Association between preconception anti-androgen therapy and pregnancy outcomes of patients with PCOS: A prospective cohort study

Abstract

BackgroundPolycystic ovary syndrome (PCOS) not only increases fertility challenges for women of reproductive age, but also leads to increased complications during pregnancy and even affects the birth weight of newborns. Also, hyperandrogenemia is associated with lower pregnancy rates and lower live birth rates and may even play a role in preterm delivery and pre-eclampsia in patients with PCOS. However, it is still controversial whether PCOS patients are treated with androgen-lowering therapy before pregnancy.ObjectiveTo assess the effect of anti-androgen therapy prior to ovulation induction on maternal and infant pregnancy outcomes in patients with PCOS.MethodsProspective cohort study.ResultsA total of 296 patients with PCOS were enrolled in the study. The prevalence of adverse pregnancy outcomes, and neonatal complications was lower in DRSP(with drospirenone ethinyl estradiol tablets (II) pretreatment) group than in NO-DRSP(without drospirenone ethinyl estradiol tablets (II) pretreatment) groups (DRSP vs. NO-DRSP: adverse pregnancy outcomes, 12.16% vs. 27.03%, P=0.001; neonatal complications, 17.16% vs. 36.67%, P<0.001). No significant difference was found in maternal complications. Further subgroup analysis revealed that PCOS with pretreatment decreased the risk of preterm delivery (2.99% vs. 10.00%; Adjusted RR, 3.80; 95% CI, 1.19-12.13), pregnancy loss (9.46% vs. 18.92%; Adjusted RR, 2.07; 95% CI, 1.08-3.96), low birth weight (0.75% vs 7.50%; Adjusted RR, 12.08; 95% CI, 1.50-97.31), fetal malformations(1.49% vs. 8.33%; Adjusted RR, 5.63; 95% CI, 1.20-26.33).There were no significant differences in the incidence of DM and PIH as pregnancy complications between the two groups (P>0.05).ConclusionOur findings suggest that preconception androgen-lowering therapy in patients with PCOS improves pregnancy outcomes and reduces neonatal complications.

ApoC3 is expressed in oocytes and increased expression is associated with PCOS progression

“…PCOS is a multi-factorial and heterogeneous syndrome characterized by excessive androgens, ovulatory dysfunction, and polycystic ovarian morphology, and is often accompanied with metabolic disorders, such as insulin resistance (IR), abnormal lipid metabolism, metabolic syndrome, type 2 diabetes and cardiovascular disease. Its impact on women’s physical and mental health has made it a severe public health challenge [ 4 – 8 ].…”

The Role of Different Methods in Defining Cardiometabolic Risk and Metabolic Syndrome in Women with Polycystic Ovary Syndrome

“…Alterations in endometrial competence as well as oocyte and embryo quality have been noted in PCOS patients [5]. Beyond changes affecting multiple reproductive mechanisms, PCOS has additionally been demonstrated to be a risk factor for higher pregnancy problem rates, including preterm birth, perinatal fetal mortality, pre-eclampsia, gestational diabetes, and gestational hypertension [6].…”