KatCarney

Human Reproduction
July 2003 (Volume 18, Number 7)

Pregnancy Outcome in Women With PCOS and in Controls Matched by Age and Weight

Haakova L, Cibula D, Rezabek K, Hill M, Fanta M, Zivny J
Human Reproduction. 2003;18(7):1438-1441

Summary: This retrospective, case-control study did not find increased risk of gestational diabetes or hypertensive disorders among lean women with polycystic ovary syndrome (PCOS) when compared with age- and weight-matched control women.

This was a case-control study that evaluated pregnancy outcome in women with PCOS and weight- and age-matched control patients. PCOS was diagnosed on the basis of the following criteria: oligomenorrhea, polycystic-appearing ovaries on ultrasound, ovulatory infertility, elevated serum level of one of the following androgens (testosterone, androstenedione, dehydroepiandrosterone, or dehydroepiandrosterone sulphate). Cases and controls were followed at the same obstetrics unit. They were all screened for gestational diabetes. In addition, data were collected for the presence of hypertension or hypertensive complications during pregnancy. Information was obtained from medical records and/or during in-person interviews. Family history for diabetes and cardiovascular disease was assessed in first- and second-degree relatives. Data were collected for neonatal complications (need for glucose infusion, jaundice, lengthy hospital stay).

The study enrolled 66 women with PCOS and 23 controls (23/43 eligible controls). At baseline, age, body mass index (BMI) [23.7 vs 23.2 kg/m2], and parity were similar. Family and personal history of diabetes and cardiovascular disease were similar between cases and controls. The number of total pregnancies (including the index pregnancy) was similar, but the number of deliveries was significantly lower in the PCOS group. Mean gestational age at delivery was lower in the PCOS group (36.4 vs 39.7 weeks). There were significantly more multiple gestations in the PCOS group. Within the PCOS group, mean gestational age and birth weight were significantly lower for multiple gestations. When only singletons were considered, however, birth weight and gestational age at delivery were similar to that of control gestations. A similar proportion of PCOS and control women developed gestational diabetes (4.9% vs 12.12%) and hypertensive (8.2% vs 6.0%) complications. Neonatal complications occurred with similar frequency in the 2 groups. This retrospective, case-control study did not find increased risk of gestational diabetes or hypertensive disorders among lean women with PCOS when compared with age- and weight-matched control women.

Clinical Commentary: PCOS is a common endocrine/metabolic disorder affecting up to 10% of reproductive age women. Several diagnostic criteria exist, but the most widely accepted are oligo-ovulation, clinical or laboratory hyperandrogenism, and the lack of another endocrine disorder (adrenal disease, hyperprolactinemia) responsible for the findings. It is now recognized that many cases of PCOS are associated with insulin resistance and that women with PCOS are at increased risk for diabetes and cardiovascular disease. PCOS is also associated with ovulatory infertility. According to some reports, once pregnancy is achieved, the rate of spontaneous abortion and the risk of gestational diabetes and hypertensive complications are increased. Because these observations are usually based on small number of patients in studies that are not ideally designed, it is important to collect further information to assess the excess risk.

This study enrolled 66 women with PCOS. Inclusion criteria are appropriate, although it is not stated that other endocrine disorders that could be responsible for the clinical picture were excluded. Controls were non-PCOS women who delivered at the same hospital. Of the 43 eligible women, data were available for only 23. The authors link diabetic and cardiovascular complications to insulin resistance but fail to provide information about insulin resistance among cases or controls. As obesity is an independent risk factor for insulin resistance, one would expect higher rate of diabetic and hypertensive complications among women with higher BMI. This study enrolled women with normal body weight.

A possible explanation for the nonsignificant findings is the possibility that lean women (including those with PCOS) are at lower risk when compared with obese women. Since women with PCOS have ovulatory problems, ovarian stimulation is necessary to induce ovulation. This can be achieved with various drugs, including insulin-sensitizing medications. Information about the potential use of such drugs is not discussed. Their use could further influence the rate of diabetic and hypertensive complications during pregnancy. As a result of ovulation induction, the rate of multiple gestations was higher in the PCOS group. This explains the higher rate of premature deliveries and lower birth weight among cases. When multiple gestations were excluded, the rate of premature delivery and low birth weight were no longer different. The rate of diabetic and hypertensive complications was not different between cases and controls. As this study enrolled lean PCOS women with unknown insulin resistance status, the conclusions that can be drawn are limited. The issues raised by this study are important. Are cardiovascular and diabetic complications higher among women with PCOS? Are there certain types of PCOS women who are at especially increased risk? If such women are identified, can insulin-sensitizing drugs offer benefits to them? These questions will have to be investigated in further studies.

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