Associations Between Polycystic Ovary Syndrome and Adverse Obstetric and Neonatal Outcomes

A Population Study of 9.1 Million Births

Ginevra Mills; Ahmad Badeghiesh; Eva Suarthana; Haitham Baghlaf; Michael H. Dahan

Disclosures

Hum Reprod. 2020;35(8):1914-1921. 

In This Article

Results

There were 9 096 788 births between 2004 and 2014, inclusively. Of these pregnancies, 14 882 women, or 163.6 per 100 000, had a documented diagnosis of PCOS. Within the 11-year study period, there was a steady rise in the incidence of PCOS, from 49.1 per 100 000 in 2004 to 366.04 per 100 000 in 2014 (P < 0.001).

Baseline demographic characteristics for our study population are summarised in Table I. Women with PCOS were more likely to be older than 25 years of age and Caucasian, have higher household incomes and private insurance and deliver in an urban teaching hospital, as compared with the non-PCOS obstetrical population. Pregnant women with PCOS were also less likely to smoke or use recreational drugs in pregnancy. Baseline metabolic conditions in the PCOS and non-PCOS cohort of women, stratified by singleton and multiple pregnancies, are listed in Table II. Women with PCOS were more likely to be obese and to have chronic hypertension, pre-gestational diabetes or treated thyroid disease. Women with PCOS were also more likely to have undergone IVF treatment and have multi-gestation pregnancies, and more multiple gestations in the PCOS cohort were the result of IVF treatment than in the non-PCOS cohort (Table II).

The crude and adjusted effect measures for the association between delivery, infectious and neonatal outcomes and their respective prevalence in each cohort, stratified by single and multiple pregnancies, are outlined in Table III. In all pregnancies, women with PCOS were more likely to experience PPROM (aOR 1.48, 95% CI 1.20–1.83), PTD (aOR 1.37, 95% CI 1.24–1.53, P < 0.001), placental abruption (aOR 1.63, 95% CI 1.30–2.05), and were more likely to deliver by C/S (aOR 1.50, 95% CI 1.40–1.61, P < 0.001), after controlling for confounding effects of age, race, income level, insurance type, obesity, IVF use, previous C/S, chronic HTN, pre-gestational diabetes, thyroid disease, smoking, recreational drug use, pregnancy-associated HTN, gestational HTN, PEC, PEC with superimposed HTN and GDM.

There was no statistical difference in the number of women undergoing IOL between the PCOS and the reference group (aOR 0.98, 95% CI 0.91–1.04, P = 0.44) for all pregnancies. However, in women with multiple gestations, those with PCOS were less likely to undergo an IOL (aOR 0.78, 95% CI 0.63–0.97, P = 0.03). After controlling for all confounding effects, women with PCOS were more likely than non-PCOS women to experience chorioamnionitis in labour (aOR 1.58, 95% CI 1.34–1.86, P < 0.001) and to develop maternal infections in the post-partum period (aOR 1.58, 95% CI 1.36–1.84, P < 0.001).

With the exception of cases of multiple gestations (aOR 1.27, 95% CI 1.01–1.62, P = 0.04), there was no difference in the number of women who gave birth to SGA infants (aOR 0.97, 95% CI 0.82–1.15, P = 0.72). There was also no difference in the number of IUFDs between the two groups (aOR 1.03, 95% CI 0.68–1.59, P = 0.88). Interestingly, women with PCOS were more likely to give birth to infants with congenital anomalies than those without PCOS (aOR 1.89, 95% CI 1.51–2.38, P < 0.001).

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