Anti-Müllerian hormone in type 2 and gestational diabetes during the second half of pregnancy: relationship with sexual steroid levels and metabolic parameters

Abstract

Hyperandrogenemia and hyperinsulinemia are observed in women with diabetes during pregnancy. The effect of diabetes on anti-Müllerian hormone (AMH) levels during pregnancy is unclear. The aim of this study was to determine the AMH levels in women with type 2 diabetes (T2D) and gestational diabetes (GD) compared to healthy (C) pregnant women during the second half of gestation. A prospective study of 69 pregnant women with T2D (N: 21), GD (N: 24) and C (N: 24) were followed up during the second half of pregnancy. Clinical assessments and blood samples were collected at 26.7 (25–27.8); 34 (32–34.9) and 37.5 (37–40) weeks of gestation. AMH, sexual steroids, insulin, homeostatic model assessment of insulin resistance, HbA1c levels were measured. AMH levels were similar between T2D, GD and C (p = .07). A decline of AMH levels during the second half of gestation was observed in the three groups (p < .0001). AMH levels were negatively associated with age (p < .001). A positive association between AMH and testosterone (p < .05) was found in all groups. A progressive decline of AMH levels is observed in diabetic and healthy women during the second half of pregnancy. Testosterone levels are an independent factor that influences AMH levels during pregnancy. However, AMH levels are not affected by the presence of diabetes during gestation.

Chinese abstract

已观察到糖尿病患者在妊娠期有高雄激素血症和高胰岛素血症, 但糖尿病对妊娠期抗苗勒管激素（AMH）水平的影响尚不清楚。本研究的目的是确定在妊娠后半期2型糖尿病合并妊娠的妇女（T2D）和妊娠期糖尿病妇女（GD）与健康对照（C）孕妇的AMH水平。一项前瞻性研究募集69例孕妇：T2D (N: 21), GD (N: 24) 和C (N: 24), 在妊娠后半期随访。分别在妊娠26.7（25 - 27.8）, 34（32 - 34.9）和37.5（37 - 40）周进行临床评估和血液样本收集。测定AMH, 性类固醇激素, 胰岛素, 稳态模型评估的胰岛素抵抗指数、糖化血红蛋白水平。结果：三组AMH水平相似(p =.07)。而在妊娠后半期观察到三组的AMH水平均有下降(p < .0001)。且AMH水平与年龄呈负相关 (p <.001)。并在三组中均发现AMH与睾酮呈正相关(p < 0.05)。在糖尿病合并妊娠和健康孕妇的妊娠后半期观察到AMH是在逐渐下降。妊娠期间睾酮的水平是影响AMH水平的独立因素。然而, AMH水平不受妊娠期糖尿病发生的影响。

Keywords:

• Anti-Müllerian hormone
• androgens
• estrogens
• diabetes
• pregnancy

Acknowledgements

We wish to thank Gabriel Cavada, Ph.D., University of Chile, for performing the statistical analysis of the study.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

Fondo Nacional de Desarrollo Ciéntifico y Tecnológico10.13039/50110000285011121460This work was supported by the Fondo Nacional de Desarrollo Ciéntifico y Tecnológico (FONDECYT Grant No. 11121460, 2012) to Claudio Villarroel.