Lifestyle and pregnancy complications in polycystic ovary syndrome: The SCOPE cohort study

Abstract

Summary Objectives To investigate the risk of pregnancy complications in women with and without polycystic ovary syndrome after consideration of lifestyle factors. Design Prospective cohort. Patients and measurements Participants (n = 5628) were apparently healthy nulliparous women with singleton pregnancies from the Screening for Pregnancy Endpoints study in New Zealand, Australia, United Kingdom and Ireland. Multivariable regression models were performed assessing the association of self‐reported polycystic ovary syndrome status with pregnancy complications with consideration of lifestyle factors at the 15th week of gestation. Results Women with polycystic ovary syndrome (n = 354) were older, had a higher socio‐economic index and body mass index and were less likely to consume alcohol and smoke but more likely to do vigorous exercise and take multivitamins. In univariable analysis, polycystic ovary syndrome was associated with increased risk of gestational diabetes (OR: 2.2, 95% CI: 1.2, 4.0). In multivariable models, polycystic ovary syndrome was only significantly associated with decreased risk of large for gestational age (OR: 0.62, 95% CI: 0.40, 0.98) with a population attributable risk of 0.22%. None of the other outcomes were attributable to polycystic ovary syndrome status. Conclusions Polycystic ovary syndrome is associated with a lower risk of large for gestational age infants. In this low‐risk population, the risk of pregnancy complications was not increased in women with polycystic ovary syndrome who were following a healthy lifestyle. Further studies are warranted assessing the contribution of lifestyle factors to the risk of pregnancy complications in higher risk groups of women with and without polycystic ovary syndrome.

The incidence of gestational diabetes mellitus among women with polycystic ovary syndrome: a meta-analysis of longitudinal studies

“…Given the great potential for reducing the disease burden of PCOS patients, future research should continue to identify interventions that can be easily implemented in patients with PCOS, especially during their preconception period. Additionally, due to lack of data in many subgroups, we were unable to perform meta regression analysis for some possible confounders, such as socioeconomic status, family history of GDM, physical activity, drinking and diet habit [ 6 , 54 ]. Accordingly, there might be considerable uncertainty regarding the pooled incidence of GDM among PCOS patients.…”

Clinical management of pregnancy in women with polycystic ovary syndrome: An expert opinion

“…46,47 In a large unselected population of women with and without PCOS, the risk of GDM was similar where women with PCOS had a higher BMI at week 15 of pregnancy but similar early gestational weight gain. 19 Studies reporting GDM in women with and without PCOS do not often report abdominal obesity and insulin resistance status at preconception or at early pregnancy 10 as risk factors for GDM. 48 The risk of hypertensive disorders of pregnancy including gestational hypertension and pre-eclampsia is also higher in women with PCOS.…”

“…A large study on an unselected population of women with and without PCOS found that a high-risk profile for pregnancy and birth complications in PCOS can possibly be compensated by a healthy lifestyle and similar gestational weight gain before the 20th week of pregnancy. 19 Recommendations for optimizing diet during pregnancy are optimal intake of core food groups (whole grains and cereals, vegetables, fruit, meat and/or alternatives, and dairy or alternatives) and limiting intake of "discretionary" or noncore foods which are typically high in sugar, salt, saturated fat, and energy. 60,61 While micronutrient recommendations also differ from country to country, these generally focus on achieving sufficiency in key micronutrients and additional supplementation of folate and iodine to reduce the risk of pregnancy and birth complications.…”

“…For weight, recommendations are to achieve appropriate gestational weight gain to optimize maternal and foetal outcomes. A large study on an unselected population of women with and without PCOS found that a high‐risk profile for pregnancy and birth complications in PCOS can possibly be compensated by a healthy lifestyle and similar gestational weight gain before the 20th week of pregnancy 19 . Recommendations for optimizing diet during pregnancy are optimal intake of core food groups (whole grains and cereals, vegetables, fruit, meat and/or alternatives, and dairy or alternatives) and limiting intake of “discretionary” or noncore foods which are typically high in sugar, salt, saturated fat, and energy 60,61 .…”

“…The association of PCOS with pregnancy and birth complications varies by PCOS phenotype, target population, ethnic background, self or family history of metabolic, reproductive, and potentially psychological complications during or outside pregnancy, and women's lifestyle. 10,[18][19][20] In pregnancy, obesity is an independent risk factor for complications, as is excess gestational weight gain. 10,18,21 Both obesity and increased gestational weight gain are documented in PCOS although whether there is an additional adverse impact of gestational weight gain on pregnancy and birth complications in women with PCOS is not still well understood.…”