Affecting nearly 10–15% of women, polycystic ovary syndrome (PCOS) is the leading cause of infertility. Various treatments are available to induce pregnancy. PCOS is significantly associated with gestational diabetes mellitus (GDM), a condition that carries major maternal and neonatal risks. However, the potential involvement of infertility treatments as a risk factor for GDM in this population remains unclear.

Our study aims to define the prevalence of GDM in this population and to study the determinants of its onset, with a focus on infertility treatments, through an observational cohort study of pregnant women between 1997 and 2024 who were followed up at the university hospital centre where their PCOS was diagnosed. Univariate and multivariate analyses and survival curves were performed.

The prevalence of GDM was 32.5% [95% CI: 28.8–36.3] in the total population ( n = 622), 32.7% [95% CI: 27.7–38.2] in untreated women ( n = 321) and 32.2% [95% CI: 27.0- 37.9] in treated women ( n = 301), with difference found between the subgroups after ajustement on age and BMI ( P = .04). The time to initiation of insulin therapy was similar between women receiving infertility treatment and those not receiving such treatment (Log-rank test P = .83). In logistic regression, age, BMI, blood pressure, triglycerides, testosterone and LH appeared to be independent risk factors for GDM.

The prevalence of GDM in women with PCOS is not similar between those treated for infertility using ART and those not treated. Other determinants of GDM within this population have been identified, which could potentially enable early detection of women at risk and the implementation of personalized care in a precision medicine approach.