Associations between polycystic ovary syndrome and adverse obstetric and neonatal outcomes: a population study of 9.1 million births

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>STUDY QUESTION</jats:title> <jats:p>Does polycystic ovary syndrome (PCOS) confer an independent risk for adverse delivery and neonatal outcomes, based on analysis of the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database?</jats:p> </jats:sec> <jats:sec> <jats:title>SUMMARY ANSWER</jats:title> <jats:p>After controlling for all potential confounding effects, women with PCOS are at an increased risk of experiencing preterm pre-labour rupture of membranes (PPROM), pre-term delivery (PTD), placental abruption, caesarean section (C/S) delivery, chorioamnionitis and post-partum maternal infections.</jats:p> </jats:sec> <jats:sec> <jats:title>WHAT IS KNOWN ALREADY</jats:title> <jats:p>PCOS may be associated with an increased risk of adverse perinatal outcomes. However, there remain significant gaps in understanding the correlation between PCOS and important delivery and neonatal complications.</jats:p> </jats:sec> <jats:sec> <jats:title>STUDY DESIGN, SIZE, DURATION</jats:title> <jats:p>This is a retrospective population-based cohort study utilising data from the HCUP-NIS over 11 years from 2004 to 2014. A cohort of all deliveries between 2004 and 2014 inclusively was created. Within this group, all deliveries to women with PCOS were identified as part of the study group (n = 14 882), and the remaining deliveries were categorised as non-PCOS births and comprised the reference group (n = 9 081 906).</jats:p> </jats:sec> <jats:sec> <jats:title>PARTICIPANTS/MATERIALS, SETTING, METHODS</jats:title> <jats:p>The HCUP-NIS is the largest inpatient sample database in the USA and it is comprised of hospital inpatient stays throughout the entire country. It provides information relating to 7 million inpatient stays per year, includes ∼20% of admissions, and represents over 96% of the American population.</jats:p> </jats:sec> <jats:sec> <jats:title>MAIN RESULTS AND THE ROLE OF CHANCE</jats:title> <jats:p>After adjustment for all potential confounders, women with PCOS were more likely to experience PPROM (aOR 1.48, 95% CI 1.20–1.83), PTD (aOR 1.37 95% CI 1.24–1.53) and placental abruption (aOR 1.63, 95% CI 1.30–2.05) and were more likely to deliver by C/S (aOR 1.50, 95% CI 1.40–1.61 (all P &amp;lt; 0.001). Women with PCOS more often developed chorioamnionitis (aOR 1.58, 95% CI 1.34–1.86, P &amp;lt; 0.001) and maternal infections (aOR 1.58, 95% CI 1.36–1.84 (both P &amp;lt; 0.001)). With the exception of multiple gestations (aOR 1.27, 95% CI 1.01–1.62, P = 0.04), there was no difference in the number of women who gave birth to small for gestational age (SGA) infants (aOR 0.97, 95% CI 0.82–1.15, P = 0.72) between the women with PCOS and the reference group. Intrauterine foetal deaths (IUFDs) were also comparable between the two groups (aOR 1.03, 95% CI 0.68–1.59, P = 0.88). However, congenital anomalies were more likely to occur in the offspring of women with PCOS (aOR 1.89, 95% CI 1.51–2.38, P &amp;lt; 0.001).</jats:p> </jats:sec> <jats:sec> <jats:title>LIMITATIONS, REASONS FOR CAUTION</jats:title> <jats:p>This is a retrospective analysis utilising an administrative database which relies on the accuracy and consistency of the individuals coding the data. There are known limitations in how accurately hospital coding is able to capture perinatal conditions and complications, making it difficult to know with certainty that such events are accurate.</jats:p> </jats:sec> <jats:sec> <jats:title>WIDER IMPLICATIONS OF THE FINDINGS</jats:title> <jats:p>Women with PCOS are more likely to experience adverse delivery and neonatal outcomes. It is important to additionally consider the risk of all other co-existing conditions frequently encountered in PCOS women, as these risks are additive and place women with PCOS at significantly increased risk of adverse pregnancy outcomes.</jats:p> </jats:sec> <jats:sec> <jats:title>STUDY FUNDING/COMPETING INTEREST(S)</jats:title> <jats:p>No specific funding was obtained for this study. The authors have no conflicts of interest to disclose.</jats:p> </jats:sec>

Gestational metformin administration in women with polycystic ovary syndrome: A systematic review and meta‐analysis of randomized control studies

“…Due to the small number of articles, we relaxed the original inclusion criteria in the protocol (CRD42020182038) and no longer required matched for baseline characteristics. Only studies that met the inclusion criteria were considered 1 : The study design should be RCT 2 ; The participants should be diagnosed as PCOS according to 1990 US NIH criteria, 2003 Rotterdam criteria, or 2006 AE-PCOS criteria without any other aetiologies for hyperandrogenism or infertility 3 ; The study should have a placebo or blank control of PCOS 4 ; The metformin administration should be throughout pregnancy or at least during the first trimester. Studies that did not provide any information on the outcomes of focus were excluded.…”

“…They suffer from a higher risk of gestational diabetes mellitus (GDM), preterm delivery, pregnancy-induced hypertension (PIH), preeclampsia (PE), miscarriage and increased intrauterine growth restriction (IUGR), extreme birthweight, admission to the neonatal intensive care unit (NICU) for their offspring. 3,4 In addition to reproductive aspects, women with PCOS also exhibit metabolism syndrome features, including insulin resistance (IR), obesity, and dyslipidemia. 1,5 Among these metabolic disorders, IR is most likely a cornerstone of the pathophysiology of PCOS.…”

Analysis of Upstream Regulators, Networks, and Pathways Associated With the Expression Patterns of Polycystic Ovary Syndrome Candidate Genes During Fetal Ovary Development

“…GWAS have also identified 19 PCOS susceptibility loci among the Han Chinese, European and Korean ancestry [reviewed in detail by McAllister et al (2015) ; Jones and Goodarzi (2016) ; Hiam et al (2019) ]. More so, the fetal origin of PCOS has been studied in human ( Davies et al, 2012 ; Echiburú et al, 2020 ; Mills et al, 2020 ) and animal models including mice ( Sullivan and Moenter 2004 ), rats ( Wu et al, 2010 ), sheep ( Birch et al, 2003 ), and monkeys ( Dumesic et al, 1997 ). The possible fetal predisposition of the syndrome has also been studied further in bovine and human fetal ovaries using qRT-PCR technique ( Hartanti et al, 2020 ; Liu et al, 2020 ).…”

The relationship between polycystic ovary syndrome and insulin resistance from 1983 to 2022: A bibliometric analysis

“…The relationship between polycystic ovary syndrome and insulin resistance from to : A bibliometric analysis Introduction Polycystic ovary syndrome (PCOS) is a complex disease with highly heterogeneous clinical manifestations, which affects about 6-10% of women of reproductive age worldwide, making them prone to infertility, adverse pregnancy outcomes, endometrial cancer, and other diseases (1,2). Studies have shown that about 35-80% of PCOS patients have insulin resistance (IR) (3,4), which means researchers are paying more and more attention to the role of IR in PCOS.…”