PCOS increases the risk of adverse birth outcomes


recently Nature Communications The study explored the association between polycystic ovary syndrome (PCOS) and birth outcomes in women with PCOS and assessed the role of potential confounding factors.

PCOS increases the risk of adverse birth outcomesStudy: Systematic review and meta-analysis of birth outcomes in women with polycystic ovary syndromeImage source: MMD Creative/Shutterstock.com

Polycystic Ovary Syndrome and Birth Outcome

PCOS affects about 13% of women of reproductive age. Women with PCOS who undergo fertility treatment to conceive are more likely to have anovulatory infertility.

Other health disorders, such as high blood pressure, obesity, and depression, are also more common in women with PCOS, and may be associated with poorer birth outcomes in offspring.

Meta-analyses conducted on women with PCOS have shown that women with PCOS have more adverse outcomes, such as perinatal mortality, admission to neonatal intensive care units (NICU), lower average birth weight, and preterm birth, compared to women without PCOS. However, there are some shortcomings in the research.

For example, reports on indices associated with birth weight in offspring of women with and without PCOS are inconsistent. Other shortcomings include a lack of sub-group analysis and unclear data on the effect of maternal characteristics on birth outcomes.

About the study

This meta-analysis and systematic review is an updated version of previously published reviews, including publications up to 4 April 2017.

Here, the search period was extended to July 13, 2022, and only papers published in English were included. Several databases such as Medline, EMBASE, Cochrane, Health Technology Assessment, etc. were considered.

Studies that were included contained observational data on preterm birth, low birth weight, fetal growth, small or large for gestational age, and macrosomia for women with and without PCOS.

Studies that used the International Classification of Diseases (ICD) or self-reported PCOS were excluded. For inclusion, the PCOS diagnosis had to meet the Rotterdam criteria.

Random-effects meta-analyses were conducted to generate combined effect estimates for the association between pregnancy outcomes and PCOS status. In additional exercises, the results were validated by excluding studies where women became pregnant after bariatric surgery or were taking metformin after conception.

Study findings

A total of 73 articles were included in the current systematic review, providing data on 77,811 offspring of women without PCOS and 15,070 offspring of women with PCOS.

Women with PCOS were younger, had higher gestational weight gain, and higher body mass index (BMI) compared with women without PCOS. Younger age in PCOS remained significant in sensitivity analyses.

In both baseline and sensitivity analyses, women with PCOS had a relatively higher probability of preterm birth. The probability did not change significantly over time among women with and without PCOS.

This result was also true in pregnancies following assisted reproductive technology (ART), but not in pregnancies with gestational diabetes (GDM).

In terms of birth weight, women with PCOS had lower average birth weights. This result did not change over time and was robust even with additional exercise. However, this was not true in post-ART and GDM pregnancies.

In subgroup analysis, where women were of similar age and had similar age-BMI, PCOS was associated with lower mean birth weight.

Macrosomia, or high birthweight (about 4,000 grams), was similar among women regardless of their PCOS status, and this result was robust in sensitivity analyses.

Additionally, the result was time-invariant, as shown by the cumulative meta-analysis. The odds of pregnancy were similar in those with GDM, post-ART pregnancies, and prospective and high-quality studies.

Women with PCOS were also found to be more likely to have impaired fetal growth. This result was not maintained in post-ART pregnancies nor in age or age-BMI-matched subsamples. However, this result was also seen in some prospective studies, and no study has reported impaired fetal growth in pregnancies with GDM.

There was no difference in the odds of small gestational age between the two groups of women. Furthermore, no difference was observed in the odds of large gestational age. These results were robust in sensitivity analyses.

Cumulative meta-analysis suggested decreasing magnitudes in odds for both younger and older gestational age.

The odds of small size for gestational age were lower in post-ART pregnancies and prospective studies, but not in GDM pregnancies or high-quality studies. The odds of large size for gestational age were similar in post-ART pregnancies and GDM pregnancies and in prospective and high-quality studies.

conclusion

This analysis found that women with PCOS are more likely to have premature birth, impaired fetal growth, and low birth weight babies. Risk factors such as ART, BMI, and age should also be given due attention in women with PCOS.

One limitation centers around the lack of consistency in defining risk factors across studies. Many studies failed to report gestational weight gain, while others provided vague or inconsistent definitions for some outcome variables.

In addition, few studies were available for subgroup analysis, including pregnancies with GDM, pregnancies after ART, and high-quality studies.

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