Implications of Polycystic Ovary Syndrome for Pregnancy and for the Health of Offspring

Abstract

II.

Physiological Aspects of Female Fertility: Role of the Environment, Modern Lifestyle, and Genetics

“…In general, women with PCOS are at a greater risk of miscarriage than women without features of PCOS; in addition, they are at greater risk of gestational diabetes, preeclampsia, and premature labor in pregnancy, and the perinatal mortality rate is greater for infants born to women with PCOS (87,139). In later life, women with PCOS were twice as likely to have a non-injury-related hospital admissions, three times more likely to develop type II diabetes, four times more likely to be obese, and were significantly more likely to have cerebrovascular and cardiovascular disease, suffer a thromboembolic event, and have a hospital admission for a mental health condition than a woman without a diagnosis of PCOS (139).…”

“…Other systemic changes prevalent in women with PCOS, influencing conception and miscarriage, are an elevated serum plasminogen activator inhibitor-1 (124) and an abnormal expression of some molecular markers with the endometrium, including insulin-like growth factor binding protein-1, glycodelin, homeobox protein (HOXA 10), and a endometrial progesterone resistance (53,249,295,306). The consequences of this disturbed systemic and endometrial environment is a reduced chance of conception, an increased risk of miscarriage, and in pregnancy a predisposition to growth restriction, preeclampsia, and prematurity (41,87,269).…”

“…Of particular importance in relation to obesity is that women with PCOS, which is characterized by hyperinsulinemia and hyperandrogenism (231), are particularly predisposed to weight gain (340), exacerbating their risk of obstetric, perinatal, and neonatal complications in addition to an increase in congenital malformations (87). In general, women with PCOS are at a greater risk of miscarriage than women without features of PCOS; in addition, they are at greater risk of gestational diabetes, preeclampsia, and premature labor in pregnancy, and the perinatal mortality rate is greater for infants born to women with PCOS (87,139).…”

Fertility Treatment for Women with PCOS

“…Obesity is associated with an increased risk of anovulation, increased androgen production and decreased response to follicular stimulating hormone (FSH) equating to decreased fecundity both in natural conception and assisted reproductive techniques [10]. Risks to the foetus if conception does occur include increased rates of congenital anomalies (neural tube defects, omphalocele and cardiac defects) [11], increased rates of hypoglycaemia of the newborn and other complications of gestational diabetes and long-term greater risks of metabolic disease for life. Risks to the pregnant obese patient include greater incidence of hypertensive disorders in pregnancy, increased incidence of thromboembolic events, increased incidence of gestational diabetes, increased risks of operative delivery and increased risks of perineal trauma [11].…”

“…Risks to the foetus if conception does occur include increased rates of congenital anomalies (neural tube defects, omphalocele and cardiac defects) [11], increased rates of hypoglycaemia of the newborn and other complications of gestational diabetes and long-term greater risks of metabolic disease for life. Risks to the pregnant obese patient include greater incidence of hypertensive disorders in pregnancy, increased incidence of thromboembolic events, increased incidence of gestational diabetes, increased risks of operative delivery and increased risks of perineal trauma [11]. For all these reasons, it is imperative that patients embarking on fertility treatment are first counselled and advised to optimise their weight and aim for a body mass index (BMI) in the healthy range.…”