanisms.

A retrospective study to investigate the risk factors for gestational diabetes mellitus and its impact on maternal and neonatal outcomes

BACKGROUND

Currently, risk factors for gestational diabetes mellitus (GDM) and its impact on maternal and neonatal outcomes have not been fully elucidated. Therefore, we performed a retrospective epidemiologic study to explore the above research objectives.

METHODS

We collected extensive clinical data from January 2020 to June 2023 for 855 maternity cases at the Department of Obstetrics and Gynecology, Chaoyang Hospital, Capital Medical University. Vitamin D deficiency, undergoing assisted reproductive techniques, advanced maternal age (≥35), multiparas, abortion history, pre-pregnancy body mass index (≥25.0), twin pregnancy, polycystic ovary syndrome (PCOS), family history of diabetes, history of delivering a low-birth-weight infant, and weight gain during gestation of >2 kg per month (mean) as variables that may affect GDM to investigate the risk factors for GDM. In addition, a total of 15 adverse postpartum outcomes (including maternal complications and neonatal complications) were used to explore the adverse effects of maternal comorbidity with GDM. Variables that were significant in the univariate logistic regression model were included in the multivariate logistic regression model. Receiver operating characteristic (ROC) curves were conducted for the ability to predict the risk of the GDM and its impact on maternal and neonatal outcomes, using variables derived from the multivariate logistic regression models.

RESULTS

The results of multivariate logistic regression analyses shown that only multipara was not a risk factor for the development of GDM. Postpartum hemorrhage (blood loss ≥500 ml) and the neonatal Apgar score (≤9) (all P > 0.05) was excluded in the multivariate logistic regression model. According to the results of multivariate logistic regression analyses, the incidence of hypothyroid complications, hyperlipidemic complications, postpartum anemia, gestational hypertension, racket placenta, premature rupture of membranes, fetal malposition, macrosomia (≥4000 g), low-birth-weight infants (<2500 g), prematurity, neonatal infections, neonatal jaundice, and fetal distress was higher in pregnancies with combined GDM (all P < 0.05). The model demonstrated excellent diagnostic performance, with an area under the ROC curve of 0.91, indicating its efficacy in predicting adverse prognostic outcomes associated with maternal GDM.

CONCLUSIONS

It is essential for women of childbearing age to correct vitamin D deficiency as well as to maintain their body mass index within the normal range before preparing for pregnancy. Maternal weight gain needs to be managed appropriately throughout pregnancy, which may reduce the risk of GDM to some extent. Therefore, our results suggest that effective measures to reduce the risk of GDM are essential for both the mother and the newborn.

Metabolic Profiles of Pregnancy With Polycystic Ovary Syndrome: Insights into Maternal-Fetal Metabolic Communication

CONTEXT

Polycystic ovary syndrome (PCOS) pregnancies are linked to metabolic disorders affecting maternal and fetal outcomes, with maternal metabolites differing from those in normal pregnancies.

OBJECTIVE

To investigate the metabolic communication at the maternal-fetal interface in PCOS pregnancies.

DESIGN

Placenta and umbilical cord serum were analyzed using gas chromatography-mass spectrometry. In-depth analysis was performed with clinical characteristics.

SETTING

Placenta and umbilical cord serum were analyzed using gas chromatography-mass spectrometry, alongside clinical characteristics.

PARTICIPANTS

Forty-five uncomplicated PCOS pregnancies and 50 normal pregnancies.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The metabolic characteristics at the maternal-fetal interface in PCOS pregnancies and the underlying mechanisms.

RESULTS

A total of 79 metabolites in the placenta and 25 in umbilical cord serum showed significant differences between PCOS and normal pregnancies. The 10 most significant placental metabolites were identified through receiver operating characteristic analysis, 9 of which correlated significantly with maternal serum testosterone levels. Lasso regression analysis identified 4 key placental metabolite combinations: gamma-aminobutyric acid, proline, glycine, and isoleucine, achieving an area under the curve of 93.24%. In umbilical cord serum, 6 metabolites differed significantly between PCOS and normal pregnancies, with the highest area under the curve reaching 76.07%; 5 of these metabolites showed significant correlations with maternal serum testosterone levels. Nine differential metabolites were shared between the placenta and umbilical cord serum, which also shared metabolic pathways, including ABC transporters and aminoacyl-tRNA biosynthesis, potentially influencing maternal-fetal interactions.

CONCLUSION

This study identifies the metabolomic profile and key pathways in maternal-fetal communication during PCOS pregnancies.

Assessment of prevalence, risk factors, and psychosocial factors of gestational diabetes mellitus: A prospective observational study

BACKGROUND

Gestational diabetes mellitus (GDM) is a significant public health problem due to its negative impacts on maternal and neonatal outcomes. The primary objective of this study was to determine the prevalence of GDM among pregnant women at a single tertiary care hospital and to identify the associated risk factors, including psychosocial stressors. Additionally, we aimed to classify the stressors to understand their relative impact.

METHODS

We conducted a prospective observational study on 280 antenatal mothers from RIMS, Kadapa, between October 2023 and March 2024. We enrol participants according to standard diagnostic criteria, including and excluding them. GDM was diagnosed using a 75 g oral glucose tolerance test (OGTT) between 24-28 weeks of gestation. Participants were categorized into GDM (n = 60) and non-GDM (n = 220) groups. We evaluated psychosocial stress factors such as emotional burden, social support, and healthcare-related stress using a Gestational Diabetes Stress Scale (GDSS). Statistical analysis was performed using SPSS v20. Chi-square and t-tests were used to assess associations.

RESULTS

The prevalence of GDM was 4.7 %. GDM was significantly associated with advanced maternal age (>35 years), pre-pregnancy BMI > 26 kg/m2, and a history of hypertension (p < 0.05). Multiparity (third pregnancy) was more common in the GDM group (33.3 %). Emotional burden (23.5 %) was the leading psychosocial stressor, followed by medication, lifestyle, social, and healthcare-related stress.

CONCLUSION

GDM is associated with both clinical and psychosocial factors. Advanced maternal age, obesity, and hypertension were major associated risk factors. The emotional burden significantly contributed to the overall stress in GDM patients. Integrating psychosocial screening into antenatal care could support better clinical outcomes.

Maternal polycystic ovarian syndrome and offspring psychopathology and neurodevelopment

Polycystic ovarian syndrome (PCOS) is a common female endocrinologic condition that affects both the metabolic and reproductive systems and is the most frequent cause of anovulatory infertility. It is also associated with a range of psychiatric outcomes in individuals, including bulimia nervosa, schizophrenia, bipolar disorder, depression, anxiety, and personality disorders. At the same time, evidence suggests that hyperandrogenism, the characteristic trait of PCOS, may impair fetal neurodevelopment. Epidemiological studies have linked maternal PCOS with a variety of behavioral and psychiatric conditions in offspring including autism spectrum disorder and attention deficit hyperactivity disorder. In this review, we explore evidence for potential underlying biological mechanisms that might explain these observed associations, discuss the complex interplay between genetics and various environmental factors across generations, and highlight avenues for future research.

Effect of Chronic Endometritis on Prognosis and Reproductive Outcomes in Infertile Women With Endometrial Hyperplasia

PROBLEM

Chronic endometritis has been shown to cause infertility, and chronic inflammation has been confirmed to be associated with the development of cancer. However, the effect of chronic endometritis on endometrial hyperplasia (EH) among infertile women has not been studied. So, we aim to investigate whether chronic endometritis affects the prognosis and reproductive outcome in infertile women with EH who had preserved fertility therapy.

METHOD

This study employed a retrospective design. Infertile women who underwent hysteroscopic biopsy and were diagnosed as EH were enrolled. We used CD138 immunohistochemical staining in endometrium paraffin sections of EH patients. The patients were divided into two groups according to whether they were diagnosed as chronic endometritis or not, and the disease outcome and reproductive outcome were analyzed.

RESULT

The results showed that after progesterone therapy, women with a persistent chronic endometritis exhibited a lower rate of complete response (p = 0.002) of EH, along with an increased incidence of miscarriage after embryo transfer (p = 0.005).

CONCLUSION

Our study indicates a high prevalence rate of chronic endometritis in infertile women with EH, with potential implications for prognosis and subsequent reproductive outcomes, whether antibiotics should be added to the treatment of patients with EH combined with chronic endometritis deserves further investigation.

Exploring the Interconnections Between Mitochondrial Dysfunction and Polycystic Ovary Syndrome: A Comprehensive Integrated Analysis

Polycystic ovary syndrome (PCOS) is a leading cause of anovulatory infertility and is strongly linked to mitochondrial dysfunction (MD) in reproductive-age women. MD contributes to excessive reactive oxygen species (ROS) accumulation, exacerbating disease progression. This study aimed to identify key MD-related genes (MDRGs) involved in PCOS through bioinformatics analyses and experimental validation. Two PCOS transcriptome datasets (GSE34526 and GSE5850) were analyzed to identify differentially expressed genes (DEGs), which were then intersected with MDRGs to obtain MD-related DEGs (MDDEGs). Functional enrichment (GO, KEGG, GSEA) and protein-protein interaction (PPI) network analyses identified eight hub MDDEGs (MMP9, PPP1 CA, PSMD12, LIFR, PRKAA1, ITGAM, SUCLA2, GPBAR1). A rat PCOS model was established to validate hub gene expression via RT-qPCR, western blotting, and immunohistochemistry. The experimental data confirmed that seven hub genes exhibited consistent expression patterns with GSE34526 (P < 0.05), while only PRKAA1 and LIFR matched GSE5850 findings. Additionally, ROC analysis for the five most significant genes (LIFR, PBK, PRKAA1, RCAN1, MMP9) demonstrated promising diagnostic value (AUC > 0.85). This study highlights the role of MD in shaping the immune microenvironment of PCOS and identifies novel molecular targets for potential therapeutic interventions.

Global burden of polycystic ovary syndrome among women of childbearing age, 1990-2021: a systematic analysis using the global burden of disease study 2021

BACKGROUND

The escalating global incidence of polycystic ovary syndrome (PCOS) necessitates a thorough examination of its epidemiological trends and sociodemographic correlations. Our study bridges this gap by analyzing the global impact of PCOS among women of childbearing age (WCBA) from 1990 to 2021, aiming to inform strategies for enhanced prevention and management.

METHODS

We extracted data from the Global Burden of Disease Study 2021 (GBD 2021), focusing on the burden of PCOS among women aged 15-49 years. We assessed incidence, prevalence, and disability-adjusted life years (DALYs) trends using the estimated annual percentage change (EAPC) and explored the link between PCOS burden and sociodemographic index (SDI).

RESULTS

In 2021, the prevalence cases of PCOS worldwide were 65.77 million, the incidence cases were 1,175.07 thousand, and the DALYs cases were 576.05 thousand. Compared with 1990, the percentage changes were 89, 49, and 87%, respectively. The EAPCs indicated upward trends in prevalence and DALYs rates, with a less pronounced increase in incidence rates. The middle SDI region had the highest PCOS case numbers, and the 45-49 age group in this region experienced the most significant burden increase. A strong positive correlation existed between PCOS prevalent rates and SDI (r = 0.582, p < 0.001).

CONCLUSION

The global burden of PCOS among WCBA has significantly increased over the past three decades, particularly in the 45-49 age group in middle SDI regions. The correlation between PCOS prevalent rates and SDI highlights the role of socio-economic factors in PCOS epidemiology. Tailored prevention and management strategies are crucial for reducing the global burden of PCOS and improving female health outcomes.

Insulin resistance-induced mitochondrial dysfunction and pyroptosis in trophoblasts: protective role of metformin

BACKGROUND

Gestational diabetes mellitus (GDM) affects up to 14% of pregnancies globally, with insulin resistance (IR) playing a critical but often underappreciated role in its pathogenesis. Yet the specific impact of insulin at IR levels on mitochondrial function and pyroptosis in first-trimester trophoblasts remains unclear. Metformin use in GDM pregnancies is rising, but its impact on placental mitochondrial function is uncertain. This study aimed to investigate the impact of IR, a key feature of GDM, on mitochondrial dysfunction and pyroptosis in trophoblasts and to evaluate the protective effects of metformin.

METHODS

Dual staining assays using TUNEL and caspase-1, and enzyme-linked immunosorbent assay were conducted to assess pyroptosis and pyroptosis-related inflammatory markers in placentas from 42 GDM patients and 39 controls. In vitro, HTR-8/SVneo trophoblast cells were treated with IR-level insulin concentrations, and a concentration gradient of metformin to evaluate the mitochondrial damage, pyroptosis, and cell viability.

RESULTS

There was a significant increase in pyroptosis in GDM placenta, as well as pyroptosis-related inflammatory markers, IL-1β and IL-18. Placental IL-1β and IL-18 levels were strongly correlated with IR indices, especially in GDM cases. Moreover, IR-level insulin concentrations induced mitochondrial dysfunction and activated the NLRP3 inflammasome, triggering pyroptosis in HTR-8/SVneo trophoblasts. Metformin, particularly at therapeutic doses (10-100 µM), mitigated IR-induced mitochondrial damage by promoting mitochondrial biogenesis and reducing pyroptosis via suppressing the ROS/TXNIP/NLRP3 pathway. Metformin-treated cells exhibited enhanced mitochondrial respiration, restored membrane potential homeostasis, and reduced oxidative stress.

CONCLUSION

IR, independent of hyperglycemia, drives placental inflammation and trophoblastic injury via pyroptosis. Targeting the ROS/TXNIP/NLRP3 pathway with metformin or other therapeutic agents offers potential therapeutic value in managing IR-related complications in GDM.

Exploring the Therapeutic Potential of Terminalia chebula Retz. in Alleviating the Complications of Letrozole-Induced PCOS in Rat Model

Polycystic Ovarian Syndrome is a leading gynecological condition that is being known to affect women fertility irrespective of their reproductive age. Though its prevalency and adverse effects in causing the female infertility is know to be reported worldwide, it has the steroidal pills having remarkable side effects as their effective medication to treat and manage its symptoms. Inorder to find a novel curative plant besed therapy, this study investigates the therapeutic potential of Terminalia chebula Retz. to manage the complications of PCOS. In this present study, the bioactive compounds of Terminalia chebula Retz. fruit extract were identified by GC-MS and the experimental animals (female Wistar rats) were categorized into six groups including control, letrozole-induced PCOS group, metformine treated as standard control, along with the groups orally treated with T. chebula fruit extracts at various concentrations. As a result of PCOS induction, the level of LPx got increased evidencing the increased lipid metabolism where the other antioxidant levels were decreased. The serum hormonal profile revealed a considerable decrease in estrogen and progesterone levels while the levels of LH, FSH, testosterone, and insulin were increased. The mRNA and protein expressions of CYP17A1, was upregulated whereas the CYP19A1 and PPAR-γ found to have lower expression on concerning the control group. These entire physiological, and biochemical observed during the successful induction of PCOS got restored to normal after being treated with the fruit extract of T. chebula in the experimental animals and implied its potentiality in managing the complications of PCOS.

Computational analysis of potential drug-like compounds from Solanum torvum - A promising phytotherapeutics approach for the treatment of diabetes

Diabetes mellitus (DM) is a global pandemic that is characterized by high blood glucose levels. Conventional treatments have limitations, leading to the search for natural alternatives. This study focused on Solanum torvum (STV), a medicinal plant, to identify potential anti-diabetic compounds using molecular docking and molecular dynamics simulations. We focused on identifying natural inhibitors of two key enzymes involved in glucose metabolism: α-amylase (1HNY) and α-glucosidase (4J5T). In our preliminary docking study, rutin showed the highest binding affinity (-11.58 kcal/mol) to α-amylase, followed by chlorogenin (-7.58 kcal/mol) and myricetin (-5.82 kcal/mol). For α-glucosidase, rutin had the highest binding affinity (-11.78 kcal/mol), followed by chlorogenin (-7.11 kcal/mol) and fisetin (-6.44 kcal/mol). Hence, chlorogenin and rutin were selected for further analysis and compared with acarbose, an FDA-approved antidiabetic drug. Comparative docking revealed that chlorogenin had the highest binding affinity of (-9.9 kcal/mol) > rutin (-8.7 kcal/mol) and > acarbose (-7.7 kcal/mol) for α-amylase. While docking with α-glucosidase, chlorogenin again had the highest binding affinity of (-9.8 kcal/mol) > compared to rutin (-9.5 kcal/mol) and acarbose (-7.9 kcal/mol). Molecular dynamics (MD) simulations were conducted to assess their stability. We simulated 100 nanoseconds (ns) trajectories to analyze their stability on various parameters, including RMSD, RMSF, RG, SASA, H-bond analysis, PCA, FEL, and MM-PBSA on the six docked proteins. In conclusion, our study suggests that chlorogenin and rutin derived from STV may be effective natural therapeutic agents for diabetes management because of their strong binding affinities for the α-amylase and α-glucosidase enzymes.Communicated by Ramaswamy H. Sarma.

Comparison of metformin with inositol versus metformin alone in women with polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

Metformin was the first medication targeting insulin resistance in PCOS, and it has been extensively studied as a metabolic treatment option. In recent years, inositols have emerged as potential treatment options for PCOS, but confidence in the available evidence supporting their use is limited.

METHODS

We comprehensively searched PubMed, Embase, and Cochrane databases for RCTs comparing the use of combined metformin and inositol versus metformin alone in women with PCOS. A random-effects model was used to calculate the risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). A p-value of <0.05 was deemed as statistically significant.

RESULTS

Six RCTs and 388 patients were included in the analysis, with follow-up ranging from 3 to 6 months. Combination therapy was significantly associated with improved menstrual cycle regularity (RR 1.56; 95% CI 1.01 to 2.41; p = 0.04), and lower values of modified Ferriman-Gallwey score (MD -0.97; 95% CI -1.53 to -0.40; p < 0.01) and LH/FSH ratios (MD -0.13; 95% CI -0.24 to -0.03; p = 0.01). Differences in acne (p = 0.58), body mass index (p = 0.13), fasting blood glucose (p = 0.07) and HOMA-IR (p = 0.25) were not statistically significant.

CONCLUSION

In this meta-analysis of RCTs, combination therapy was associated with cycle regularization and reduction in hirsutism and LH/FSH ratio compared to metformin monotherapy. Further studies are needed to clarify the true benefits of the use of inositol in PCOS treatment.

Gestational diabetes mellitus and polycystic ovary syndrome, a position statement from EGOI-PCOS

Gestational diabetes mellitus is a worldwide health issue in pregnancy, posing a threat to both mother and child. One of the major risk factors for the development of gestational diabetes mellitus is polycystic ovary syndrome, primarily due to the biochemical hyperandrogenism and metabolic issues, commonly observed in these patients. In recent years, the Expert Group on Inositol in Basic and Clinical Research and on PCOS (EGOI-PCOS) has sought to better understand the pathogenesis behind polycystic ovary syndrome, in order to accurately diagnose and treat patients according to their individual needs. Through the scope of polycystic ovary syndrome, this position paper examines the characteristics of both conditions, and underlying biological mechanisms, before moving on to common treatment strategies to avoid or treat gestational diabetes mellitus in women with polycystic ovary syndrome.

The role of CLDN11 in promotion of granulosa cell proliferation in polycystic ovary syndrome via activation of the PI3K-AKT signalling pathway

Polycystic ovary syndrome (PCOS) is a complex gynecological endocrinological condition that significantly impacts women's fertility during their reproductive lifespan. The causes of PCOS are multifaceted, and its pathogenesis is not yet clear. This study established a rat model of PCOS and, in conjunction with clinical samples and database data, analysed the role of claudin 11 (CLDN11) in follicular granulosa cells (GCs) in regulating the proliferation of GCs. Our findings revealed a notable decrease in the protein expression of CLDN11 within the follicular GCs of individuals with PCOS. In vitro rat cell experiments revealed that interference with CLDN11 significantly inhibited viability and increased the apoptosis of GCs. Additional research has illuminated the mechanism by which CLDN11 regulates the expression levels of CCND1 and PCNA through the PI3K/AKT signalling pathway, significantly influencing the proliferation of rat follicular GCs. Furthermore, overexpression of CLDN11 via an adeno-associated virus (AAV) vector was found to reverse the PCOS-like phenotype induced in rats by letrozole. Our findings suggest that CLDN11 stimulates the proliferation of these cells by activating the PI3K/AKT pathway, thereby increasing the expression of CCND1 and PCNA. These discoveries underscore the critical function of CLDN11 in regulating the functionality of follicular GCs, which offers novel insights into the fundamental mechanisms governing PCOS.

Health literacy assessment and analysis of influencing factors in pregnant women with gestational diabetes mellitus in Southwest China

Objective

The main objectives of our study are evaluating the health literacy level among women with gestational diabetes mellitus (GDM) in Southwest China and explore the influencing factors, using a multidimensional health literacy assessment scale (Chinese version of the HLS-14). Given that the HLS-14 has not been used in GDM previously, its reliability and validity testing was included as a secondary objective.

Method

It was a cross-sectional survey with 565 GDM pregnancies. The Maternal and child health information access questionnaire, Chinese version of the HLS-14, Perceived Social Support Scale (PSSS) and General Self-efficacy Scale (GSES) was used to collect health information access behaviors, health literacy, social support and self-efficacy levels, respectively. SPSS 21.0 was used for descriptive statistical, multiple stepwise linear regression analysis and exploratory factor analysis (EFA). Amos 26.0 was used for confirmatory factor analysis (CFA).

Results

The Chinese version of HLS-14 has good reliability and validity in GDM pregnancies. The Cronbach's α are 0.849, 0.866, 0.859, and 0.883, respectively. The exploratory factor analysis extracted three common factors with a cumulative variance contribution rate of 68.405%. The confirmatory factor analysis model fit was good (χ2/df = 2.595, RMSEA = 0.055, IFI = 0.970, TLI = 0.963, CFI = 0.970). The HL level in pregnancies with GDM was moderate with a mean score of 3.26 ± 0.41, of which 24.10% had limited HL, 41.87% had moderate HL, and 34.03% had adequate HL. Regression analysis showed that the women with higher family support (β = 0.298, p < 0.001), recording pregnancy management diary (β = 0.199, p < 0.001), higher the family income (β = 0.140, p < 0.001), lower pre-pregnancy BMI (β = -0.116, p = 0.004), longer time spent searching for health information (β = 0.111, p = 0.006), and searching for health information through a medical health information website (β = 0.093, p = 0.019) had higher HL levels. These variables explained 23.1% of the variance in HL.

Conclusion

The Chinese version of the HLS-14 has good applicability in the GDM pregnancies. The HL level of them is moderate, needs to be improved. Healthcare professionals should focus on the GDM population with low family income and high pre-pregnancy BMI, fully mobilize their social support system, provide reliable access to information, encourage all GDM pregnancies to use pregnancy management diaries to record their self-management behaviors, and ensure the effectiveness of health education.

Research Progress of Risk Factors Associated with Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) is a common endocrine condition associated with adverse pregnancy outcomes. In recent years, a growing number of risk factors associated with gestational diabetes mellitus have been defined. GDM poses a serious threat to maternal health. The etiology is complex and multifactorial and can be divided into inherent and modifiable factors. The inherent factors have been described in other literature, while the modifiable factors are mainly the risk of lifestyle habits. In this study, we performed a narrative review of the progress of risk factors associated with gestational diabetes mellitus.

Triglyceride-glycaemic index: Insights into predicting fetal macrosomia and its interaction with gestational diabetes mellitus: A cohort study of Chinese pregnant women

OBJECTIVE

This study investigates the association between a new insulin resistance indicator, the triglyceride-glucose (TyG) index, and the risk of macrosomia.

DESIGN

This is a prospective cohort study.

METHODS

This study included 1332 women who delivered at Peking University International Hospital between October 2017 and August 2019. Participants were divided equally into three groups based on the TyG index. Logistic regression and restricted cubic spline (RCS) analyses were used to evaluate the relationship between the TyG index and macrosomia and conducted subgroup analyses. The TyG index's ability to predict macrosomia was assessed using the receiver operating characteristic (ROC) curve.

RESULTS

Multivariable logistic regression analysis revealed that the TyG index is an independent risk factor for macrosomia (Odds ratio [OR] 1.84, 95% confidence interval [CI] 1.02-3.30, p < .05). RCS analysis indicates that the risk of macrosomia increases with the rise of the TyG index (p for nonlinearity <.001) when the TyG index is >6.53. Subgroup analysis showed a synergistic additive interaction between the TyG index and gestational diabetes mellitus (GDM) of macrosomia. The area under the ROC curve for the predictive model was 0.733 (95% CI 0.684, 0.781), with a sensitivity of 76.4% and specificity of 66.9%. Incorporating the TyG index alongside traditional risk factors notably enhances macrosomia prediction (p < .05).

CONCLUSIONS

The TyG index independently predicts macrosomia, and exhibits an additive interaction with GDM in its occurrence. Integrating the TyG index with traditional risk factors improves the prediction of macrosomia.

TRIAL REGISTRY

Clinical trials. gov [NCT02966405].

Gaps in knowledge regarding the diagnostic criteria and management of PCOS in Germany: An anonymous web-based survey

Introduction

Polycystic Ovary Syndrome (PCOS) is a multifactorial condition that can include a myriad of symptom complexes. A study in North America demonstrated that a significant percentage of physicians were unaware of crucial aspects of PCOS. This study aimed to examine the level of knowledge about PCOS among physicians in Germany.

Methods

An anonymous cross-sectional online questionnaire was distributed to all gynecological clinics and fertility centers in Germany. The responsible gynecologists in service were contacted and they were asked to distribute the questionnaire among the employed physicians in their clinic.

Results and discussion

The questionnaire was completed 206 times. 92 (65.7 %) of all respondents were board-certified gynecologists without specialty training in reproductive medicine and gynecologic endocrinology (Non-RMGE), 48 (34.3 %) had completed this training (RMGE). RMGE were more likely to know the correct criteria for the diagnosis of PCOS (97.9 % vs. 51.3 %; p < 0.001) and were able to name a higher number of correct symptoms that may be associated with PCOS (20.8 vs. 14.0; p < 0.001) than Non-RMGE (B = 4.530, CI 1.379-7.680; p = 0.006). The preferred general treatments and fertility treatments for PCOS patients also differed significantly between the two groups (p = 0.002, p < 0.001). The participants were asked how doctors and healthcare professionals could be best supported to improve the care of PCOS patients. Over 58.3 % of participants considered the creation of a PCOS website dedicated to healthcare professionals to be valuable.

Conclusion

This study is the first to identify knowledge gaps about PCOS among physicians in Germany. The findings also highlight the potential disparities in PCOS knowledge between hospital and fertility center settings, emphasizing the need for improved training to ensure consistent and high-quality care for PCOS patients. The participants preferred a dedicated website for health professionals, indicating a demand for easily accessible information and training resources.

Exploring lncRNA expression in follicular fluid exosomes of patients with obesity and polycystic ovary syndrome based on high-throughput sequencing technology

BACKGROUND

Infertility is a reproductive health problem that attracts worldwide attention. Polycystic ovary syndrome (PCOS) is a major cause of female infertility and patients with obesity and PCOS are particularly common in clinical practice. Long non-coding RNA (lncRNAs) are a functional core in cells that regulate gene expression, transcription, and chromatin modification processes, and participate in epigenetics, cell cycle, and cell differentiation. LncRNAs are assumed to play a role in the occurrence and development of PCOS; however, their specific mechanism of action remains to be elucidated.

METHODS

High-throughput sequencing technology has been used to sequence and analyze lncRNAs in exosomes from the follicular fluid of patients with obesity and PCOS and those who underwent assisted reproductive therapy owing to male factors. Specific expression profiles of patients with obesity and PCOS were obtained and functional information analysis combined with a literature review were performed to screen for differentially expressed lncRNAs, which were validated using real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR).

RESULTS

High-throughput sequencing analysis revealed that compared to normal patients with male infertility, patients with obesity and PCOS had a total of 20 lncRNAs with significant expression differences in follicular fluid exosomes. Among them, 17 lncRNAs were upregulated and three were downregulated. Functional analysis showed that differentially expressed genes were mainly enriched in "cell metabolism," "cell adhesion," and other aspects: related gene pathways mainly involved Huntington's disease, Parkinson's disease, spliceosomes, non-alcoholic fatty liver disease, and ribosomes. Verification of differentially expressed lncRNAs revealed that the expression of lncRNAs TPT1-AS1, PTOV1-AS1, PTPRG-AS1, and SNHG14 in follicular fluid exosomes was consistent with the sequencing results.

CONCLUSION

A preliminary differential expression profile of lncRNAs in exosomes of patients with obesity and PCOS was established by transcriptomic analysis of these individuals. Our bioinformatics analysis results may be applicable to further study of the impact mechanism involving obesity and PCOS. These differentially expressed lncRNAs maybe served as potential biomarkers for in-depth studies of the occurrence, development on Follicle quality and function for patients with PCOS in the future.

The Novel Insight of Gut Microbiota from Mouse Model to Clinical Patients and the Role of NF-κB Pathway in Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is a metabolic disorder characterized by hyperandrogenism and related symptoms in women of reproductive age. Emerging evidence suggests that chronic low-grade inflammation plays a significant role in the development of PCOS. The gut microbiota, a complex bacterial ecosystem, has been extensively studied for various diseases, including PCOS, while the underlying mechanisms are not fully understood. This review comprehensively summarizes the changes in gut microbiota and metabolites observed in PCOS and their potential association with the condition. Additionally, we discuss the role of abnormal nuclear factor κB signaling in the pathogenesis of PCOS. These findings offer valuable insights into the mechanisms of PCOS and may pave the way for the development of control and therapeutic strategies for this condition in clinical practice. By bridging the gap between mouse models and clinical patients, this review contributes to a better understanding of the interplay between gut microbiota and inflammation in PCOS, thus paving new ways for future investigations and interventions.

Associations of nutritional status and dietary habits with the development of female infertility. A case-control study

Introduction

Female infertility is a multifactorial condition influenced by lifestyle and dietary factors. Understanding the relationship between nutritional status, dietary habits, and infertility could provide insights for targeted interventions.

Methods

A case-control study was conducted in health centers and hospitals in Alicante, Spain. The study included 60 infertile and 30 fertile women aged 18-40, selected through consecutive sampling. Data on body composition and dietary intake were collected and analyzed.

Results

Infertile women exhibited significantly lower muscle mass (p = 0.005) and larger hip circumference (p = 0.034) compared to fertile women. Additionally, a significant association was found between high red meat consumption and an increased risk of female infertility (p = 0.011).

Discussion

These results suggest that body composition and dietary habits, particularly muscle mass and red meat intake, play a key role in female fertility. Interventions aimed at improving muscle mass, reducing localized body fat, and limiting red meat consumption may enhance fertility outcomes. Further longitudinal research is needed to confirm these findings across diverse populations.

Shared diagnostic genes and potential mechanisms between polycystic ovary syndrome and recurrent miscarriage revealed by integrated transcriptomics analysis and machine learning

Objective

More and more studies have found that polycystic ovary syndrome (PCOS) is significantly associated with recurrent spontaneous abortion (RSA), but the specific mechanism is not yet clear.

Methods

Based on the GEO database, we downloaded the PCOS (GSE10946, GSE6798 and GSE137684) and RSA (GSE165004, GSE26787 and GSE22490) datasets and performed differential analysis, weighted gene co-expression network (WGCNA), functional enrichment, and machine learning, respectively, on the datasets of the two diseases, Nomogram and integrated bioinformatics analysis such as immune infiltration analysis. Finally, the reliability of the diagnostic gene was verified by external verification and collection of human specimens.

Results

In this study, PCOS and RSA datasets were obtained from Gene Expression Omnibus (GEO) database, and a total of 23 shared genes were obtained by differential analysis and WGCNA analysis. GO results showed that the shared genes were mainly enriched in the functions of lipid catabolism and cell cycle transition (G1/S). DO enrichment revealed that shared genes are mainly involved in ovarian diseases, lipid metabolism disorders and psychological disorders. KEGG analysis showed significant enrichment of Regulation of lipolysis in adipocytes, Prolactin signaling pathway, FoxO signaling pathway, Hippo signaling pathway and other pathways. A diagnostic gene FAM166 B was obtained by machine learning and Nomogram screening, which mainly played an important role in Cellular component. GSEA analysis revealed that FAM166B may be involved in the development of PCOS and RSA by regulating the cell cycle, amino acid metabolism, lipid metabolism, and carbohydrate metabolism. CIBERSORT analysis showed that the high expression of FAM166 B was closely related to the imbalance of multiple immune cells. Further verification by qPCR suggested that FAM166 B could be used as a common marker of PCOS and RSA.

Conclusions

In summary, this study identified FAM166B as a common biomarker for PCOS and RSA, and conducted in-depth research and analysis of this gene, providing new data for basic experimental research and early prognosis, diagnosis and treatment of clinical diseases.

Endocrine Characteristics and Obstetric Outcomes of PCOS Patients with Successful IVF and Non-IVF Pregnancies

Background/Objective: Infertility affects an estimated 40-50% of women with polycystic ovary syndrome (PCOS), the leading cause of anovulatory infertility, but only a small proportion of the patients require in vitro fertilization (IVF) therapy. Both PCOS and IVF are associated with an increased risk of obstetric complications. To compare preconception endocrine profiles and symptoms, as well as obstetric outcomes of PCOS patients who achieved successful pregnancies with and without IVF treatment. Methods: A single-center retrospective cohort study was conducted. Data spanning from 2012 to 2019 were compiled from patients with PCOS who visited the Gynecologic Endocrinology Unit and the Infertility Unit at the Department of Obstetrics and Gynecology, University of Debrecen. Patients diagnosed with PCOS who had had at least one successful delivery beyond the 23rd gestational week at the department were eligible for inclusion in the study. Results: Fifteen percent of the 206 pregnancies leading to successful deliveries of 232 newborns in our cohort conceived with IVF. A one year increase in the maternal age increased the odds of being in the IVF group by 22% (OR: 1.222, 95% confidence interval, CI: 1.11-1.35, p < 0.001). Baseline DHEAS and androstenedione levels were significantly lower in the IVF group as compared to the non-IVF group: 1 μmol/L increase in the DHEAS level decreased the odds of being in the IVF group by 18% (OR: 0.82, 95% CI: 0.66-1.01, p = 0.06), and 1 μg/L increase in the serum androstenedione concentration decreased the same odds by 42% (OR: 0.58, 95% CI: 0.33-1.02, p = 0.056). DHEAS levels <6.5 μmol/L had an OR 3.86 (95% CI 1.10-13.50, p = 0.04) and LH/FSH ratio <1.3 had an OR 3.58 (95% CI 1.18-10.81, p = 0.03) for being in the IVF group. The birth weight (3069 ± 683 g vs. 3362 ± 638 g, p = 0.02) and the gestational age (37.23 ± 2.55 vs. 38.54 ± 2.28 weeks, p = 0.004) were significantly lower in the IVF group, but in the singleton subgroups, no significant differences could be found. Birth weight percentiles showed no significant difference in either subgroup. In the IVF group, both preterm delivery (29% vs. 8.3%, OR 4.53, 95% CI 1.75-11.70, p = 0.002; singleton subgroup: 17.4% vs. 6.3%, OR 3.12, 95% CI 0.89-10.92, p = 0.07) and cesarean section (71% vs. 43.2%, OR 3.22, 95% CI 1.40-7.40, p = 0.006; singleton subgroup: 65.2% vs. 42.4%, OR 2.55, 95% CI 1.02-6.35, p = 0.04) were more frequent than in the non-IVF group. Gestational diabetes and preeclampsia were not significantly different in the IVF and non-IVF groups. Conclusions: In PCOS patients with successful pregnancies, those who conceive with IVF seem to be different in their baseline hormone levels and symptoms from the non-IVF group. Adverse obstetric outcomes are more common in the IVF group, and some of these differences persist when adjusting for singleton pregnancies and maternal age, too.

A rapid and validated GC-MS/MS method for simultaneous quantification of serum Myo- and D-chiro-inositol isomers

BACKGROUND

Myo-inositol (MI) and D-chiro-inositol (DCI) are two paramount isomers of inositol, both vital in glucose and steroid metabolism. Deficits in MI, DCI or MI/DCI ratio are expressly concerned with several pathological process, whereas MI and DCI lack practical measurement for human specimen.

METHODS

To quantify MI and DCI in serum samples simultaneously, a gas chromatography tandem mass spectrometry (GC-MS/MS) method was established. The process flow was optimized in ion source, derivative agent volume and reaction time. The performance characteristics were verified by commercial standards and clinical serums.

RESULTS

This method was confirmed to be sensitive (LOD ≤ 30 ng/mL of MI, ≤3 ng/mL of DCI) and reproducible (RSD < 6 % for repeated analyses). Quantitative determinations performed good linearity within the measurement range of 0.500-10.00 and 0.005-0.500 μg/mL for MI and DCI respectively (R2 > 0.999). The recoveries of MI and DCI were 97.11-99.35 % and 107.82-113.09 %, respectively. This method was successfully applied to 114 clinical specimens. No significant matrix effect was observed in serum samples under current conditions.

Changes in adverse obstetrical and neonatal outcomes over time in American women with polycystic ovary syndrome: an 11-year study of a population database

PURPOSE

To determine whether the prevalence in American demographic and resultant adverse obstetric outcomes changed in women with polycystic ovary syndrome between the years of 2004-2014 inclusively, based on data derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database.

METHODS

This is a retrospective population-based study using data derived from the HCUP-NIS database from the years of 2004-2014, inclusively. Within this group, all pregnancies to women with PCOS were identified and separated by year, creating 11 groups.

RESULTS

Risk factors including non-Caucasian race, lower socioeconomic status, and rates of obesity and thyroid disease increased over time. The rates of gestational diabetes mellitus demonstrated a slight decrease, (21.3% in 2004 to 18.0% in 2014, P = 0.01). The number of women with preterm premature rupture of membranes decreased from 3.0% in 2004 to 2.0% in 2014 (P = 0.04). Rates of preterm delivery decreased from 14.8% in 2004 to 9.8% in 2014 (P < 0.001). Rates of cesarean section decreased from 57.3% in 2004 to 45.7% in 2014 (P < 0.001), while rates of spontaneous vaginal delivery increased from 37.4% in 2004 to 50.1% in 2014 (P < 0.001). The rate of wound complications decreased from 2.1% in 2004 to 0.4% in 2014 (P < 0.001). However, the rate of congenital anomalies increased from 0.5% in 2004 to 1.2% in 2014 (P = 0.001).

CONCLUSIONS

In spite of increases in demographic risk factors associated with increased pregnancy complications, we hypothesize that the interventions made to minimize the risks of cesarean section and manage metabolic complications in women with PCOS during the period of study have resulted in improved pregnancy outcomes during the period of study.

Predicting Unfavorable Pregnancy Outcomes in Polycystic Ovary Syndrome (PCOS) Patients Using Machine Learning Algorithms

Background and Objectives: Polycystic ovary syndrome (PCOS) is a complex disorder that can negatively impact the obstetrical outcomes. The aim of this study was to determine the predictive performance of four machine learning (ML)-based algorithms for the prediction of adverse pregnancy outcomes in pregnant patients diagnosed with PCOS. Materials and Methods: A total of 174 patients equally divided into 2 groups depending on the PCOS diagnosis were included in this prospective study. We used the Mantel-Haenszel test to evaluate the risk of adverse pregnancy outcomes for the PCOS patients and reported the results as a crude and adjusted odds ratio (OR) with a 95% confidence interval (CI). A generalized linear model was used to identify the predictors of adverse pregnancy outcomes in PCOS patients, quantifying their impact as risk ratios (RR) with 95% CIs. Significant predictors were included in four machine learning-based algorithms and a sensitivity analysis was employed to quantify their performance. Results: Our crude estimates suggested that PCOS patients had a higher risk of developing gestational diabetes and had a higher chance of giving birth prematurely or through cesarean section in comparison to patients without PCOS. When adjusting for confounders, only the odds of delivery via cesarean section remained significantly higher for PCOS patients. Obesity was outlined as a significant predictor for gestational diabetes and fetal macrosomia, while a personal history of diabetes demonstrated a significant impact on the occurrence of all evaluated outcomes. Random forest (RF) performed the best when used to predict the occurrence of gestational diabetes (area under the curve, AUC value: 0.782), fetal macrosomia (AUC value: 0.897), and preterm birth (AUC value: 0.901) in PCOS patients. Conclusions: Complex ML algorithms could be used to predict adverse obstetrical outcomes in PCOS patients, but larger datasets should be analyzed for their validation.

Prenatal exposure to polycyclic aromatic hydrocarbons and phthalate acid esters and gestational diabetes mellitus: A prospective cohort study

BACKGROUND

Polycyclic aromatic hydrocarbons and phthalate acid esters (PAHs & PAEs), known as endocrine disrupting chemicals (EDCs), widely exist in daily life and industrial production. Previous studies have suggested that PAHs & PAEs may modify the intrauterine homeostasis and have adverse effects on fetal development. However, epidemiological evidence on the associations between PAHs & PAEs and gestational diabetes mellitus (GDM) is still limited.

OBJECTIVE

To investigate the effects of prenatal PAHs &PAEs exposure on the risk of GDM and hyperglycemia in pregnant women.

METHODS

The study population was a total of 725 pregnant women from a prospective birth cohort study conducted from December 2019 to December 2021. Blood glucose levels were collected by the hospital information system. Urinary PAHs & PAEs concentrations were determined by gas chromatography tandem mass spectrometry. The Poisson regression in a generalized linear model (GLM), multiple linear regression, quantile-based g-computation method (qgcomp), and Bayesian kernel machine regression (BKMR) were applied to explore and verify the individual and overall effects of PAHs & PAEs on glucose homeostasis. Potential confounders were adjusted in all statistical models.

RESULTS

A total of 179 (24.69%) women were diagnosed with GDM. The Poisson regression suggested that a ln-unit increment of 4-OHPHE (4-hydroxyphenanthrene) (adjusted Risk Ratio (aRR) = 1.13; 1.02-1.26) was associated with the increased GDM risk. Mixed-exposure models showed similar results. We additionally found that MBZP (mono-benzyl phthalate) (aRR = 1.19; 1.02-1.39) was positively related to GDM risk in qgcomp model. Although neither model demonstrated that 2-OHNAP (2-hydroxynaphthalene) and 9-OHFLU (9-hydroxyfluorene) increased the risk of GDM, 2-OHNAP and 9-OHFLU exposure significantly increased blood glucose levels. BKMR model further confirmed that overall effects of PAHs & PAEs were significantly associated with the gestational hyperglycemia and GDM risk.

CONCLUSIONS

Our study presents that environmental exposure to PAHs & PAEs was positively associated with gestational glucose levels and the risks of developing GDM. In particular, 2-OHNAP, 9-OHFLU, 4-OHPHE and MBZP may serve as important surveillance markers to prevent the development of GDM.

Investigating the causal impact of polycystic ovary syndrome on gestational diabetes mellitus: a two-sample Mendelian randomization study

Introduction

Determining the causal relationship between polycystic ovary syndrome (PCOS) and gestational diabetes mellitus (GDM) holds significant implications for GDM prevention and treatment. Despite numerous observational studies suggesting an association between PCOS and GDM, it remains unclear whether a definitive causal relationship exists between these two conditions and which specific features of PCOS contribute to increased incidence of GDM.

Methods

The causal relationship between polycystic ovary syndrome (PCOS), its characteristic indices, and gestational diabetes mellitus (GDM) was investigated using a two-sample Mendelian randomization study based on publicly available statistics from genome-wide association studies (GWAS). The inverse-variance weighted method was employed as the primary analytical approach to examine the association between PCOS, its characteristic indices, and GDM. MR Egger intercept was used to assess pleiotropy, while Q values and their corresponding P values were utilized to evaluate heterogeneity. It is important to note that this study adopts a two-sample MR design where PCOS and its characteristic indices are considered as exposures, while GDM is treated as an outcome.

Results

The study results indicate that there is no causal relationship between PCOS and GDM (all methods P > 0.05, 95% CI of OR values passed 1). The IVW OR value was 1.007 with a 95% CI of 0.906 to 1.119 and a P value of 0.904. Moreover, the MR Egger Q value was 8.141 with a P value of 0.701, while the IVW Q value was also 8.141 with a P value of 0.774, indicating no significant heterogeneity. Additionally, the MR Egger intercept was 0.0004, which was close to zero with a P value of 0.988, suggesting no pleiotropy. However, the study did find a causal relationship between several other factors such as testosterone, high-density lipoprotein, sex hormone-binding globulin, body mass index, waist-hip ratio, apolipoprotein A-I, number of children, diabetes illnesses of mother, father and siblings, hemoglobin A1c, fasting insulin, fasting blood glucose, years of schooling, and GDM based on the IVW method.

Conclusion

We observed no association between genetically predicted PCOS and the risk of GDM, implying that PCOS itself does not confer an increased susceptibility to GDM. The presence of other PCOS-related factors such as testosterone, high-density lipoprotein, and sex hormone-binding globulin may elucidate the link between PCOS and GDM. Based on these findings, efforts aimed at preventing GDM in individuals with PCOS should prioritize those exhibiting high-risk features rather than encompassing all women with PCOS.

Depletion of gut microbiota influents glucose metabolism and hyperandrogenism traits of mice with PCOS induced by letrozole

Background

Polycystic ovary syndrome (PCOS) is a multifaceted disorder that impacts metabolism, reproduction, as well as endocrine function, characterized by excessive levels of androgen and insulin resistance. The gut microbiota has been implicated in the pathogenesis of PCOS. However, the precise mechanisms through which the gut microbiota influences PCOS still require further elucidation.

Methods

The PCOS mouse model was established through the administration of letrozole to both conventional and antibiotics-treated mice. The evaluation of glucose metabolism, sex hormone levels, and ovarian morphology was conducted. Furthermore, the fecal samples from each group of mice were subjected to 16S rRNA gene sequencing, and functional prediction of gut microbiota was proceeded using PICRUSt2 to explore potential mechanisms.

Results

By using letrozole-induced PCOS mice model, we manifested that antibiotic intervention significantly reduced the serum total testosterone level and ameliorated glucose intolerance. Antibiotic treatment reduced the number of amplicon sequence variants (ASVs), as well as the Shannon and Simpson index. Meanwhile, letrozole induced a significant increase in the Shannon and Simpson index instead of ASVs. Through random forest model analysis, the results revealed significant alterations in three distinct groups of microbiota, namely Clostridia_vadinBB60_group, Enterorhabdus, and Muribaculaceae after letrozole treatment. Further correlation analysis revealed a positive association between alterations in these microbiota and both serum total testosterone levels and the area under the curve (AUC) of blood glucose in IPGTT. The administration of antibiotics led to a decrease in the absolute abundance of 5 ASVs belonging to unclassified Clostridia_vadinBB60_group, unclassified Enterorhabdus, and unclassified Muribaculaceae, which exhibited a positive correlation with the levels of total testosterone in mice serum, as well as the area under the curve of blood glucose in IPGTT. Moreover, 25 functional pathways of gut microbiome were significantly discrepant between the letrozole-treated mice with and without antibiotics.

Conclusion

These results suggest that disturbance of the gut microbiota may take participate in the progression of PCOS and manipulating the composition of the gut microbiota may be a therapeutic approach for managing PCOS.

Purinergic receptor P2X7 activates NOX2/JNK signaling to participate in granulosa cell inflammation and apoptosis in polycystic ovary syndrome

Increasing evidence shows that polycystic ovary syndrome (PCOS) is often accompanied by an inflammatory response, hence, appropriately managing granulosa cell inflammation is critical to regaining ovarian function in PCOS. In this study, the differential levels of purinergic receptor P2X7 between the control and PCOS samples in the dataset GSE34526 were assessed, then PCOS mouse models were established. Following evaluating the fluctuations in hormone levels, inflammatory cytokines, and P2X7, mice received treatment with the P2X7 antagonist A740003. Its effects on hormones, inflammation, apoptosis, and NOX2 signaling in mice were examined. Afterward, primary mouse granulosa cells were isolated, and the mediating role of NOX2 signaling in the P2X7 regulatory pathway was confirmed by transfection of NOX2 overexpression plasmids. The results demonstrated that P2X7 was significantly elevated in the PCOS samples in the dataset. Compared with the control group, PCOS mice had significant differences in the follicle-stimulating hormone, luteinizing hormone, testosterone, anti-Müllerian hormone, inflammatory factors, and P2X7. Treatment with A740003 partially restored these parameter levels, including NOX2 signaling. Based on in vitro experiments on primary mouse granulosa cells, the above findings were re-verified, and the overexpression of NOX2 could reverse the regulatory function of P2X7. The present study highlights that P2X7 level increases in PCOS, and inhibition of P2X7 can reduce disease symptoms. It is involved in inflammation and apoptosis in granulosa cells through NOX2/JNK signaling.

Influence of hsCRP Parameter on the Occurrence of Metabolic Syndrome in Patients with Polycystic Ovary Syndrome

PCOS (polycystic ovary syndrome) is a common endocrine disorder that affects 8-13% of women of reproductive age. Increased body weight and insulin resistance may be associated with chronic inflammation, which increases the risk of cardiovascular complications. CRP (C-reactive protein) tests may be use to assess persistent inflammation. Elevated CRP levels may be associated with insulin resistance and type 2 diabetes. Determination of hsCRP, highly sensitive C-reactive protein, can be used to assess cardiovascular risk in women with PCOS. In this study, 120 women between the ages of 18 and 42 were divided into two groups: patients with polycystic ovary syndrome (n = 80) and regular menstruating women in whom PCOS was excluded (n = 40). Lipid and carbohydrate metabolism parameters and hsCRP levels were assessed, followed by receiver operating characteristic (ROC) analysis for hsCRP, where metabolic syndrome was the dependent variable. For hsCRP, the cutoff point was 1.44 (mg/dL). Sensitivity for the cutoff point was 0.913 and specificity was 0.691. The area under the curve (AUC) was 0.851 (p < 0.000). The closer the AUC value is to unity, the better the predictive ability of the studied variable. There was also a statistically significant correlation between hsCRP levels and the presence of metabolic syndrome.

Nomogram for Predicting Live Birth after the First Fresh Embryo Transfer in Patients with PCOS Undergoing IVF/ICSI Treatment with the GnRH-Ant Protocol

Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility. A better understanding of factors associated with pregnancy outcomes and successful prediction of live birth after IVF/ICSI are important to guide clinical practice. This was a retrospective cohort study investigating live birth after the first fresh embryo transfer using the GnRH-ant protocol in patients with PCOS between 2017 and 2021 at the Reproductive Center of Peking University Third Hospital. A total of 1018 patients with PCOS were qualified for inclusion in this study. BMI, AMH level, initial FSH dosage, serum LH and progesterone levels on the hCG trigger day, and endometrial thickness were all independent predictors of live birth. However, age and infertility duration were not significant predictors. We developed a prediction model based on these variables. The predictive ability of the model was demonstrated well, with areas under the curve of 0.711 (95% CI, 0.672-0.751) and 0.713 (95% CI, 0.650-0.776) in the training cohort and validation cohort, respectively. Additionally, the calibration plot showed good agreement between the prediction and the observation (p = 0.270). The novel nomogram could be helpful for clinicians and patients in clinical decision-making and outcome evaluation.