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Birth and Delivery · Birth Outcomes

Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis

Qin JZ, Pang LH, Li MJ, Fan XJ, Huang RD, Chen HY

Published June 26, 2013 Reproductive biology and endocrinology : RB&E, 11, 56
DOI 10.1186/1477-7827-11-56 PMID 23800002 PMC PMC3737012

RRM Academy Synopsis

Women with PCOS have higher risks of pregnancy complications

A 2013 meta-analysis of 27 studies found that women with polycystic ovary syndrome (PCOS) had higher risks of high blood pressure disorders in pregnancy. They also had more gestational diabetes, preterm births and cesarean sections. Their babies had a higher risk of intensive care admission.

Key Findings

  • The meta-analysis pooled 27 studies with 4982 women with PCOS and 119692 controls. The 21-study analysis also found a higher risk of gestational diabetes mellitus with PCOS.
  • Pregnancy-induced hypertension was more likely in women with PCOS (odds ratio [OR] 3.43; 95% CI: 2.49–4.74; 13 studies) after one study of borderline eligibility was excluded.
  • Preeclampsia was more likely (OR 2.17; 95% CI: 1.91–2.46; 14 studies), and so was preterm birth (OR 1.93; 95% CI: 1.45–2.57; 12 studies), each after studies of borderline eligibility were excluded.
  • Cesarean section was more likely after one borderline study was excluded (OR 1.74; 95% CI: 1.38–2.11; 9 studies).
  • Infants of women with PCOS were more likely to be admitted to a neonatal intensive care unit (OR 2.32; 95% CI: 1.40–3.85; 5 studies).

Interpretation

The paper is a meta-analysis, which pools the results of published studies. Most of the 27 studies were retrospective, and 10 were prospective. For preterm birth and cesarean section, the analysis of all studies found no significant difference. The significant results for those two outcomes appeared after studies of borderline eligibility were excluded. In 21 studies the controls conceived without infertility treatment. In most studies the women with PCOS conceived with ovulation induction or assisted reproductive technology. The authors note that obesity often goes with PCOS, and the studies did not sort women into lean and obese groups. The authors advise guidelines for monitoring during pregnancy and delivery.

RRM Context

PCOS is now also called polyendocrine metabolic ovarian syndrome (PMOS). Restorative reproductive medicine treats it as a hormone and metabolic condition. It looks for the causes before treatment. The review's authors state that insulin resistance, high androgens and obesity interact in PCOS to raise the risk of late pregnancy complications, including preeclampsia and gestational diabetes. They call it a chronic disease across a woman's lifespan.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of childbearing age. The risk of pregnancy and neonatal complications in women with PCOS is debatable. In order to determine the risk of pregnancy and neonatal complications, evidence regarding these risks was examined.

Methods

Literature searches were performed in the electronic databases MEDLINE, EMBASE, and CENTRAL based on the established strategy and eligible tries were included according to inclusion and exclusion criteria. A systematic literature review looking at rates of gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preeclampsia, premature delivery, neonatal birth weight, caesarean section and admission to a neonatal intensive care unit (NICU) was conducted in women with PCOS. Pregnancy outcomes between women with PCOS versus controls were included. Sensitivity analyses were performed to determine the reliability of the available evidence and to validate the results. The study was performed with the approval of the ethics committee of the First Affiliated Hospital of Guangxi Medical University.

Results

A total of 27studies, involving 4982 women with PCOS and 119692 controls were eligible for the meta-analysis. Women with PCOS demonstrated a significantly higher risk of developing GDM (OR3.43; 95% CI: 2.49-4.74), PIH (OR3.43; 95% CI: 2.49-4.74), preeclampsia (OR2.17; 95% CI: 1.91-2.46), preterm birth (OR1.93; 95%CI: 1.45-2.57), caesarean section (OR 1.74; 95% CI: 1.38-2.11) compared to controls. Their babies had a marginally significant lower birth weight (WMD -0.11g; 95%CI: -0.19 - -0.03), and higher risk of admission to NICU (OR 2.32; 95% CI: 1.40-3.85) compared to controls.

Conclusions

Women with PCOS have increased risk of adverse pregnancy and neonatal complications. It is necessary to establish guidelines for supervision during pregnancy and parturition to prevent these complications.

Topics

Related research

Birth and Delivery › Birth Outcomes › Maternal Morbidity · Pregnancy › Pregnancy Complications › Gestational Diabetes
Jun Z Qin, Li H Pang, Mu J Li, Xiao J Fan, Ru D Huang, Hong Y Chen
J Qin, L Pang, M Li, X Fan, R Huang, H Chen
PMID 23800002 23800002 DOI 10.1186/1477-7827-11-56 10.1186/1477-7827-11-56 Qin et al. 2013, Qin 2013

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