Is Lower Ovarian Reserve Associated With Increased Risk of Diabetes, Obesity?

Women with lower ovarian reserve—defined as the number and quality of a woman's eggs—are not at increased risk for obesity and diabetes, according to a study published in Menopause.

Researchers set out to determine whether “trends of adiposity and glucose metabolism parameters in women with low ovarian reserve status based on their anti-Mullerian hormone (AMH) levels differ from those with high ovarian reserve.” The AMH is found in the blood and helps to estimate the duration of a woman's reproductive lifespan, according to a statement.

This population-based cohort study included 1015 participants between the ages or 20 and 50. Women were divided into first and fourth quartiles of age-specific AMH and the mean follow-up period was 16 years. Investigators used generalized estimating equation (GEE) models to compared changes in adiposity and metabolic parameters between participants. In addition, researchers used pooled logistic regression “to compare progression of prediabetes mellitus (pre-DM) and DM between the women of these two age-specific AMH quartiles.”

In the past, studies have found associations between premature ovarian insufficiency, defined as menopause before the age of 40, and cardiometabolic risk factors like obesity and diabetes. Menopause transition has also been shown to be associated with cardiometabolic risk factors, regardless of age. These findings indicate “a changing endocrine profile resulting from decreased ovarian function can influence cardiometabolic risk and increase cardiovascular mortality," reserachers said.

Participants were divided between the first (n = 268), second (n = 233), third (n = 256), and fourth (n = 258) age-specific quartiles of AMH.

The study yielded the following results:

• After a 16-year median follow-up period, a significant difference was observed in the proportion of women who reached menopause in different age-specific quartiles of AMH: 196 (73.1%), 140 (60.1%), 130 (50.8%), and 121 (46.9%) of the first, second, third, and fourth quartiles, respectively (P < .001)
• Prevalence of comorbidities of obesity and central obesity among women in different age-specific quartiles of AMH was not statistically significant (P = .1)
• Odds ratio (OR) of diabetes progression (adjusted for age, BMI, menopausal status, physical activity) in women in first quartile of AMH was not significantly different, compared with those in the fourth quartile of AMH (OR, 1.28; P = .4; 95% CI, 0.74-2.20)

“Although previous research has clearly established a link between early menopause and cardiovascular disease risk, the present study showed that lower ovarian reserve, as measured by a single AMH level, was not associated with greater over time trends in adiposity and markers of glucose metabolism,” said Stephanie Faubion, MD, medical director of the North American Menopause Society. She continued, “Additional study is needed to determine how best to predict cardiometabolic risk in women with and without primary ovarian insufficiency in order to initiate appropriate risk reduction strategies.”

Despite women in both the lowest and highest quartiles of AMH exhibiting a significant positive trend in adiposity indices, researchers found this trend did not significantly differ between the two groups.

Researchers conclude AMH should not be used as a biomarker to predict cardiometabolic risk factors in healthy, reproductive-age females.

Reference

Amiri M, Tehrani FR, Rahmati M, et al. Do trends of adiposity and metabolic parameters vary in women with different ovarian reserve status? A population-based cohort study. Menopause. 2020;27(6). doi: 10.1097/GME.0000000000001513.