Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity—A systematic review, meta‐analysis, and meta‐regression

Abstract

Summary Polycystic ovary syndrome (PCOS) is associated with an increased risk of maternal pregnancy and delivery complications. However, the impact of clinical features of PCOS and other potential risk factors in PCOS is still unknown. We aimed to investigate the association of PCOS with maternal pregnancy and delivery complications with consideration of risk factors and potential confounders. The meta‐analysis included 63 studies. PCOS was associated with higher miscarriage, gestational diabetes mellitus, gestational hypertension, pre‐eclampsia, induction of labour, and caesarean section. The association of PCOS with these outcomes varied by geographic continent, PCOS phenotypes, and study quality. Pre‐eclampsia and induction of labour were not associated with PCOS on body mass index‐matched studies. No outcome was associated with PCOS on assisted pregnancies. Age was significantly associated with higher miscarriage on meta‐regression. There were no studies assessing perinatal depression. We confirm that PCOS is associated with an increased risk of maternal pregnancy and delivery complications. The association of PCOS with the outcomes is worsened in hyperandrogenic PCOS phenotypes, in specific geographic continents, and in the highest quality studies but disappears in assisted pregnancies. Future studies in PCOS are warranted to investigate proper timing for screening and prevention of maternal pregnancy and delivery complications with consideration of clinical features of PCOS.

The Association between Dietary Intake, Asthma, and PCOS in Women from the Australian Longitudinal Study on Women’s Health

“…Polycystic ovary syndrome (PCOS) is an endocrine disorder with a reported overall prevalence rate of 6% to 10% [1] based on the Rotterdam diagnostic criteria of two of three features, i.e., oligoor anovulation, hyperandrogenism (clinical or biochemical), and polycystic ovaries on ultrasound, after exclusion of other causes [2]. PCOS is associated with reproductive (hyperandrogenism, anovulation, infertility, and pregnancy complications) [3] and metabolic features (elevated prevalence of and risk factors for type 2 diabetes and cardiovascular disease) [4,5], along with psychological impact, such as increased risk of depression and anxiety [6] and impaired quality of life [7]. Insulin resistance is a key pathophysiological contributor to PCOS.…”

Pregnancy outcome in women with polycystic ovary syndrome in relation to second-trimester testosterone levels

“…In childbearing age, infertility is one of the most common problems in women with PCOS, but with assisted reproductive technology, longitudinal studies suggest overall high fecundity (Persson et al, 2019). Once pregnant, women with PCOS face a higher risk of miscarriage, gestational diabetes, gestational hypertension, preeclampsia and preterm birth (Palomba et al, 2015;Yu et al, 2016;Bahri Khomami et al, 2018;Bahri Khomami et al, 2019). According to a recent meta-analysis, these risks are independent of obesity, even though obesity is a major risk factor on its own for these complications (Bahri Khomami et al, 2019).…”

“…Once pregnant, women with PCOS face a higher risk of miscarriage, gestational diabetes, gestational hypertension, preeclampsia and preterm birth (Palomba et al, 2015;Yu et al, 2016;Bahri Khomami et al, 2018;Bahri Khomami et al, 2019). According to a recent meta-analysis, these risks are independent of obesity, even though obesity is a major risk factor on its own for these complications (Bahri Khomami et al, 2019). High levels of AMH, in contrast, seem protective of gestational hypertension, and unrelated to other obstetric and neonatal complications (Shand et al, 2014;Valdimarsdottir et al, 2019).…”

The impact of obesity on the gestational diabetes differential between pregnant women with and without polycystic ovary syndrome

“…Bahri Khomami et al recently published a meta‐analysis investigating the role of maternal obesity on the association between polycystic ovary syndrome (PCOS) and fetal and maternal outcomes. One of the outcomes was gestational diabetes mellitus (GDM), and they included 39 studies that recruited a total of 11 565 women with PCOS and 177 296 women without PCOS and compared them to assess the role of PCOS per se on the development of GDM.…”

“…The fundamental question that the authors attempted to answer was if there was a higher risk for women with PCOS in terms of GDM and if this was independent of other GDM risk factors. The authors used univariate meta‐regression as well as subgroup analysis of BMI matched and non‐matched studies to conclude that indeed there was an independent predictive role of PCOS on the development of GDM …”