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Reproductive, metabolic profiles similar in daughters of women with, without PCOS
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The daughters of mothers with and without polycystic ovary syndrome have similar reproductive and metabolic profiles throughout the puberty transition, according to findings from a matched case-control study.
“Our findings differ from other large studies of daughters of women with PCOS, where generally there has been a higher prevalence of reproductive and metabolic abnormalities among daughters of mothers with PCOS,” Richard S. Legro, MD, of the department of obstetrics and gynecology at Penn State College of Medicine, M.S. Hershey Medical Center in Hershey, Pennsylvania, and colleagues wrote. “We did note an increased prevalence of [small for gestational age] or decreased birth weights in daughters of women with PCOS.”
Legro and colleagues analyzed data from 76 daughters from 60 mothers with PCOS and 82 daughters from 53 control mothers without PCOS or type 2 diabetes and a history of regular menstrual cycles. Researchers assessed reproductive and metabolic parameters via ovarian ultrasound, whole-body DXA scans, a modified 2-hour oral glucose tolerance test and two timed urinary collections. Researchers used linear mixed-effects models to compare baseline characteristics between PCOS and control daughters stratified by the three Tanner stage groups; primary endpoint was hyperandrogenism detected by urinary levels of adrenal or ovarian sex steroids.
Researchers observed no between-group differences in detection rates or mean levels for unconjugated estrogens, androgens or conjugated sex steroids at any Tanner stage; results were similar for glucose-challenged salivary insulin levels. DXA body composition measurements, including bone mass, lean body mass and fat, were also similar between PCOS and control daughters, although researchers observed an increased android/gynoid fat ratio in PCOS daughters vs. controls in the Tanner 2/3 group in a subregion analysis (P = .02). Among Tanner stage 4/5 participants, 69% of PCOS daughters had hirsutism (Ferriman-Gallwey score 8) vs. 31% of controls (P = .04).
Legro and colleagues cited several potential reasons behind the study findings. The inheritance of PCOS and PCOS-related traits could be low in daughters, they wrote, as PCOS is a heterogeneous and likely a complex genetic syndrome without a clear Mendelian pattern of trait inheritance. However, the researchers also noted that the full phenotype of PCOS may not present until well beyond the pubertal transition.
“The difficulties in making a diagnosis of PCOS in adolescent girls in the later stages of puberty is well documented, as relative hyperandrogenism, oligomenorrhea and polycystic ovaries all may be a part of normal puberty for girls,” the researchers wrote. “Our Tanner 2/3 group of PCOS daughters were younger than the control daughters, and this may suggest that they entered puberty at a younger age, which has been associated with the later development of PCOS.”
The researchers noted that further studies are needed with a more racially and ethnically diverse cohort with longer follow-up.
“Providing reassurance to the mother with PCOS about her daughter and avoiding excessive evaluation and intervention in an asymptomatic daughter may be the prudent course,” the researchers wrote. – by Regina Schaffer
Disclosure: Legro reports receiving consultant fees from AstraZeneca, Bayer, Clarus Therapeutics, Euroscreen, Kindex, Millendo and Takeda, and research funding from Ferring. Please see the full study for the other authors’ relevant financial disclosures.
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