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

Abstract

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.

Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity—A systematic review, meta‐analysis, and meta‐regression

“…We confirm a prior meta‐analysis reporting a higher risk for miscarriage in PCOS . Prior research reports the risk factors for miscarriage, both in PCOS and in the general population, include obesity and ART use . Of these, we report the increased rate of miscarriage was retained in BMI‐matched studies, studies for women with either BMI below or above 30 kg m −2 and that miscarriage in PCOS was not associated with BMI in meta‐regression.…”

“…It is characterized by hyperandrogenism (HA), oligo/anovulation (AnOvu), and/or polycystic ovary morphology (PCOM) . PCOS is associated with metabolic, reproductive, and psychological features . Women with PCOS have intrinsic insulin resistance (IR), which is mechanistically distinct from the IR associated with obesity, and obesity will further worsen both IR and the clinical presentation of PCOS .…”

“…PCOS is associated with metabolic, reproductive, and psychological features . Women with PCOS have intrinsic insulin resistance (IR), which is mechanistically distinct from the IR associated with obesity, and obesity will further worsen both IR and the clinical presentation of PCOS . Women with PCOS are more likely to have increased oxidative stress, and to experience infertility requiring assisted conception, and when they conceive, there is also an increased risk for pregnancy and delivery complications …”

“…Previous meta‐analyses on pregnancy and delivery complications report an increased risk for miscarriage, gestational diabetes mellitus (GDM), gestational hypertension (GHTN), pre‐eclampsia (PE), and caesarean section (CS) in women with PCOS . Given the heterogeneity of PCOS and confounding variables associated with pregnancy complications, diverse risk factors may contribute to the increased rate of pregnancy complications in PCOS . Obesity, IR, HA, and increased‐oxidative stress may aggravate PCOS severity and modulate the rate of pregnancy and delivery complications .…”

“…Despite empirical evidence for an increased prevalence of maternal pregnancy and delivery complications in women with PCOS, there are still significant gaps in understanding the potential pathophysiological pathways for these associations. This is likely because of both the complexity and heterogeneity of PCOS, the range of potential confounders for pregnancy complications, and the variable methodology of conducted studies with these factors often not considered in prior meta‐analyses. The aims of this systematic review, meta‐analysis, and meta‐regression were to assess the prevalence of pregnancy and delivery complications in women with and without PCOS and in consideration of clinical and biochemical symptoms of PCOS and potential confounders of these outcomes.…”