Women with PCOS at Increased Risk of Pregnancy-Associated Cardiometabolic Complications

Michael Dahan, MD

New research from McGill University suggests a diagnosis of polycystic ovary syndrome (PCOS) could serve as an independent risk factor for gestational diabetes and other pregnancy-associated metabolic complications.

A common condition among women of childbearing age, results of the analysis indicate PCOS was associated with increased odds of developing gestational diabetes, gestational hypertension, and preeclampsia after adjustment for confounding factors.

“We discovered that PCOS is a risk factor for morbidity in pregnancy,” explained lead investigator Michael Dahan, MD, an assistant professor in the Department of Obstetrics and Gynecology at McGill University, in a statement. “We are now able to precisely determine the relative risk in pregnancy related to the disease process itself by controlling for underlying conditions, which previous studies were unable to do.”

With PCOS impacting 1 in 10 women of childbearing age, Dahan and a team of colleagues sought to narrow the knowledge gap surrounding its associations with increased prevalence of maternal pregnancy complications through an analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database. Using the database, which is the largest inpatient sample database in the US and contains information related to more than 7 million hospital admission per year, investigators identified a cohort of more than 9 million patients for inclusion in their analysis.

Using a time period ranging from 2004-2014, investigators identified 14,882 deliveries to women with PCOS and 9,081,906 deliveries identified during the study period were categorized as non-PCOS births. Of note, final analysis performed by investigators adjusted for age, race, income level, insurance type, obesity, IVF use, previous cesarean section, chronic hypertension, pregestational diabetes, thyroid disease, multiple gestations, smoking, and recreational drug use.

When comparing the study arms, rates of obesity (22.3% vs 3.5%; P <.001), chronic hypertension (8.4% vs. 1.8%; P <.001), pregestational diabetes (4.1% vs 0.9%; P <.001), and previous treatment for thyroid disease (12.6% vs 2.4%; P <.001) were all greater among women with PCOS. Additionally, data from HCUP-NIS indicated women with PCOS were more likely to have undergone IVF treatment (2.4% vs 0.1%; P <.001), have multi-gestation pregnancies (5.9% vs. 1.5%; P <.001)—investigators also pointed out more multiple gestations in the PCOS group were the result of IVF treatment than the non-PCOS groups (12.3% vs 2.3%; P <.001).

In adjusted analyses, investigators found women with PCOS were more likely to develop  gestational diabetes (aOR, 2.19; 95% CI, 2.02-2.37), pregnancy associated hypertension (aOR, 1.38; 95% CI, 1.27-1.50; P < 0.001), gestational hypertension (aOR, 1.47; 95% CI, 1.31-1.64), preeclampsia (aOR, 1.29; 95% CI, 1.14-1.45) and superimposed PEC (aOR, 1.29; 95% CI, 1.04-1.59) than women in the non-PCOS cohort.

When assessing women pregnant with multiple fetuses, PCOS was associated with a statistically significant increased risk of developing gestational diabetes mellitus (aOR, 2.33; 95% CI, 1.92-2.83; P <.001). Investigators pointed out there was also a trend toward an increased risk for developing pregnancy-related hypertension (aOR, 1.92; 95% CI, 0.99-1.42; P=.058).

“PCOS is the most common hormonal condition among reproductive age women,” added Dahan, in the aforementioned statement. “It is important to consider the risk of other co-existing conditions frequently encountered in women with PCOS, as these risks are additive and place them at a significantly increased risk of adverse pregnancy outcomes.”

This study, “Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: a population-based study on 9.1 million pregnancies,” was published in Human Reproduction.