A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome

Abstract

Polycystic ovary syndrome (PCOS) is a common reproductive disorder associated with many characteristic features, including hyperandrogenaemia, insulin resistance and obesity which may have significant implications for pregnancy outcomes and long-term health of the woman. This meta-analysis was conducted to evaluate the risk of pregnancy and neonatal complications in women with PCOS. Electronic databases were searched for the following MeSH headings: PCOS, hyperandrogenism, pregnancy outcome, pregnancy complications, diabetes mellitus, type II. A handsearch of human reproduction and fertility and sterility was also conducted. Studies in which pregnancy outcomes in women with PCOS were compared with controls were considered for inclusion in this meta-analysis. Fifteen of 525 identified studies were included, involving 720 women presenting with PCOS and 4505 controls. Women with PCOS demonstrated a significantly higher risk of developing gestational diabetes [odds ratio (OR) 2.94; 95% confidence interval (CI): 1.70-5.08], pregnancy-induced hypertension (OR 3.67; 95% CI: 1.98-6.81), pre-eclampsia (OR 3.47; 95% CI: 1.95-6.17) and preterm birth (OR 1.75; 95% CI: 1.16-2.62). Their babies had a significantly higher risk of admission to a neonatal intensive care unit (OR 2.31; 95% CI: 1.25-4.26) and a higher perinatal mortality (OR 3.07; 95% CI: 1.03-9.21), unrelated to multiple births. In conclusion, women with PCOS are at increased risk of pregnancy and neonatal complications. Pre-pregnancy, antenatal and intrapartum care should be aimed at reducing these risks.

Maternal obesity: the interplay between inflammation, mother and fetus

“…2,[4][5][6] Maternal obesity is associated with several fetal and neonatal complications, most significantly fetal death and premature birth. 4,[7][8][9][10][11] In addition, maternal obesity has been related to the development of metabolic syndrome, diabetes and obesity in children, thus perpetuating this dangerous cycle. 4,5,8,12 With increased infertility, many obese women have looked to assisted reproductive technology such as in vitro fertilization (IVF).…”

The impact of ovulation induction and ovarian stimulation on the risk of pregnancy-induced hypertension and on neonatal outcomes: A case/control study

“…It has been assumed that PCOS could induce hypertension through insulin resistance [25,26], which in turn is associated with higher blood pressure [26,27]. PCOS has also been associated with a particular state of endometrial progesterone resistance [8]. These mechanisms could interfere with the process of decidualization, with restrictive trophoblast endovascular invasion associated with defective spiral artery remodeling [8,9,28,29] and placental alterations [30].…”

“…PCOS has also been associated with a particular state of endometrial progesterone resistance [8]. These mechanisms could interfere with the process of decidualization, with restrictive trophoblast endovascular invasion associated with defective spiral artery remodeling [8,9,28,29] and placental alterations [30].…”

“…Indeed, after exclusion of twin pregnancies, that carry specific over risks [1,2], the role of the underlying cause of infertility, such as a polycystic ovarian syndrome (PCOS) [8] through the hormonal environment induced by hormonal stimulation and menstrual preconditioning [9], and the role of the diverse types of ovarian stimulation and assisted reproductive technology (ART) procedures with mild or high estrogen levels [10], have been questioned. In the meta-analysis of Boosman et al [8], women with PCOS demonstrated a significantly higher risk of developing pregnancyinduced hypertension (PIH); but two more recent reviews [11,12] suggested that heterogeneous aetiological factors associated with PCOS, such as obesity, could be involved in this adverse outcome. Moreover, a possible over risk of PIH attributable to the type of ovarian stimulation itself was never investigated in pregnancies obtained among the PCOS women [11].…”

Oxidative stress in pregnancy and fertility pathologies

“…Women with PCOS present difficulties in becoming pregnant and often experience spontaneous abortion, along with menstrual and skin disorders (Agarwal et al 2012;Ruder et al 2008), as well as increased risk of gestational diabetes mellitus, hypertension, and preeclampsia during pregnancy (Boomsma et al 2006;Roos et al 2011).…”