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Polycystic Ovary Syndrome, Gestational Diabetes, and Bulimia Nervosa

St. George’s Hospital Medical School London SW17 0RE, United Kingdom

In the pages of this journal, Holte et al. (1) have recently reported an increase in clinical, endocrine, and ultrasonographic features of the polycystic ovary syndrome in women with a history of gestational diabetes mellitus (GDM). From this controlled study they suggested that women with a history of GDM have a disturbed balance between insulin sensitivity and ß-cell activity, but those with polycystic ovaries as well may be more prone to insulin resistance.

In a study examining the impact of pregnancy and bulimia nervosa (2), we found that 17% of pregnant women with active bulimia nervosa suffered from GDM, whereas McCluskey et al. (3) established that three quarters of 34 patients with bulimia nervosa had polycystic ovaries and approximately one third of 153 patients with polycystic ovarian syndrome had scores on the BITE (a self-rating scale for bulimia) that suggested the presence of bulimic eating patterns (4). From this it has been suggested that the polycystic ovarian syndrome may be phenotypically expressed via altered insulin resistance, resulting from gross fluctuations in carbohydrate intake, and that bulimic eating patterns need to be stabilized before recommending weight loss in women with polycystic ovary syndrome (5).

Given that there are demonstrable overlaps between the polycystic ovary syndrome, GDM, and bulimia nervosa, it could be argued that bulimia nervosa represents the "missing link" in understanding the findings of Holte et al. (1), although prospective studies would be required to establish the direction of casualty.

Footnotes

¹ Received March 22, 1999. Accepted August 25, 1999. Address correspondence to: John F. Morgan, Department of Psychiatry, St. George’s Hospital Medical School, London SW17 0RE, United Kingdom.

References

1. Holte J, Gennarelli G, Wide L, et al. 1998 High prevalence of polycystic ovaries and associated clinical, endocrine and metabolic features in women with previous gestational diabetes mellitus. J Clin Endocrinol Metab. 83:1143–1150.[Abstract/Free Full Text]
2. Morgan JF, Lacey JH, Sedgwick PM. 1999 Impact of pregnancy on bulimia nervosa. B J Psychiatry. 174:135–140.[Abstract/Free Full Text]
3. McCluskey SE, Lacey JH, Pearce JM. 1992 Binge-eating and polycystic ovaries. Lancet. 340:723.[Medline]
4. McCluskey S, Evans C, Lacey JH, et al. 1991 Polycystic ovary syndrome and bulimia. Fertil Steril. 55:287–291.[Medline]
5. Morgan JF. 1999 Bulimic eating patterns should be stabilised in polycystic ovarian syndrome. BMJ318 :328.

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