Effect of low-dose oral contraceptives on carbohydrate and lipid metabolism in women with recent gestational diabetes: results of a controlled, randomized, prospective study

Article Abstract:

Half of women with gestational diabetes (transient diabetes that develops during pregnancy) go on to develop frank diabetes within 15 years. During this time, glucose tolerance (the ability to control blood glucose levels after meals and during fasting) deteriorates. Women with gestational diabetes who have taken high-dose oral contraceptives (OCs) often experience a worsening of this condition. Progesterone-like hormones apparently decrease glucose tolerance and increase tissue resistance to the effects of insulin, while estrogen counteracts these effects. However, studies of low-dose OCs in women with prior gestational diabetes have yielded conflicting conclusions, so it is unclear whether OCs contribute to deterioration of glucose metabolic control in women who have had gestational diabetes. The effects of two types of low-dose OC containing progestins (progesterone-like compounds) and estrogen on metabolism of carbohydrates and lipids were evaluated in 230 women and compared with metabolic findings in women who did not use OCs. All women had a history of gestational diabetes and all were counseled to use a standard diet for diabetics. Thirteen months of study were completed by 156 patients. Glucose tolerance was similar among all groups at the start of the study, at 3 months, and at 6 to 13 months. Glucose tolerance impairment and the incidence of diabetes increased among the women, with no difference in this trend among groups. Women who had more severe gestational diabetes initially were significantly more likely to develop impaired glucose tolerance and diabetes. The blood cholesterol level decreased to a similar extent in each group of women, a normal occurrence following pregnancy. Levels of high-density lipoprotein, a cholesterol-containing particle associated with decreased risk of cardiovascular disease in higher concentrations, were higher among the group taking OCs containing estrogen and norethindrone than among those taking OCs taking estrogen plus levonorgestrel and those not using OCs. The results indicate that OC use did not influence the progression of glucose intolerance in women with recent gestational diabetes. Research should continue on the long-term medical course of patients with gestational diabetes and on long-term effects of low-dose OCs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Prognosis, Diabetes, Diabetes mellitus, Lipid metabolism, Diabetes in pregnancy, Gestational diabetes

---

Antiprogestin treatment decreases midluteal luteinizing hormone pulse amplitude and primarily exerts a pituitary inhibition

Article Abstract:

Much of reproductive function is regulated by the pituitary's secretion of protein hormones such as luteinizing hormone (LH). LH levels rise and fall during a woman's monthly cycle, but closer inspection of these changes over hourly periods reveals that LH is secreted in pulses (pulsatile) rather than a smooth, continuous fashion. The frequency and amplitude of LH pulses change during the monthly cycle, and these changes are associated with changes in progesterone levels. Specifically, following the cycle midpoint, during the luteal phase, progesterone levels increase and LH pulses become less frequent but increase in amplitude (strength). Mifepristone (RU 486) is a newly available synthetic steroid drug that blocks the effects of progesterone and interferes with the effects of another steroid hormone, cortisol. Pituitary secretion of LH is modulated by endogenous opioids, morphine-like compounds made by the body. Opioid block by the drug naloxone alters the pulsatile release of LH. To better understand the interaction between progesterone and LH secretion, the effects of mifepristone and naloxone on LH pulses were evaluated. Average LH levels declined when mifepristone was given with or without naloxone, but increased when naloxone was given. LH pulse amplitude decreased with mifepristone, but frequency did not significantly change. Pulse amplitude decreased as well with mifepristone plus naloxone but increased with naloxone alone. Pulse frequency increased significantly only when naloxone alone was given. These results support the idea that mifepristone, and therefore progesterone, directly affect the amplitude of pituitary pulsatile LH secretion. This is likely not mediated by endogenous opioids. Further, the effects of opioids, as indicated by effects on pulse frequency, may not be completely dependent on progesterone. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Menstrual cycle, Mifepristone, Endorphins, Luteinizing hormone

---

Effects of desogestrel on carbohydrate metabolism

Article Abstract:

Oral contraceptives containing desogestrel appear to have minimal effect on carbohydrate metabolism. Desogestrel is a highly selective progestin that is widely used in oral contraceptives in Europe and is the subject of much research in the US. Progestins in general have been associated with impaired carbohydrate metabolism, depending on the dose. Specifically, they have been found to interfere with insulin receptor binding. Older, high-dose oral contraceptives were associated with elevated insulin levels and impaired glucose tolerance. Reformulated low-dose oral contraceptives are associated with minimal alterations in blood glucose and insulin levels. In a study that compared carbohydrate metabolism in women who took oral contraceptives with those who did not, all women who took oral contraceptives experienced some decline in glucose tolerance. Oral contraceptives that contained desogestrel had the least effect on glucose tolerance and insulin secretion.

Carbohydrate metabolism, Progestational hormones, Synthetic, Progestational agents

Similar abstracts:

• Abstracts: Clinical aspects of the relationship between oral contraceptives, abnormalities in carbohydrate metabolism, and the development of cardiovascular disease
• Abstracts: Effects of long-term gestodene-containing oral contraceptives administration on hemostasis
• Abstracts: Long-term treatment of 189 acromegalic patients with the somatostatin analog octreotide: results of the International Multicenter Acromegaly Study Group
• Abstracts: Prognostic indicators of the resolution of nonimmune hydrops fetalis and survival of the fetus. part 2 An isolated intracardiac echogenic focus as a marker for aneuploidy
• Abstracts: The course of labor after endurance exercise during pregnancy. Neonatal morphometrics after endurance exercise during pregnancy

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.