Clinical management of pregnancy in women with polycystic ovary syndrome: An expert opinion

Abstract

Polycystic ovary syndrome (PCOS) is associated with a higher risk for pregnancy and birth complications according to the specific features associated with PCOS.The features include obesity before and during pregnancy, hyperandrogenism, insulin resistance, infertility, cardiometabolic risk factors, and poor mental health.PCOS is not often recognized as a risk factor for poor pregnancy and birth outcomes in pregnancy care guidelines, while its associated features are. Pregnancy-related risk profile should ideally be assessed for modifiable risk factors (e.g., lifestyle and weight management) at preconception in women with PCOS. Hyperglycaemia should be screened using a 75-g oral glucose tolerance test at preconception or within the first 20 weeks of pregnancy if it has not been performed at preconception and should be repeated at 24-28 weeks of pregnancy. In the absence of evidence of benefit for strategies specific to women with PCOS, the international evidencebased guidelines for the assessment and management of PCOS recommend screening, optimizing, and monitoring risk profile in women with PCOS (at preconception, during and postpregnancy) consistent with the recommendations for the general population. Recommended factors include blood glucose, weight, blood pressure, smoking, alcohol, diet, exercise, sleep and mental health, emotional, and sexual health among women with PCOS. The guidelines recommend Metformin in addition to lifestyle for assisting with weight management and improving cardiometabolic risk factors, particularly in those with overweight or obesity.

Causal association of metabolites and polycystic ovarian syndrome: A Mendelian randomization study

“…Moreover, the solubility of alkaloids like piperine in ethanol may contribute to the association with alcohol intake. It is worth noting that a previous study by M. Bahri Khomami et al also reported a positive association between liquor intake and an increased risk of PCOS [39]. Considering these ndings, it is possible that PCOS patients may consume more alcohol, leading to a higher intake of piperine.…”

Insulin-like growth factor binding protein-1 and insulin in polycystic ovary syndrome: a systematic review and meta-analysis

“…The inclusion criteria were as follows: (1) studies that measured IGFBP-1 and insulin levels in PCOS and non-PCOS women; (2) studies that compared IGFBP-1 and insulin levels among different weight women with or without PCOS; or (3) studies written in English. Diagnostic criteria for PCOS are shown in Table 1.…”

Polycystic Ovarian Syndrome (PCOS): Does the Challenge End at Conception?

“…Another study by Sha et al [ 41 ], in a meta-analysis of pregnancy-related outcomes and complications in women with polycystic ovary syndrome undergoing IVF found that women with PCOS had higher risks of miscarriage (OR 1.41); however, the authors concluded by stating that they were unable to perform a further analysis to evaluate the influence of phenotypic variants of PCOS on the prevalence of pregnancy and neonatal complications. Finally, an expert opinion piece published in 2022 on the association between PCOS and miscarriage stated that women with PCOS are at increased risk for ectopic pregnancy, hydatidiform molar pregnancy, and miscarriage, mainly following fertility treatments, but that given that fertility treatments are known risk factors for the outcomes, it is hard to disentangle the association of PCOS per se with these adverse outcomes [ 42 ].…”

“…This controversy about the role of possible confounding factors in the risk between GDM and PCOS unfortunately therefore remains, with a recent expert opinion [ 42 ] concluding that the higher risk of GDM was independent of, yet exacerbated by, obesity in PCOS related to insulin resistance, in contrast to three relatively recent publications including two meta-analyses and a Danish prospective study which all [ 56 , 57 , 58 ] concluded that PCOS may not be an individual risk factor for GDM as pregnancies in PCOS are characterized by factors known to increase the risk of GDM, especially high BMI and fertility treatment.…”