Low-Grade Chronic Inflammation in Pregnant Women With Polycystic Ovary Syndrome: A Prospective Controlled Clinical Study

Palomba, Stefano; Falbo, Angela; Chiossi, Giuseppe; Orio, Francesco; Tolino, Achille; Colao, A; Sala, Giovanni Battista La; Zullo, Fulvio

doi:10.1210/jc.2014-1214

Cited by 67 publications

(55 citation statements)

References 38 publications

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“…In PCOS patients, this subclinical inflammation persists during gestation and is exacerbated by pregnancy, and it is associated with adverse pregnancy outcomes [43]. These findings corroborate existing molecular evidence of the subclinical inflammation that may be, at least in part, implicated in PCOS pathogenesis [41,42] Collectively, the published studies indicate that the prevalence of NAFLD is remarkably high among young women with PCOS, independent of overweight/obesity and other MetS features.…”

Section: Introductionsupporting

confidence: 74%

Evidence that non-alcoholic fatty liver disease and polycystic ovary syndrome are associated by necessity rather than chance: a novel hepato-ovarian axis?

2015

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Increasing evidence suggests that non-alcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS) are associated with obesity, insulin resistance, metabolic syndrome, cardiovascular disease, cirrhosis, and liver tumors. On these grounds, we have hypothesized that NAFLD and PCOS occur more frequently than expected by chance alone. We have tested this hypothesis by reviewing the clinical and biological evidence that supports a significant association between NAFLD and PCOS. PubMed was extensively searched for articles published through March 2015 using the keywords "nonalcoholic fatty liver disease" or "fatty liver" combined with "PCOS." Several cross-sectional and case-control studies have consistently demonstrated that the prevalence of NAFLD is remarkably increased in young women with PCOS, independent of overweight/obesity and other coexisting metabolic syndrome features, and that these women are more likely to have the more severe forms of NAFLD (non-alcoholic steatohepatitis, advanced fibrosis, and cirrhosis). Accumulating evidence suggests that NAFLD, especially its necro-inflammatory form, may exacerbate hepatic and systemic insulin resistance and releases multiple pro-inflammatory, pro-coagulant, and pro-fibrogenic mediators that may play important roles in the pathophysiology of PCOS. These findings call for more active and systematic search for NAFLD among women with PCOS. Conversely, gastroenterologists/hepatologists need to be aware of the presence of PCOS among female patients with NAFLD and compatible clinical features. Finally, all these patients should undergo regular follow-up not only for liver-related complications but also for cardio-metabolic diseases.

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Section: Introductionsupporting

confidence: 74%

Evidence that non-alcoholic fatty liver disease and polycystic ovary syndrome are associated by necessity rather than chance: a novel hepato-ovarian axis?

2015

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“…There is limited research exploring this hypothesis. Some studies indicate that a combination of hyperandrogenism and IR and/or hyperinsulinemia may result in increased risk of adverse pregnancy outcomes in women with PCOS such as pregnancy loss, foetal growth abnormalities, GDM, GH, PE, preterm birth and antepartum haemorrhage through altering normal placental implantation . Adverse maternal and neonatal complications were assessed in a study of 885 primiparous women and controls (n = 85 PCOS by NIH, n = 78 PCOS only by Rotterdam, n = 14 PCOS only by the Androgen Excess and PCOS Society criteria and n = 708 controls) .…”

Section: Possible Contributing Mechanisms Of Pcos In Adverse Pregnancmentioning

confidence: 99%

Section: Possible Contributing Mechanisms Of Pcos In Adverse Pregnancmentioning

confidence: 99%

“…In PCOS, a state of low‐grade chronic inflammation may be induced by hyperandrogenism and/or IR with raised inflammatory markers including white blood cells (WBC) count, C‐reactive protein (CRP), inflammatory cytokines (ie interleukin‐6 (IL‐6) and interleukin‐8 (IL‐8)), and cellular adhesion molecules (ie soluble endothelial leucocyte adhesion molecule‐1 (sE‐selectin), soluble intercellular adhesion molecule‐1 (sICAM‐1) and soluble vascular cell adhesion molecule‐1(sVCAM‐1)) . On the other hand, normal physiological changes in pregnancy include the aberration of maternal immune system where elevated WBC count and CRP levels have been observed . A prospective study by Palomba et al confirmed that compared to women without PCOS, those with PCOS have higher serum levels of inflammatory markers (WBC and CRP) prior to pregnancy with significantly higher elevations in pregnancy associated with adverse maternal and neonatal outcomes such as GDM, GH, PE, PTB, antepartum haemorrhage, SGA and LGA .…”

Section: Possible Contributing Mechanisms Of Pcos In Adverse Pregnancmentioning

confidence: 99%

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Polycystic ovary syndrome and adverse pregnancy outcomes: Current state of knowledge, challenges and potential implications for practice

Khomami

Boyle

Tay

et al. 2018

Clinical Endocrinology

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Summary Although there is a growing body of literature reporting that pregnancies in women with polycystic ovary syndrome (PCOS) are associated with greater complications than those without PCOS, methodological differences across studies make these results difficult to consolidate. This narrative review outlines potential mechanisms involved in adverse pregnancy outcomes in PCOS and the nature of the complications. It covers limitations of current evidence and future research directions. Future research should include prospective studies with phenotypic stratification of PCOS and matching or consideration of specific PCOS manifestations and risk factors specific to each pregnancy complication. This review also emphasizes the importance of following a healthy lifestyle for women with PCOS and of individualized care according to overall risk factors for pregnancy complications.

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“…Prior studies report an increased risk of adverse obstetric outcomes and also increased risk of metabolic complications in LGA babies later in life . While some prior studies have reported that PCOS is associated with a higher rate of LGA babies, this was not supported by recent meta‐analyses . In the general population several factors including obesity, excessive GWG, diabetes mellitus, GDM, multiparity, age and certain ethnicities are associated with increased risk of LGA babies .…”

Section: Discussionmentioning

confidence: 99%

Lifestyle and pregnancy complications in polycystic ovary syndrome: The SCOPE cohort study

Khomami

Moran

Kenny

et al. 2019

Clinical Endocrinology

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Summary Objectives To investigate the risk of pregnancy complications in women with and without polycystic ovary syndrome after consideration of lifestyle factors. Design Prospective cohort. Patients and measurements Participants (n = 5628) were apparently healthy nulliparous women with singleton pregnancies from the Screening for Pregnancy Endpoints study in New Zealand, Australia, United Kingdom and Ireland. Multivariable regression models were performed assessing the association of self‐reported polycystic ovary syndrome status with pregnancy complications with consideration of lifestyle factors at the 15th week of gestation. Results Women with polycystic ovary syndrome (n = 354) were older, had a higher socio‐economic index and body mass index and were less likely to consume alcohol and smoke but more likely to do vigorous exercise and take multivitamins. In univariable analysis, polycystic ovary syndrome was associated with increased risk of gestational diabetes (OR: 2.2, 95% CI: 1.2, 4.0). In multivariable models, polycystic ovary syndrome was only significantly associated with decreased risk of large for gestational age (OR: 0.62, 95% CI: 0.40, 0.98) with a population attributable risk of 0.22%. None of the other outcomes were attributable to polycystic ovary syndrome status. Conclusions Polycystic ovary syndrome is associated with a lower risk of large for gestational age infants. In this low‐risk population, the risk of pregnancy complications was not increased in women with polycystic ovary syndrome who were following a healthy lifestyle. Further studies are warranted assessing the contribution of lifestyle factors to the risk of pregnancy complications in higher risk groups of women with and without polycystic ovary syndrome.

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Low-Grade Chronic Inflammation in Pregnant Women With Polycystic Ovary Syndrome: A Prospective Controlled Clinical Study

Abstract: In PCOS patients, the low-grade chronic inflammation persists during gestation and is exacerbated by pregnancy, and it is associated with adverse pregnancy outcomes.

Cited by 67 publications

References 38 publications

Evidence that non-alcoholic fatty liver disease and polycystic ovary syndrome are associated by necessity rather than chance: a novel hepato-ovarian axis?

Evidence that non-alcoholic fatty liver disease and polycystic ovary syndrome are associated by necessity rather than chance: a novel hepato-ovarian axis?

Polycystic ovary syndrome and adverse pregnancy outcomes: Current state of knowledge, challenges and potential implications for practice

Lifestyle and pregnancy complications in polycystic ovary syndrome: The SCOPE cohort study

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