PREGNANCY COMPLICATIONS AND OUTCOMES IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME
Gona Aziz Rahim a
a Obstetrician and Gynecologist, Maternity Teaching Hospital in Sulaymaniyah City, Kurdistan Region, Iraq.
Submitted: 27/4/2022; Accepted: 18/7/2022; Published: 21/9/2022
DOI Link: https://doi.org/10.17656/jsmc.10367
Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that has profound implications for women throughout their reproductive years. PCOS is associated with reproductive challenges, including difficulty in conceiving and pregnancy-related complications of miscarriage, hypertensive disorders, gestational diabetes and prematurity, and increased cesarean section(C/S) rate.
To determine the pregnancy-related complications and outcomes in women with PCOS and to find the risk of these complications in obese and overweight.
Patients and Methods
Prospective cohort study was conducted in a Maternity teaching hospital and private hospitals and clinics in Sulaymaniyah City Jan. 2018 to Dec. 2021. Involved 313 women with PCOS trying to conceive. PCOS women were diagnosed by having two of the following three criteria, known as Rotterdam criteria (oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries as seen by ultrasound scan), with the exclusion of other causes of androgen excess and menstrual cycle irregularity or amenorrhoea. They are followed a few months before conception, pregnancy and delivery. Way of conceiving (natural or by induction of ovulation), adverse pregnancy outcomes, and complications like early pregnancy loss, Pregnancy-induced hypertension (PIH), pre-eclampsia (PET), Gestational diabetes mellitus (GDM), preterm delivery, and mode of delivery were recorded. The risk of these complications in obese and overweight compared to normal weight cases was recorded.
This study included 313 women with PCOS, pregnancy complications were PIH (12.1%), PET (2.2%), GDM (10.5%), pre-term delivery (4.5%), Miscarriage (19.5%), ectopic pregnancy (1.9%), biochemical pregnancy (1.6%), intrauterine fetal death(IUFD) 0.3%, the relation of these complications with pregnancy outcomes showed significant results with p-value of 0.04, 0.02, and 0.01 for PIH, PET, and GDM respectively. These complications were more in obese and overweight PCOS pregnant women than in normal-weight PCOS, but these associations were not significant.
Women with PCOS are at increased risk of adverse pregnancy outcomes; pre-pregnancy education, hormonal status regulation, diet and lifestyle changes, and weight loss with better follow-up of these women during pregnancy may decrease these complications. Introducing specific guidelines for pregnant women with PCOS may be beneficial.
PCOS, Pregnancy outcomes, Pregnancy complications,Overweight PCOS, Obese PCOS, Normal wt PCOS.
Adom H Balen. Polycystic ovary syndrome. In: Luesley DM, Kilby MD, Obstetrics & Gynaecology, An Evidence-based Text for the MRCOG. 3rd ed. Taylor & Francis Group. Publishing; UK London, 2016.P. 654-61.
Adom Balen. Polycystic ovary syndrome and secondary amenorrhoea. In: Edmonds K, Lees C, Bourne T,. Dewhurst's Textbook of Obstetrics and Gynaecology. 9th ed. John Wiley & Sons Ltd. Publishing; UK oxford 2018.P.632-52.
Lobo RA. Polycystic ovary syndrome. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, Philadelphia. Comprehensive Gynecology. 7th ed. Elsevier, Inc. Publishing; 2017.P. 881-96.
Carson SA.Amenorrhea and abnormal uterine bleeding. In: Ling FW, Snyder RR, Carson SA, Fowler WC, Philadelphia. Step-Up to obstetrics and gynecology. 1st ed. Wolters Kluwer Health Publishing; 2015.P. 303-18.
Monash Centre for health research and implementation (MCHRI). International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Australia, Melbourne. Monash University. Budget strategy and outlook 2018. Budget paper no. 38-43,2018. [Internet] Monash: MCHRI; 2018. Available from: monash.edu/medicine/sph pm/mchri/PCOS.
World Health Organization. Geneva. Obesity and overweight. Budget strategy and outlook 2021. Budget paper no. 1,2021. [Internet] Genova: WHO; 2021. Available from https://www.who.int.
World Health Organization. Geneva. Diagnostic criteria and classification of hyperglycemia are first detected in pregnancy. Budget strategy and outlook 2013. Budget paper no. 5,2013. [Internet] Genova: WHO; 2013. Available from https://www.who.int.
Schneider D, Gonzalez JR, Yamamoto M, Yang J, Lo J C. The Association of Polycystic Ovary Syndrome and Gestational Hypertensive Disorders in a Diverse Community-Based Cohort. Journal of Pregnancy. 2019.
Roos N, Sahlin L, Ordeberg G E, Falconer H, Kieler H, Stephansson O. Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population-based cohort study. BJ journal. 2011; 343: d6309.
Ghazeeri G S, Nassar AH, Younes Z, Awwad J T. Pregnancy outcomes and the effect of metformin treatment in women with polycystic ovary syndrome: an overview. Acta Obstet Gynecol Scand. 2012; 91(6): 658-78.
Mills G, Badeghiesh A, Suarthana E, Baghlaf H, Dahan M H. Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: A population-based study of 9.1 million pregnancies. EMJ. 2020; 6(1):29-32.
De Wilde M A, Ruiter M L, Veltman-Verhulst S M, Kwee A, Laven J S, Lambalk C B, et al. Increased complications in singleton pregnancies of women previously diagnosed with polycystic ovary syndrome predominantly in the hyperandrogenic phenotype. Fertility and sterility J. 2017;108(2):0015-0282.
Radon P A, McMahon M J, Meyer W R. Impaired glucose tolerance in pregnant women with polycystic ovary syndrome. Obstet Gynecol. 1999; 94(2):194-7.
Wang Y, Zhao X, Zhao H, Ding H, Tan J, Chen J, et al. Risks for gestational diabetes and pregnancy-induced hypertension are increased in polycystic ovary syndrome. Biomed Res Int. 2013;2013:182582.
Palomba S, Wilde M. A, Falbo A, Koster M P H, La Sala G B, Fauser B C J M. Pregnancy complication in women with polycystic ovary syndrome. Human Reproductive Update. 2015;21(5):575-92.
Wang T, Fu H, Chen L, Xu Y. Pregnancy complication among women with polycystic ovary syndrome in china: a meta-analysis. J of the south-central university. Medical science. 2017;42(11): 1300-10.
Yu HF, Chen H, Gong J, Roa D P. Association between polycystic ovary syndrome and the risk of pregnancy complication: Systematic review and meta-analysis. Medicine(Baltimore). 2016; 95(51): e 4863.
Bjercke S, Dale P O, Tanbo T, Storeng R, Ertzeid G, Abyholm T. Impact of insulin resistance on pregnancy complication and outcome in women with polycystic ovary syndrome. Gynecol. Obstet. Invest. 2002; 54(2): 94-8.
Nielsen J H, Birukov A, Jensen R C, Kyhl H B, Jorgensen J S, Anderson M S, et al., Blood pressure and hypertension during pregnancy in women with polycystic ovary syndrome: Odense child cohort. Obstetrics & Gynecology. 2020; 99(10):1354-63.
Kashyap S, Claman P. Polycystic ovary disease and the risk of pregnancy-induced hypertension. J Repr. Med..2000;45(12):991-4.
Christ J P, Gunning M N, Meun C, Eijkemans M J, Rijn V, Gouke J, et al.Pre-conception characteristics predict obstetrical and neonatal outcomes in polycystic women ovary syndrome. J. Clin. Endocrinol& Metab. 2019;104(3);809-18.
Hart R, Doherty D A. Using data linkage, the potential implications of a PCOS diagnosis on a woman's long-term health. J. Clin. Endocrinol. Metab. 2015;100(3);911-19.
Doherty D A, Newnham J P, Bower C, Hart R. Implication of polycystic ovary syndrome for pregnancy and offspring health. Obs. Gynecol. 2015;125(6):1397-1406.
Liu Q, Wang J, Xu Q, Kong L, Wang J. A retrospective cohort study of obstetric complications and birth outcome in women with the polycystic ovarian syndrome. J. Obstet. & Gynecol.2022;42(4): 574-79.
Boomsma CM, Eijkemans M J, Hughes EG, Visser G H A, Fauser B C J M, Macklon N S. A meta-analysis of pregnancy outcome in women with polycystic ovary syndrome. Hum. Reprod. Update. 2006;12(6):673-83.
Katulski K, Czyzyk A, Podfigurna-Stopa A, Genazzani AR, Meczekalski B. Pregnancy complications in polycystic ovary syndrome patients. Gynecol. Endocrinol.2015;31(2):87-91.
Qin J Z, Pang L H, Chen H Y. Obstetric complication in women with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod. Biol. & Endocrinol. 2013;11(56):doi:10.1186/1477-7827-11-56.
Kjerulff L E, Sanchez-Ramos L, Duffy D. Pregnancy outcomes in women with polycystic ovary syndrome: a meta-analysis. Am J Obstet Gynecol. 2011;204(6):558.e1-6.
Muharram R, Danang P Y, Maidarti M, Harzif A K, Pratama G, Wiweko B, et al. Relationship between obstetric complications in women undergoing IVF with PCOS: A Retrospective cohort study. Research Square. 2020;https://doi.org/10.21203/rs.3.rs-49457/v1.
Mann A, Sagili H, Subbaiah M. Pregnancy outcome in women with polycystic ovary syndrome. J Obstet Gynecol India. 2020;70(5):360-65.
Villarroel A C, Echiburu B, Riesco V, Maliqueo M, Carcamo M, Hirschfeld C, et al. Polycystic ovary syndrome and pregnancy: clinical experience. Rev Med Chil.2007;135(12):1530-8.
Jakubowicz D J, Iuorno M J, Jakubowicz S, Roberts K A, Nestler J E. Effect of metformin on early pregnancy loss in the polycystic ovary syndrome. JCEM.2002;87(2):524-9.
D'Alterio M N, Sigilli M, Succu A G, Ghisu V, Lagana A S, Sorrentino F, et al. Pregnancy outcome in women with polycystic ovarian syndrome(PCOS). Minerva Obstet Gynecol. 2022;74(1):45-59.
Tolstrup J, Jonsdottir F, Ring C M, Andersen M, Ehlers J, Hedengran K, et al. Complication in pregnant women with polycystic ovary syndrome. Ugeskrift for Laeger. 2016;178(12);V05150439.
Joham A E, Palomba S, Hart R. Polycystic ovary syndrome, obesity, and pregnancy. Semin Reprod. Med. 2016;34(2):93-101.
Tanvir KM, Rahman M L. Pregnancy complications in women with PCOS: A Meta-analysis. Dhaka University Journal of science. 2021;69(2):82-7.
Dahan M H, Badeghiesh A, Mills G, Baghlaf H. The effect of obesity on pregnancy complication risks in women with polycystic ovary syndrome. Fertility and Sterility. 2021;116(3);53.
Homburg R. Pregnancy complications in PCOS. Best Pract Res Clin Endocrinol Metab.2006;20(2);281-92.
Linne Y. Effect of obesity on women's reproduction and complications during pregnancy. Obes Rev. 2004;5(3):137-43.
© The Authors, published by University of Sulaimani, College of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.