This article is more than 5 years old. Information may no longer be current.
Overweight, obesity influence PCOS-related complications
Click Here to Manage Email Alerts
Women with polycystic ovary syndrome and overweight or obesity are more likely to experience PCOS-related comorbidities and complications vs. women without the condition, including adverse reproductive, metabolic and psychological outcomes, according to an overview of systematic reviews.
“A systematic review is widely considered to provide the highest level of evidence compared to other study methodologies, and recent years have seen an increasing number summarizing the assessment of PCOS,” Emily W. Gilbert, a doctoral student at the Monash Centre for Health Research and Implementation at Monash University School of Public Health and Preventive Medicine, Victoria, Australia, and colleagues wrote in the study background. “However, many of these reviews present conflicting results, highlighting the need for synthesis and critical appraisal of the pertaining literature to reach more consistent conclusions.”
Gilbert and colleagues analyzed data from 23 systematic reviews or meta-analyses assessing the comorbidities and complications associated with PCOS conducted between 2009 and September 2017. Studies were conducted in Australia (n = 4), China (n = 5), Greece (n = 2), Iran (n = 4), the Netherlands (n = 2), Sweden (n = 1), Switzerland (n = 1), the United Kingdom (n = 4) and the United States (n = 4). Nine reviews included all study types, five reviews included observational studies only, two included cohort and case-control studies only and two reviews included cross-sectional studies only, with three not stating inclusion criteria. The number of studies included in each systematic review ranged from five to 106, with total participants ranging from 213 to 767,988. Outcomes of interest included PCOS comorbidities and complications related to reproduction, metabolism, psychological and other outcomes, such as cancer and vitamin D level.
Reproductive comorbidities
Two reviews assessed maternal and/or fetal complications in pregnant women with PCOS. One noted an increased prevalence of hypoglycemia, perinatal death, gestational diabetes, pregnancy-induced hypertension, preterm delivery, caesarean section delivery and miscarriage among women with PCOS. A second review found women with PCOS were at a markedly higher risk for gestational diabetes vs. women without PCOS, according to the researchers.
Metabolic comorbidities
In three reviews analyzing the effects of obesity on glucose homeostasis in adult women with PCOS, researchers found that women with PCOS and overweight or obesity had greater insulin resistance vs. normal-weight women with PCOS, whereas another review found that women with PCOS and vitamin D deficiency had a higher fasting blood glucose, fasting insulin, more insulin resistance and reduced beta-cell function vs. women with PCOS who did not have vitamin D deficiency. Women with PCOS were also more likely to have metabolic syndrome than BMI- and non-BMI-matched women without PCOS. Women with PCOS were also more likely to have overweight, obesity and central obesity vs. women without PCOS.
Psychological comorbidities
In six reviews assessing the psychological complications of PCOS, four evaluated health-related quality of life and three reviews measured the prevalence of symptoms of anxiety or depression. Reviews suggested that women with PCOS reported higher emotional distress vs. women without PCOS, as well as lower values in several domains of the SF-36 survey, physical function, body pain, general health, vitality, social function, emotional role function and mental health. In reviews assessing depression and anxiety, all three studies showed higher depressive and anxiety symptom scores in women with PCOS vs. women without PCOS, according to the researchers.
The researchers noted that despite many reviews, including 575 studies and more than 1 million participants, there was a lack of high-quality evidence.
“We confirm that PCOS has a range of reproductive, metabolic, psychological and other manifestations,” the researchers wrote. “We report many of the assessed outcomes were worsened by excess adiposity, highlighting the importance of weight management as first-line PCOS therapy.”
The researchers also noted a shortage of systematic reviews regarding pregnancy outcomes in PCOS, as well as “significant knowledge gaps” regarding any associations between nonalcoholic fatty liver disease, vitamin D levels and cancers with PCOS. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
Click Here to Manage Email Alerts