Polycystic ovary syndrome and risk of stillbirth: a nationwide register‐based study

Abstract

Objective To investigate whether polycystic ovary syndrome (PCOS) is associated with increased risk of stillbirth and whether any such association is linked to PCOS with a severe hyperandrogenic profile. Design Nationwide register‐based cohort study. Setting Sweden. Population The cohort consisted of women giving birth to singleton infants in 1997–2015. All women with a diagnosis of PCOS in the period 1997–2017 and a randomly selected reference group of women without PCOS diagnosis were included. PCOS with a severe hyperandrogenic profile was defined as a PCOS diagnosis with at least two dispensations of prescribed anti‐androgens during 2005–2017. Methods The risk of stillbirth in women with PCOS was estimated through multiple logistic regression, using women without PCOS as a reference. Risks were expressed as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs), adjusted for maternal age, parity, body mass index, type‐1 diabetes, educational level and country of birth. Main outcome measures Stillbirth, at ≥22 weeks of gestation in 2008–2015 and at ≥28 weeks of gestation in 1997–2007. Results Compared with women without PCOS (n = 241 750), women with PCOS (n = 41 851) had a 50% increased risk of stillbirth (aOR 1.50, 95% CI 1.28–1.77). The incidence of stillbirth in women with PCOS was particularly increased at term. Women with PCOS and a severe hyperandrogenic profile (n = 13 713) did not have a stronger association with stillbirth than women with PCOS who did not have such a profile. Conclusions PCOS is associated with stillbirth and should be considered as a possible risk factor in antenatal care. Further research is warranted to investigate possible causal mechanisms. Tweetable abstract Women with PCOS have increased risk of stillbirth, and the incidence is particularly increased at term.

Adverse Effects of Polycystic Ovarian Syndrome on Pregnancy Outcomes in Women With Frozen-Thawed Embryo Transfer: Propensity Score-Matched Study

“…Our result is consistent with the findings of Valgeirsdottir et al. ( 36 ), who conducted a nationwide register-base cohort study and found that PCOS was associated with stillbirth. Two meta-analyses reported that PCOS is related to the risk of perinatal death, including stillbirth and early neonatal death ( 37 , 38 ).…”

Polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in England

“…[ 16 ], while a more recent study by Valgeirsdottir et.al. [ 45 ], suggests a 50% increased risk of stillbirth among women with PCOS, although the exposure ascertainment within the study suffers from misclassification due to inclusion of women with anovulation as well as women with PCOS.…”

Pathogenesis and prevention of adverse pregnancy outcomes in polycystic ovary syndrome

“…PCOS is strongly associated with pre-eclampsia (PE), gestational diabetes mellitus (GDM), very preterm birth (PTB), large-for-gestational-age fetuses (LGA), and asphyxia during labour. 2 In the study by Valgeirsdottir et al, 1 women with PCOS had a 50% increased risk of stillbirth compared with women without PCOS, especially at term. In this study, the mechanisms of stillbirth are well explained, which include the following: hyperandrogenism and associated insulin resistance; obesity; hypertensive disorders; placental diseases, fetal anomalies and umbilical cord abnormalities; fetal growth restriction (FGR); GDM; and chronic inflammation, oxidative stress and mitochondrial dysfunction.…”

“…2 We previously showed that an induction of labour for non-medical reasons among low-risk women was associated with adverse health outcomes for both women and infants, compared with women with a spontaneous start of labour. 3 Because a large number of women need to be induced to prevent one stillbirth, a more proactive practice style, as stated in the paper of Gural-Ulganci et al, 1 will come at the costs of other adverse outcomes in many women and infants.…”