Pre-Conception Characteristics Predict Obstetrical and Neonatal Outcomes in Women With Polycystic Ovary Syndrome

Abstract

Context Women with polycystic ovary syndrome (PCOS) are at increased risk for obstetric and perinatal complications. At present, it is unknown how characteristics of PCOS relate to the likelihood of these complications. Objective To evaluate which preconception features are associated with obstetric and perinatal disease among infertile women with PCOS. Design Data from two prospective cohort studies completed from January 2004 until January 2014 were linked to Dutch Perinatal national registry outcomes. Setting Two Dutch university medical centers. Participants 2768 women diagnosed with PCOS were included. Participants underwent an extensive standardized preconception screening. Exclusion criteria included: age <18 years or >45 years, language barrier, or failure to meet PCOS criteria. Interventions None. Main Outcome Measures Outcome measures were obtained from the Dutch Perinatal national registry and included: preeclampsia, preterm delivery, small for gestational age (SGA), low Apgar score, and any adverse outcome. Results 1715 (62% of participants) women with PCOS were identified as undergoing a pregnancy with live birth after screening. In fully adjusted models, prepregnancy free androgen index was associated with subsequent preeclampsia [OR (95% CI), 1.1 (1.0 to 1.1)]. Fasting glucose [1.4 (1.2 to 1.7)] and testosterone [1.5 (1.2 to 1.7)] predicted preterm delivery. Fasting insulin [1.003 (1.001 to 1.005)], and testosterone [1.2 (1.1 to 1.4)] predicted any adverse outcome. SGA was only predicted by features nonspecific to PCOS. Conclusions Primary disease characteristics of PCOS, chiefly hyperandrogenism and impaired glucose tolerance, predict suboptimal obstetric and neonatal outcomes. Increased surveillance during pregnancy should focus on women with PCOS and these features to help mitigate disease risk.

Generational Health Impact of PCOS on Women and Their Children

“…The study used a population of women from an infertility clinic with PCOS, who had undergone phenotypic assessment for features of PCOS prior to conception, and compared them to the national Dutch registry, with regard to the primary outcomes of pre-eclampsia and premature delivery. In agreement with previous studies, there was more than a twofold increase in the risk of pre-eclampsia (5% vs. 2%) for women with PCOS in comparison to the national registry data and the respective rates of premature delivery were 11% vs. 7% [10]. After regression analysis to determine the predictive markers for these adverse outcomes, the authors determined that a pre-pregnancy free androgen index was associated with subsequent pre-eclampsia (odds ratio (OR) 1.1, 95% confidence intervals (CI) 1.0–1.1) and serum fasting glucose (OR 1.4, CI 1.2–1.7) and testosterone (OR 1.5, CI 1.2–1.7) predicted preterm delivery.…”

“…A very insightful study by Christ et al [10] attempted to determine factors that may predict the increased obstetric risk, as PCOS is believed to be a heterogeneous condition, where anovulation may predominate for some women. However, hyperandrogenism symptoms may be the major symptom for others, hence the same obstetric risks may not apply to all.…”

Building an evidence base for IVF ‘add-ons’

“…Guidelines such as the 'TRIPOD' statement can assist consistent approaches to multivariate analysis (Moons et al, 2015) and powerful algorithms can be developed that can generate the data and advice pertinent to individual patients. Rather than avoiding the impact of individual confounding variables, this approach would embrace them, meeting the needs of the current era of personalised medicine (Mega et al, 2014, Christ et al, 2019.…”

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

“…Nowadays, PCOS is a lifelong medical condition requiring a multispecialist vision for early diagnosis and an effective management and treatment plan over time ( 10 ). Preconception care, mainly in infertility clinics, is the golden moment to identify PCOS carriers because PCOS-like outcomes, especially in female offspring, result from both genetic and epigenetic mechanisms ( 68 , 69 ). Indeed, specific PCOS-susceptibility loci may explain family predisposition and the variable clinical presentation of PCOS, including neuroendocrine, reproductive, and metabolic abnormalities ( 70 ).…”