Polycystic Ovary Syndrome, Obesity, and Pregnancy

Abstract

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to one in five reproductive-aged women. It is underpinned by insulin resistance and hyperandrogenism and is associated with metabolic, reproductive, and psychological features. Women with PCOS have higher rates of obesity and central adiposity compared with women without PCOS, and weight strongly influences prevalence and clinical severity of PCOS. Women with PCOS may have subfertility and women should be aware of factors affecting fertility, in particular the impact of obesity and age. Once pregnant, women with PCOS have significantly increased risk of pregnancy-related complications including gestational diabetes, hypertensive disorders, premature delivery, and delivery by cesarean section. The offspring of women with PCOS may have increased risk of congenital abnormalities and hospitalization in childhood. Clinicians should be aware of the increased risk and screen, prevent, and manage accordingly.

Pregnancy-related outcomes for women with polycystic ovary syndrome

“…In one study, a twofold to threefold increase in GDM was seen, 7 and PIH/PET were increased threefold to fourfold in women with PCOS, [23][24][25] which corresponds to a 50% increase in PET. 7 The need to perform an operative vaginal delivery, elective and non-elective CS was doubled, 22 and this is likely to have been impacted by the increase in maternal obesity and fetal macrosomia seen in women with GDM and multiple pregnancies derived from ART. Increased gestational weight gain has also been evident in women with PCOS, 7 as well as a five times increase in adverse pregnancy outcomes seen in women with PCOS and oligo-anovulation.…”

“…13 Various clinical and phenotypic presentations may precede the diagnosis of PCOS and include, but are not limited to, hyperandrogenism, menstrual irregularity, olio/anovulation and infertility. 7 In total, 80% of women affected by anovulatory infertility have PCOS, which is further adversely affected by excess weight. 14 Furthermore, women with anovulatory infertility have a longer interval until pregnancy, hence are more likely to require fertility investigations and treatment ( Figure 1).…”

“…14 Women diagnosed with PCOS have a lower natural conception rate, an increased rate of biochemical pregnancy and a reduced response to artificial reproductive technology (ART). 7,16 Reproductive outcomes PCOS is associated with an increase in subfertility, ectopic pregnancy and early pregnancy loss (EPL). 14,15 Potential causes are an altered endometrial environment and subsequent reduction in implantation success 7 due to the hyperinsulinemic environment and concurrent hyperandrogenism.…”

“…This is further exacerbated by obesity, the greater recourse to ART, and potentially, the greater risk of multiple pregnancies derived from recourse to ART in women with PCOS. 7 The extent of the increase in incidence of gestational diabetes (GDM), pregnancy-induced hypertension (PIH), preeclampsia (PET) and cesarean section (CS) differs slightly among studies, but are reproducibly increased even when data are adjusted for BMI. In one study, a twofold to threefold increase in GDM was seen, 7 and PIH/PET were increased threefold to fourfold in women with PCOS, [23][24][25] which corresponds to a 50% increase in PET.…”

“…7 The extent of the increase in incidence of gestational diabetes (GDM), pregnancy-induced hypertension (PIH), preeclampsia (PET) and cesarean section (CS) differs slightly among studies, but are reproducibly increased even when data are adjusted for BMI. In one study, a twofold to threefold increase in GDM was seen, 7 and PIH/PET were increased threefold to fourfold in women with PCOS, [23][24][25] which corresponds to a 50% increase in PET. 7 The need to perform an operative vaginal delivery, elective and non-elective CS was doubled, 22 and this is likely to have been impacted by the increase in maternal obesity and fetal macrosomia seen in women with GDM and multiple pregnancies derived from ART.…”