Maternal Exposure to PCOS Increases Risk of Childhood Hospitalizations

A new study from investigators in Canada is providing an overview of the apparent increase in risk of hospitalization observed among children born to mothers with polycystic ovary syndrome (PCOS).

An analysis of data from more than 1,000,000 children in Quebec from 2006-2020, results of the study demonstrate children exposed to maternal PCIOS had a 32% greater risk of hospitalization during childhood, with this risk most apparent for hospitalizations related to childhood metabolic, gastrointestinal, and central nervous system disorders.

“These findings fill a big gap in what we know about the long-term health of children whose mothers have PCOS,” Nathalie Auger, MD, MSc, associate professor of epidemiology at the School of Public Health at the University of Montreal, in a statement. “Primary care doctors and obstetricians should consider identifying women with PCOS before conception and offering early interventions such as weight management and strategies to help prevent problems such as diabetes and heart and blood vessel diseases. Family doctors and pediatricians should consider monitoring children more closely after birth to minimize morbidity. Greater parental awareness may help improve outcomes in children.”

Considered the most common endocrine condition among women of childbearing age, the impact of PCOS on the health of individual patients has been outlined in mountains of research published on the topic. However, Auger and colleagues from the University of Montreal note a lack of dedicated research examining the impact of maternal PCOS on risk of morbidity in children. Citing this dearth of information, Auger, along with Shuqin Wei, MD, PhD, and Marianne Bilodeau-Bertrand, MSc, designed the current study as a retrospective analysis of longitudinal data from a cohort 1,038,375 children to compare the risk of hospitalizations up to the age of 13 years among those exposed to maternal PCOS and those without exposure within Quebec, Canada from the Maintenance and Use of Data for the Study of Hospital Clientele repository.

For the purpose of analysis, investigators adjusted analyses for multiple maternal characteristics, including age, parity, use of assisted reproductive technologies (ART), maternal comorbidity, substance use disorders, socioeconomic deprivation, and year of birth. The main end point of interest for the study were childhood hospitalizations up to 13 years of age, with 3 primary outcomes of interest: infectious, allergic, and malignant diseases. Investigators also had multiple secondary outcomes with morbidities categorized by system, including respiratory, cardiovascular, metabolic, gastrointestinal, musculoskeletal, central nervous system, otologic, and mental and behavioral health disorders.

Of the 1,038,375 children included in the study, 7160 were born to mothers with PCOS and 1,031,215 were not exposed to maternal PCOS. Compared to those without PCOS, mothers with PCOS were more likely to be older, nulliparous (55.4% vs 49.0%), have used ART (14.7% vs 1.8%), and have comorbidities, including obesity, type 1 and 2 diabetes, hypertension, and dyslipidemia (24.8% vs 8.5%). During the 7,719,940 person-years of follow-up obtained from the cohort,275,354 children were hospitalized. The overall hospitalization rate for children exposed to PCOS was 68.9 (95% CI, 66.2-71.8) per 1000 person-years compared to 45.3 (95% CI, 45.1-45.5) per 1000 person-years for children not exposed to PCOS.

In adjusted analyses, those exposed to maternal PCOS had an increased risk of any childhood hospitalization (HR, 1.32 [95% CI, 1.26-1.40]), with increased risk observed for hospitalizations for infectious disease (HR, 1.31 [95% CI, 1.25-1.38]) and allergy-related hospitalizations (HR, 1.47 [95% CI, 1.31-1.66]). When assessing secondary outcomes of interest, an increased risk of hospitalization among those with maternal exposure to PCOS was observed for hospitalizations for childhood metabolic (HR, 1.59 [95% CI 1.16-2.18]), gastrointestinal (HR, 1.72 [95% CI, 1.53-1.92]), central nervous system (HR, 1.74 [95% CI, 1.46-2.07]), and otologic disorders (HR, 1.34 [95% CI, 1.26-1.43]). Further analysis suggested there was little difference present between associations of maternal PCOS exposure with hospitalization among boys (HR, 1.31 [95% CI, 1.24-1.39]) and girls (HR, 1.34 [95% CI, 1.26-1.43]).

“We believe that further research is needed to see if effective management of maternal PCOS can reduce the risk of health problems in offspring and improve long-term health. We need to know if exercise, dietary changes and medications can make a difference,” Auger added. “In future work, we intend to examine outcomes of pregnancy, as well as future outcomes of women with PCOS. These women may be at risk of developing cardiovascular disease or other health problems, and epidemiologic research documenting this possibility is needed to help improve the management of these patients.”

This study, “Association of PCOS with offspring morbidity: a longitudinal cohort study,” was published in Human Reproduction.