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Pregnancy more problematic for women with PCOS
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Women with polycystic ovary syndrome are more likely to experience adverse pregnancy and birth outcomes, such as gestational diabetes, even without the use of assisted reproductive technology, new data indicate.
Evidence links PCOS to a number of negative pregnancy outcomes, but many studies have primarily focused on women with PCOS who are undergoing assisted reproductive technology.
“Consequently, the extent to which the risk of adverse pregnancy outcomes in women with PCOS is attributed to the underlying disorder or infertility treatment is uncertain,” researchers at the Karolinska Institutet in Stockholm, Sweden, wrote.
To further characterize the relationship between PCOS and birth and pregnancy outcomes, the researchers analyzed data from the Swedish medical birth register on 3,787 births among women with PCOS and 1,191,336 births among women without the condition between 1995 and 2007. They accounted for maternal characteristics, socioeconomic factors and the use of assisted reproductive technology.
Increased risks
According to study results, a diagnosis of PCOS more than doubled a woman’s risk for gestational diabetes (adjusted OR=2.32; 95% CI, 1.88-2.88), as well as increased her risk for preeclampsia (adjusted OR=1.45; 95% CI, 1.24-1.69) and very preterm birth (adjusted OR=2.21; 95% CI, 1.69-2.9). In a stratified analysis, the adjusted OR for preterm birth was 1.08 (95% CI, 0.76-1.53) for women with PCOS using assisted reproductive technology and 1.58 (95% CI, 1.33-1.79) for those conceiving spontaneously. Women with PCOS were also 18% more likely than women without the condition to undergo an emergency or voluntary cesarean section, the researchers said.
Regarding adverse birth outcomes, the researchers found that infants who were large for gestational age were more frequently born to mothers with PCOS vs. mothers without the condition (adjusted OR=1.39; 95% CI, 1.19-1.62). Infants born to mothers with PCOS also had a higher risk for meconium aspiration (adjusted OR=2.02; 95% CI, 1.13-3.61) and low Apgar scores at 5 minutes (adjusted OR=1.41; 95% CI, 1.09-1.83).
Data also showed that compared with women without PCOS, women with the condition were more likely to be nulliparous (43.8% vs. 53%; P<.001); to be undergoing assisted reproductive technology (1.5% vs. 13.7%; P<.001); and to have a BMI of more than 25 (34.8% vs. 60.6%; P<.001). Hypertensive disease, diabetes and advanced age were also more common among women with PCOS, according to the researchers.
“[Women with PCOS] may need increased surveillance during pregnancy and parturition,” the researchers wrote. “Future research would benefit from focusing on glucose control, medical treatment and hormonal status among women with PCOS during pregnancy.”
More studies
In an accompanying editorial, Nick S. Macklon, MD, professor of obstetrics and gynecology at the University of Southampton and Princess Anne Hospital in the United Kingdom, said pregnant women with PCOS should be considered high-risk patients and monitored accordingly. Nevertheless, the need exists to fill certain research gaps.
“More evidence is required to support the use of currently used interventions designed to reduce perinatal risk, and this requires a greater understanding of the different PCOS phenotypes and the underlying mechanisms by which this common condition alters pregnancy outcomes,” Macklon wrote.
For more information:
Disclosure: The researchers and Dr. Macklon report no relevant financial disclosures.
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This paper, which explores risk of adverse pregnancy outcomes in women with polycystic ovary syndrome, is an important contribution to the field of PCOS research. Some of the adverse outcomes reported, namely gestational diabetes mellitus, large-for-gestational-age babies, cesarean deliveries or even preeclampsia, could be reasonably predicted, knowing the association of PCOS with insulin resistance and its consequences. Increased risk for other important adverse events, such as very preterm birth and fetal distress, manifest as low Apgar scores and meconium aspiration, were less predictable. Notwithstanding the lower pregnancy rates in PCOS patients, many of whom are anovulatory, the prevalence of PCOS was surprisingly quite low (approximately 1 in 315 deliveries), and as the authors pointed out, the diagnosis of PCOS may have been underestimated. Conversely, as also pointed out, the patients classified as PCOS in this study likely had more severe disease, this presumably exaggerating the adverse outcomes. Until we address the heterogeneity of PCOS and account for its etiology in individual women, this study is as good as it gets and women carrying this diagnosis need more careful surveillance and risk reduction in pregnancy.
–Shahla Nader, MD
Departments of Internal
Medicine and OB/GYN
University of Texas Medical School-Houston
Disclosure: Dr. Nader reports no relevant financial disclosures.
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