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Hyperandrogenism, IGT predict adverse pregnancy outcomes in PCOS

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January 3, 2019

Among women with polycystic ovary syndrome, the presence of hyperandrogenism and impaired glucose tolerance increases the odds of experiencing pregnancy complications, including preeclampsia and preterm birth, according to a secondary analysis of two Dutch cohorts.

Jacob P. Christ

“Hyperandrogenism and markers of impaired glucose regulation predict increased risk for pregnancy and neonatal complications among women with PCOS,” Jacob P. Christ, MD, a resident physician in obstetrics and gynecology at the University of Washington in Seattle and a former visiting researcher at University Medical Center Utrecht, the Netherlands, told Endocrine Today. “Women with PCOS and hyperandrogenism and impaired glucose regulation prior to pregnancy should be more closely monitored during pregnancy and may require additional interventions to prevent adverse obstetric and neonatal outcomes.”

Christ and colleagues analyzed data from 2,768 women with PCOS who participated in two prospective cohort studies conducted from 2004 to 2013 (mean age at screening, 29 years; 84% white; 30% with history of previous pregnancy). All women in the first study, recruited from an outpatient infertility unit, underwent a baseline screening, including transvaginal ultrasound. Women enrolled in the second study, designed to evaluate pregnancy and perinatal outcomes in women with PCOS, had 10 additional follow-up antenatal visits. Researchers assessed incidence of preeclampsia, preterm delivery, infants born small for gestational age, low Apgar score and any adverse outcome, using linked data from the Dutch perinatal national registry.

Within the cohort, 1,715 women (62%) had one or more pregnancies resulting in a live birth after screening. Among recorded obstetric outcomes, 4% of women developed preeclampsia and 10% delivered preterm, whereas 9% of infants were born small for gestational age and 3% of children had an Apgar score of 7 or lower, according to researchers.

In comparing women with and without individual Rotterdam diagnostic criterion for PCOS, researchers found that women with hyperandrogenism were more likely to develop preeclampsia vs. women without hyperandrogenism (5% vs. 2%; P = .003) and deliver preterm (11% vs. 7%; P = .004). There were no between-group differences for women with and without oligomenorrhea or polycystic ovarian morphology.

Researchers found that prepregnancy free androgen index was associated with subsequent preeclampsia (OR = 1.1; 95% CI, 1-1.1), whereas fasting glucose level predicted preterm delivery (OR = 1.4; 95% CI, 1.2-1.7), as did testosterone level (OR = 1.5; 95% CI, 1.2-1.7).

Researchers also observed that fasting insulin level predicted any adverse outcome (OR = 1.003; 95% CI, 1.001-1.005), as did testosterone level (OR = 1.2; 95% CI, 1.1-1.4).

“The current results suggest that primary disease characteristics of PCOS, chiefly hyperandrogenism and changes in blood glucose regulation, have relevance in predicting obstetric complications among PCOS women,” the researchers wrote. “Based on these findings, it appears that women with PCOS and these features should be the focus of increased surveillance during pregnancy in order to help mitigate these women’s and their children’s increased risk of disease.” – by Regina Schaffer

For more information:
Jacob P. Christ, MD, can be reached at University of Washington Medical Center, 1959 NE Pacific Street, Seattle WA 98195; email: j.p.christ@umcutrecht.nl.

Disclosures: Christ reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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