ORCID Profile
0000-0001-6228-2654
Current Organisation
Monash Medical Centre Clayton
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Publisher: Wiley
Date: 13-08-2021
DOI: 10.1111/OBR.13328
Abstract: There is an increasing interest in peer interventions in the management of chronic conditions, but evidence on peer interventions for body weight is lacking. The aim of this study was to examine the efficacy of peer interventions on body weight, energy intake, and physical activity in adults. Interventions delivered by peer (lay member that participants identify with) were included. We searched 14 databases. Outcomes were combined in the meta‐analysis using the inverse variance random‐effects model. From 2435 articles, 65 articles were included in the systematic review and meta‐analysis ( n = 15,673). Peer interventions resulted in significant reduction in weight (mean difference [MD] −1.05 kg 95% confidence interval [CI] −1.68, −0.43 95% prediction interval [PI] −3.25, 1.14 28 studies 7142 participants), BMI (MD −0.24 kg/m 2 95% CI −0.44, −0.04 95% PI −0.92, 0.45 25 studies 6672 participants), waist circumference (MD −0.75 cm 95% CI −1.29, −0.21 95% PI −1.36, −0.14 12 studies 4280 participants), and significant increase in physical activity (SMD 0.20 95% CI 0.09, 0.32 95% PI −0.46, 0.86 41 studies 10,778 participants) with no significant effect on energy intake. This study suggests peer interventions are effective in reducing waist circumference, but further research is needed to confirm its effect on other obesity‐related outcomes.
Publisher: Georg Thieme Verlag KG
Date: 11-2020
Abstract: This review describes the relationship between obesity and the most common reproductive (infertility) and metabolic (gestational diabetes mellitus [GDM] and type 2 diabetes mellitus [T2DM]) consequences in polycystic ovary syndrome (PCOS). It also describes the vital role of lifestyle management for PCOS. PCOS is a heterogeneous endocrine disorder common in reproductive-age women. Consensus on the exact etiological mechanisms of PCOS is unreached. Overweight or obesity is present in at least 60% of the PCOS population, but the condition occurs irrespective of BMI, with excess BMI increasing both the prevalence and severity of clinical features. Use of lifestyle therapies (nutrition, physical activity, and/or behavioral) for the prevention and management of excess weight gain, infertility, GDM, and T2DM is a vital component of best-practice PCOS care. Lifestyle management is recommended for all women with PCOS as the first-line treatment with or without medications. Due to a lack of high-quality trials demonstrating the efficacy of specific lifestyle approaches, PCOS lifestyle recommendations are as those for the general population. This review summarizes current knowledge relating to obesity and its impact on fertility, GDM, and T2DM. It also summarizes the lifestyle recommendations to best manage these conditions in women with PCOS and obesity.
Publisher: Wiley
Date: 18-09-2018
DOI: 10.1111/CEN.13828
Abstract: Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting reproductive-aged women with adverse reproductive, metabolic and psychological outcomes. It has a complex pathophysiology and therefore requires a multidiscipline clinical approach. However, there remains limited research synthesizing the broad clinical implications of PCOS which would assist clinicians in the management of PCOS. To summarize and appraise methodological quality of systematic reviews and meta-analyses evaluating complications and comorbidities associated with PCOS. A literature search from MEDLINE, EMBASE, CINAHL PLUS and PROSPERO was performed until 15 September 2017. Article selection, data extraction and quality appraisal of included reviews using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool were performed in duplicate. A narrative synthesis of the findings was conducted. Twenty-three reviews were included. All reviews were of low (n = 2) to moderate quality (n = 21). PCOS was associated with adverse pregnancy outcomes (n = 2), impaired glucose tolerance (n = 6), insulin resistance (n = 6), increased risk of type 2 diabetes (n = 1), cardiovascular disease (n = 10), metabolic syndrome (n = 2), psychological stress (n = 7), endometrial cancer (n = 1) and vitamin D deficiency (n = 1). Obesity exacerbates many of these outcomes. There is a large body of reliable evidence for adverse metabolic outcomes and smaller, but consistent evidence for psychological issues in PCOS. We identified a shortage of systematic reviews regarding pregnancy outcomes of PCOS and significant gaps in knowledge of the association between PCOS and subclinical hyperthyroidism, vitamin D levels and cancers which future studies could aim to address.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.FERTNSTERT.2019.03.027
Abstract: To evaluate the prevalence of eating disorders in women with polycystic ovary syndrome (PCOS) compared with women without PCOS and examine the relationship between PCOS, body mass index, self-esteem, and psychological distress scores. Cross-sectional, community-based study. Not applicable. A total of 8,467 participants born between 1989 and 1995 in the Australian Longitudinal Study on Women's Health with self-reported PCOS status (PCOS n = 875 vs. non-PCOS n = 7,592). None. Self-reported eating disorders, Rosenberg Self-Esteem Scale, and Kessler psychological distress scale. Compared with women not reporting PCOS, women reporting PCOS had higher prevalence of eating disorders (11.0% vs. 7.6%), low self-esteem (31.7% vs. 24.2%), and psychological distress (severe psychological distress: 21.0% vs. 13.5%). After adjusting for confounders, women reporting PCOS were more likely to report eating disorders (adjusted odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2-2.0). Low self-esteem and psychological distress were highly correlated and further increased the odds of eating disorders in women reporting PCOS. Polycystic ovary syndrome was significantly associated with low self-esteem and psychological distress but not after adjusting for confounders. Obesity was associated with low self-esteem (adjusted OR 1.5, 95% CI 1.2-1.8) and psychological distress (adjusted OR 1.2, 95% CI 1.0-1.4) but not eating disorders. Underweight women had increased odds for eating disorders (adjusted OR 2.5, 95% CI 1.8-3.4). Women with PCOS are more likely to report low self-esteem, psychological distress, and eating disorders. Low self-esteem and psychological distress are highly correlated and further increased the risk for eating disorders.
Publisher: Springer Science and Business Media LLC
Date: 12-2020
DOI: 10.1186/S12916-020-01861-X
Abstract: Polycystic ovary syndrome (PCOS) is challenging to diagnose. While the 2003 Rotterdam criteria are widely used for adults, the 2018 international PCOS guideline recommended updated Rotterdam criteria with both hyperandrogenism and oligo-anovulation for adolescents based on evidence-informed expert consensus. This study compared the prevalence of PCOS using updated and original Rotterdam criteria in community-based adolescents and explored long-term body mass index (BMI) trajectories across different diagnostic phenotypes. Overall, 227 postmenarchal adolescent females from the prospective cohort Raine Study undertook comprehensive PCOS assessment at age 14–16 years. Detailed anthropometric measurements were collected from birth until age 22 years. Cross-sectional and longitudinal BMI were analyzed using t tests and generalized estimating equations. PCOS was diagnosed in 66 (29.1%) participants using original criteria versus 37 (16.3%) participants using updated Rotterdam criteria. Using updated criteria, participants with PCOS had higher BMI than participants without PCOS from prepubertal. Only the phenotype meeting the updated criteria was significantly associated with higher long-term BMI gain whereas other PCOS phenotypes had similar BMI trajectories to participants without PCOS ( p 0.001). The use of the 2018 updated Rotterdam criteria reduces over-diagnosis of PCOS in adolescents and identifies those at the greatest risk of long-term weight gain, a key contributor to disease severity and long-term health implications. The BMI trajectories of females with PCOS on updated criteria erge prepubertally compared to those without PCOS. This work supports targeting adolescents diagnosed with PCOS on the 2018 updated criteria for early lifestyle interventions to prevent long-term health complications.
Publisher: Georg Thieme Verlag KG
Date: 09-2020
Abstract: No specific model of care (MoC) is recommended for premature ovarian insufficiency (POI), despite awareness that POI is associated with comorbidities requiring multidisciplinary care. This article aims to explore the definitions and central components of MoC in health settings, so that care models for POI can be developed. A systematic search was performed on Ovid Medline and Embase, and including gray literature. Unique definitions of MoC were identified, and thematic analysis was used to summarize the key component of MoC. Of 2,477 articles identified, 8 provided unique definitions of MoC, and 11 described components of MoC. Definitions differ in scope, focusing on disease, service, or system level, but a key feature is that MoC is operational, describing how care is delivered, as well as what that care is. Thematic analysis identified 42 components of MoC, summarized into 6 themes—stakeholder engagement, supporting integrated care, evidence-based care, defined outcomes and evaluation, behavior change methodology, and adaptability. Stakeholder engagement was central to all other themes. MoCs operationalize how best practice care can be delivered at a disease, service, or systems level. Specific MoC should be developed for POI, to improve clinical and process outcomes, translate evidence into practice, and use resources more efficiently.
Publisher: Wiley
Date: 11-12-2022
DOI: 10.1111/CEN.14647
Abstract: Women with polycystic ovary syndrome (PCOS) have a worsened metabolic profile but the progression of cardiometabolic features over time is unclear. Understanding this natural history is a key priority in PCOS research and vital for guiding the prevention and management of this common condition. We explored cardiometabolic changes that are observed in women with PCOS compared to those without PCOS across the life course. A systematic review of longitudinal cohort studies was conducted across MEDLINE, EMBASE, Ovid PsycInfo, CINAHL PLUS and EBM reviews between 15 January 2020 and 11 February 2021. Eligible studies included participants with or without PCOS diagnosed according to the 2003 Rotterdam or the 1990 National Institutes of Health (NIH) criteria. We included studies that were published from the year 1990 to 2021 with data on cardiometabolic outcomes as per the PCOS core outcomes set. There were 31 longitudinal studies with 28,316 participants from four continents. At the start of follow up, participants were aged between 1 year and 49 years with a follow‐up period ranging from 2 to 32 years. Changes in BMI and the risk of coronary heart disease were similar in adult women with and without PCOS. Women with PCOS had a higher risk of Type 2 diabetes than their non‐PCOS counterparts. Evidence for the majority of all other outcomes was conflicting and with inadequate data. Understanding the natural history of PCOS and particularly changes in cardiometabolic features remains challenging. Existing literature is extensive but heterogeneous and inconsistent. Longitudinal studies in unselected populations are needed to provide high‐quality data in this area.
Publisher: Wiley
Date: 30-05-2022
DOI: 10.1111/CEN.14757
Abstract: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting 8%–13% of reproductive‐aged women. The aetiology of the syndrome is complex, with genetic susceptibility, androgen exposure in early life and adiposity related dysfunction leading to perturbance in hypothalamic–ovarian function. PCOS clinical features are heterogeneous, with manifestations arising even in early adolescence, developing into multisystem reproductive, metabolic and psychological manifestations in adulthood. In this review, we will discuss challenges in the diagnosis of PCOS and understanding of the natural history of PCOS.
Publisher: Wiley
Date: 21-04-2022
DOI: 10.1111/CEN.14736
Abstract: To investigate lifetime reproductive outcomes and the relationship of ideal family size (IFS) achievement with metabolic, psychiatric and reproductive history in women with and without polycystic ovary syndrome (PCOS). Cross‐sectional. A total of 9034 women with ( n = 778) and without self‐reported PCOS ( n = 8256) born between 1973 and 1978 in the Australian Longitudinal Study on Women's Health. Self‐reported IFS achievement and total number of live births. Women with and without PCOS aspired for similar IFS. Compared with women without PCOS, significantly less women with PCOS achieved their IFS (53.08% vs. 60.47%, p 0.001). Higher proportion of women with PCOS did not achieve a live birth (37.15% vs. 31.64%, p = 0.002) and their median total number of live births was also lower (1 vs. 2, p 0.001) than women without PCOS. After controlling for sociodemographic factors, negative associations were observed between IFS achievement and PCOS status, various metabolic, psychiatric and reproductive history. However, only hypertension (adjusted odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.67–1.00), obesity (adjusted OR: 0.79, 95% CI: 0.69–0.90), history of in vitro fertilisation use (IVF) (adjusted OR: 0.49, 95% CI: 0.38–0.63) and maternal age at first childbirth (adjusted OR: 0.92, 95% CI: 0.91–0.93) remained inversely associated with achievement of IFS in further multivariable regression models. Metabolic conditions and reproductive history of maternal age at first childbirth and history of IVF use, but not psychological conditions, were associated with reduced odds of achieving IFS. Early family planning/initiation and optimisation of metabolic health may help to improve reproductive outcomes.
Publisher: Wiley
Date: 06-2020
DOI: 10.1111/CEN.14205
Publisher: Wiley
Date: 13-03-2018
DOI: 10.1111/CEN.13579
Abstract: Although there is a growing body of literature reporting that pregnancies in women with polycystic ovary syndrome (PCOS) are associated with greater complications than those without PCOS, methodological differences across studies make these results difficult to consolidate. This narrative review outlines potential mechanisms involved in adverse pregnancy outcomes in PCOS and the nature of the complications. It covers limitations of current evidence and future research directions. Future research should include prospective studies with phenotypic stratification of PCOS and matching or consideration of specific PCOS manifestations and risk factors specific to each pregnancy complication. This review also emphasizes the importance of following a healthy lifestyle for women with PCOS and of in idualized care according to overall risk factors for pregnancy complications.
Publisher: Georg Thieme Verlag KG
Date: 2018
Abstract: Polycystic ovary syndrome (PCOS) affects approximately one in seven women worldwide from early adulthood with heterogeneity in their healthcare needs through the life cycle. PCOS is challenging to diagnose and manage, with one-third of women reporting at least a 2-year delay in diagnosis. Current clinical services do not satisfactorily educate and support women with their erse reproductive, metabolic, and psychological care needs with fragmentation of services across health providers. Women are dissatisfied with the care they received, while the first contact general practitioners often feel ill-equipped to diagnose and manage PCOS. Despite national evidence-based guidelines recommending integrated multidisciplinary services, guideline translation has been limited, with wide practice variation and no optimal models of care. Lifestyle management and psychological support are the cornerstones of care and health providers who most commonly manage PCOS (general practitioners, dermatologists, endocrinologists, and gynecologists) require appropriate resources and multidisciplinary support. An evidence-based patient-centered clinical model of care, codeveloped by consumers and health professionals that provides education and resources and offers multidisciplinary holistic care, is vital to support women with PCOS.
Publisher: Oxford University Press (OUP)
Date: 10-05-2022
Abstract: What is the natural history of reproductive, psychological and oncological features in women with polycystic ovary syndrome (PCOS) in comparison to those without PCOS across the life course? Existing longitudinal data on changes in reproductive, psychological and oncological features in PCOS are inadequate and conflicting, but the limited evidence suggests that total testosterone (T) and dehydroepiandrosterone sulphate (DHEAS) levels decline more significantly in women with PCOS than in those without PCOS, and the risk of gestational diabetes is higher in pregnant women with PCOS compared to their counterparts without PCOS. The progression of reproductive, psychological and oncological features in PCOS remains unclear, which limits prevention and early diagnosis strategies across the lifespan. Understanding the natural history of PCOS is one of the overarching priorities in PCOS research. This is a systematic review of longitudinal cohort studies with a narrative presentation of findings. Databases MEDLINE, EMBASE, Ovid PsycInfo, CINAHL PLUS and EBM reviews were searched between 15 January 2020 and 11 February 2021 with no language restrictions. Only studies published from the year 1990 to February 2021 were included. In line with current guidelines for the assessment and management of PCOS, we included studies where participants were females with PCOS diagnosed according to the 2003 Rotterdam or the 1990 National Institutes of Health (NIH) consensus criteria. A total of 21 longitudinal studies including 62 123 participants over four continents reported reproductive, psychological and/or oncological outcomes. Participants were females aged between 15 and 49 years at baseline, with follow-up periods ranging from 4 weeks to 32 years. Consistent evidence based on limited studies suggests that total T and DHEAS levels decline to a greater degree in women with PCOS compared to those without PCOS, and the risk gestational diabetes is higher in women with PCOS than in those without PCOS. Evidence reporting changes over time in the majority of the remaining outcomes was unclear due to conflicting and/or insufficient information. There was extreme heterogeneity between studies in terms of study setting, population characteristics, follow-up period, effect measures used and laboratory testing approaches. Understanding the natural history of PCOS and changes in diagnostic, reproductive, psychological and oncological features of PCOS across the lifespan is still a challenge and the existing literature is both limited and conflicting. It is important that future long-term prospective longitudinal studies are conducted in unselected and well-characterized populations. This specific study was not funded. S.K. is supported by scholarships from the Research Training Program of the Commonwealth of Australia and Monash University H.J.T. is supported by an Australian National Health and Medical Research Council fellowship and A.E.J. is supported by the Australian National Health and Medical Research Council's Centre for Research Excellence in Women’s Health in Reproductive Life. R.A. was employed by the American Society for Reproductive Medicine and is a consultant to Spruce Biosciences and Fortress Biotech. The other authors have no conflicts of interest to declare. Prospero registration number: CRD42020165546.
Publisher: MDPI AG
Date: 25-11-2019
DOI: 10.3390/JCM8122070
Abstract: Women with polycystic ovary syndrome (PCOS) have many risk factors associated with perinatal mental disorders, but research in this area is scarce. This study aims to compare the prevalence of common perinatal mental disorders in women with and without PCOS, and examine the relationship between PCOS and common perinatal mental disorders. We performed a cross-sectional study on self-reported data of 5239 women born between 1973 to 1978 in the Australian Longitudinal Study on Women’s Health. Compared with women not reporting PCOS, women reporting PCOS had higher prevalence of antenatal depression (8.9% vs. 4.4%, p 0.001), antenatal anxiety (11.7% vs. 5.6%, p 0.001), postnatal depression (26.8% vs. 18.6%, p 0.001) and postnatal anxiety (18.4% vs. 12.0%, p 0.001). PCOS was positively associated with antenatal depression and/or anxiety (adjusted odds ratio 1.8, 95% confidence interval 1.2–2.6) but not postnatal depression and/or anxiety after controlling for sociodemographic and lifestyle factors, reproductive history, obstetric complications and pre-existing depression and anxiety. General perinatal guidelines currently do not recognize PCOS as a risk factor and the international evidence based PCOS guideline noted inadequate evidence in this area. This paper addresses the gap in literature and highlights the need to screen for common perinatal mental disorders in women with PCOS.
Publisher: Wiley
Date: 19-06-2018
DOI: 10.1111/CEN.13753
Abstract: Polycystic ovary syndrome (PCOS) affects up to 13% women and is associated with significant complications. The quality of evidence supporting the recommendations on treatment of nonreproductive outcomes in PCOS is unknown. To summarize and appraise the methodological quality of systematic reviews and meta-analyses evaluating pharmacological and surgical treatments for nonreproductive outcomes in PCOS. A literature search from MEDLINE, EMBASE, CINAHL PLUS and PROSPERO was performed from inception until 15th of September 2017. Article selection, data extraction and quality appraisal of included reviews were performed in duplicate. A narrative synthesis of the findings was conducted. This overview included 31 reviews. The quality was low for 7 (23%), moderate for sixteen (52%) and high for 8 reviews (26%). Two reviews assessed psychological outcomes. Metformin improved anthropometric (7 of 10 reviews), metabolic (4 of 14 reviews) and endocrine outcomes (3 of twelve reviews). Thiazolidinediones improved metabolic (2 of 5 reviews) and endocrine outcomes (one of 5 reviews) but worsened weight gain (5 of 5 reviews). Combined oral contraceptive pill (COCP) improved clinical hyperandrogenism (2 of 2 reviews). Statins improved lipid profile (3 of 3 reviews) and testosterone level (2 of 3 reviews). There was no conclusive evidence from included systematic reviews regarding the use of other interventions. There is reliable evidence regarding the use of metformin for anthropometric outcomes and COCPs for hyperandrogenism in women with PCOS but not for other interventions. There is significant gap in knowledge regarding the management of psychological outcomes in women with PCOS which needs further evaluation.
Publisher: Georg Thieme Verlag KG
Date: 29-06-2021
Abstract: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder and many women are dissatisfied with their healthcare under the current fragmented health services. Here, we review existing literature on PCOS healthcare services and qualitatively evaluate an integrated PCOS service based on experiences of women with PCOS. Limited prior PCOS-dedicated services have been studied and their quantitative and efficacy-focused evaluations are summarized. Here, we also provide a broader PCOS service evaluation via semistructured interviews and surveys, with thematic analysis based on a predetermined evaluation framework. Fifteen women completed interviews and surveys. Overall the integrated, evidence-based PCOS service was well-received and women were generally satisfied with appropriateness, effectiveness, and reported positive health impact resulting from the service. Integrated care, tailored treatments, education, lifestyle support, and laser therapy were highly valued. Patients reported improvements on symptoms, understanding and confidence in managing PCOS, and emotional well-being. Elements of efficiency in the initial stages, awareness and communication, and the need for service expansion and tensions between evidence-based treatments and patient preferences were also captured to guide improvement. Further research into models of care is recommended to meet the needs of women with PCOS.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 2023
Publisher: Oxford University Press (OUP)
Date: 26-05-2022
Abstract: Lifestyle (dietary and/or physical activity [PA]) modification is recommended as first-line therapy to manage polycystic ovary syndrome (PCOS). Current recommendations are based on healthy lifestyle practices for the general public since evidence for unique lifestyle approaches in PCOS is limited and low quality. We aimed to synthesize evidence on dietary and PA behaviors between women with PCOS and those without PCOS. Primary outcomes were overall diet quality, total energy intake and total PA, and secondary outcomes included macronutrients, micronutrients, food groups, foods, glycemic indices, sedentary time and sitting levels. We conducted this work to identify any unique lifestyle behaviors in women with PCOS that could underlie the propensity of weight gain and obesity in PCOS and be targeted for precision nutrition and PA interventions. These findings could be used to inform future practice recommendations and research that more effectively address complications (weight gain, obesity, diabetes, infertility, cardiovascular disease and mental health) in this high-risk population. Databases of MEDLINE, Web of Science, Scopus and CINAHL were searched until 15 February 2022 to identify observational studies documenting dietary and PA behaviors between women with PCOS and without PCOS (Controls). Studies on children, adolescents (& years), pregnant or menopausal-aged women (& years) were excluded. Data were pooled by random-effects models and expressed as (standardized) mean differences (MD) and 95% CIs. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). Fifty-four studies (N = 39 471 participants [n = 8736 PCOS 30 735 Controls]) were eligible (96% [52/54] NOS scores ≥ 7). Women with PCOS had higher cholesterol (MD: 12.78, 95% CI: 1.48 to 24.08 mg/day P = 0.03 I2 = 19%), lower magnesium (MD: −21.46, 95% CI: −41.03 to −1.91 mg/day P = 0.03 I2 = 76%), and a tendency for lower zinc (MD: −1.08, 95% CI: −2.19 to 0.03 mg/day P = 0.05 I2 = 96%) intake, despite lower alcohol consumption (MD: −0.95, 95% CI: −1.67 to −0.22 g/day P = 0.02 I2 = 0%) versus Controls. Also, women with PCOS had lower total PA (standardized mean difference: −0.38, 95% CI: −0.72 to −0.03 P = 0.03 I2 = 98%). Conversely, energy, macronutrients (carbohydrate, fat, protein, fiber), micronutrients (folic acid, iron, calcium, sodium), glycemic index and glycemic load were similar (all: P ≥ 0.06). Most eligible studies reported lower total adherence to healthy eating patterns or poorer consumption of major food groups (grains, fruits, vegetables, proteins, seeds, nuts, dairy) in women with PCOS, as described narratively since variable study methodology did not permit meta-analyses. Collective evidence supports that women with PCOS have a lower overall diet quality, poorer dietary intakes (higher cholesterol, lower magnesium and zinc) and lower total PA, despite lower alcohol consumption versus those without PCOS. Considerable heterogeneity among studies reinforces the need for research to address any relative contributions of other factors (e.g. genetic, metabolic or sociodemographic) to the observed differences. These clarifications may contribute to future evidence-based guideline recommendations on monitoring and managing PCOS in the era of precision lifestyle medicine.
Publisher: Oxford University Press (OUP)
Date: 22-09-2023
Publisher: Elsevier BV
Date: 06-2020
Publisher: Bioscientifica
Date: 22-03-2023
DOI: 10.1530/JOE-22-0232
Abstract: Polycystic ovary syndrome (PCOS) affects 8–13% of reproductive-aged women, impacts biopsychosocial factors and creates a significant health-related economic burden across the reproductive, metabolic and psychological spectrum of complications. Despite being a heterogenous condition, recent genomic studies indicate that PCOS, regardless of diagnostic criteria and clinical features, shares similar underlying biologic mechanisms. However, recent advances have shown that clinical reproductive and diagnostic features are poorly correlated to genotypes and do not represent true phenotypes. Until we have a better understanding of genetic and epigenetic influences on PCOS and long-term outcomes, targeted treatment is limited. In the interim, a unified approach to integrate evidence, optimise management and guide future research in PCOS is necessary. This has motivated an international collaboration to develop an International Evidence-Based PCOS Guideline to improve health outcomes in women with PCOS. Dissemination and translation of the guideline into health policy and clinical practice are crucial steps to close the knowledge–-practice gap, guide future research and enhance positive impact on the health of women with PCOS. Here, we review the (i) understanding of aetiology and genetics of PCOS (ii) development and translation efforts of the 2018 International Evidence-based PCOS Guideline (iii) current progress and plans for the guideline update, including the involvement of an early career researcher network to assist with evidence synthesis and (iv) the opportunity to target and guide future research for PCOS.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-09-2022
Publisher: Wiley
Date: 25-04-2022
DOI: 10.1002/DMRR.3532
Abstract: Gestational diabetes (GDM) is associated with several adverse outcomes for the mother and child. Higher levels of in idual lipids are associated with risk of GDM and metabolic syndrome (MetS), a clustering of risk factors also increases risk for GDM. Metabolic factors can be modified by diet and lifestyle. This review comprehensively evaluates the association between MetS and its components, measured in early pregnancy, and risk for GDM. Databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Embase, and Cochrane Library) were searched from inception to 5 May 2021. Eligible studies included ≥1 metabolic factor (waist circumference, blood pressure, fasting plasma glucose (FPG), triglycerides, and high‐density lipoprotein cholesterol), measured at weeks' gestation. At least two authors independently screened potentially eligible studies. Heterogeneity was quantified using I 2 . Data were pooled by random‐effects models and expressed as odds ratio and 95% confidence intervals (CIs). Of 7213 articles identified, 40 unique articles were included in meta‐analysis. In analyses adjusting for maternal age and body mass index, GDM was increased with increasing FPG (odds ratios [OR] 1.92 95% CI 1.39–2.64, k = 7 studies) or having MetS (OR 2.52 1.65, 3.84, k = 3). Women with overweight (OR 2.17 95% CI 1.89, 2.50, k = 12) or obesity (OR 4.34 95% CI 2.79–6.74, k = 9) also were at increased risk for GDM. Early pregnancy assessment of glucose or the MetS, offers a potential opportunity to detect and treat in idual risk factors as an approach towards GDM prevention weight loss for pregnant women with overweight or obesity is not recommended. Systematic review registration: PROSPERO CRD42020199225.
No related grants have been discovered for Chau Thien Tay.