Polyendocrine Metabolic Ovarian Syndrome and the Entire Spectrum of Gestational Dysglycemia: A Population‐Based Cohort Study

AIMS: Evaluating the association between polyendocrine metabolic ovarian syndrome (PMOS), traditionally termed polycystic ovary syndrome, and the broad spectrum of gestational dysglycemia in a large, universally screened population. MATERIALS AND METHODS: This retrospective cohort study used routinely collected data linked from Israeli military pre-recruitment medical evaluation (ages 16-19) and Maccabi Healthcare Services electronic health records, including two-step GDM screening during the first pregnancy, 2001-2019. Outcome was categorised into gestational normoglycemia, abnormal glucose challenge test (GCT) with a normal oral glucose tolerance test (OGTT), gestational impaired glucose tolerance (GIGT) and gestational diabetes mellitus (GDM). Multivariable logistic models were adjusted for birth year, adolescent BMI, socioeconomic position, country of birth, cognitive performance, education and age at GDM screening. RESULTS: Among 177 241 women, 13 648 (7.7%) had PMOS. Rates (95% CI) of abnormal GCT with normal OGTT, GIGT, GDM and any dysglycemia were 9.1% (8.6-9.6) versus 7.9% (7.8-8.0), 4.9% (4.5-5.3) versus 4.0% (3.9-4.1), 6.3% (5.9-6.7) versus 4.2% (4.1-4.3) and 20.3% (19.6-21.0) versus 16.1% (16.0-16.3) among women with versus without PMOS, respectively. Corresponding adjusted ORs (95% CI) were 1.18 (1.11-1.26), 1.26 (1.16-1.37), 1.61 (1.49-1.73) and 1.31 (1.25-1.37), respectively. An interaction was observed with the highest odds among women with both PMOS and high adolescent BMI (adjusted OR 1.77, 95% CI: 1.52-2.10). CONCLUSIONS: Women with PMOS, and particularly those with concomitantly high BMI, constitute a high-risk subgroup for subthreshold gestational dysglycemia and GDM, highlighting the importance of pre-pregnancy mitigation of modifiable risk factors.