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Pregnancy problems more likely with PCOS

Women with PCOS need closer monitoring during pregnancy and birth

Louise Prime

Friday, 14 October 2011

Women who have polycystic ovary syndrome are more likely to suffer an adverse pregnancy outcome than women without PCOS, shows research published today on bmj.com. The study’s authors recommend that GPs, midwives and obstetricians should more closely monitor pregnant women with the condition.

Researchers from the Karolinska Institute and University Hospital in Stockholm examined data on adverse pregnancy outcomes – gestational diabetes, pre-eclampsia, preterm birth, stillbirth, neonatal death, low Apgar score (<7 at 5 minutes), meconium aspiration, large for gestational age, macrosomia and small for gestational age – in women carrying single babies. They then compared the risks in 3787 women with PCOS and 1,191,336 women without PCOS, adjusted for factors such as the mother’s BMI, age, educational level, use of fertility treatment and whether or not she lived with the baby’s father.

Women with PCOS were more likely to be obese, and more likely to have undergone fertility treatment, than women without PCOS.

Even after adjusting for fertility treatment, BMI and age, women with PCOS had more than double the risk of developing gestational diabetes (adjusted odds ratio 2.32), giving birth before 32 weeks’ gestation (OR 2.21), and suffering pre-eclampsia (OR 1.45) than those without PCOS. Babies born to mothers with PCOS had an increased risk of being large for gestational age (OR 1.39), of meconium aspiration (OR 2.02) and of having a low Apgar score (OR 1.41).

The study’s authors concluded that women with PCOS should be monitored more closely: “These women may need increased surveillance during pregnancy and childbirth. Future research would benefit from focusing on glucose control, medical treatment and hormonal status among women with polycystic ovary syndrome during pregnancy.”

In his accompanying editorial, Professor Nick Macklon from the University of Southampton, says: “It is clear that women with polycystic ovary syndrome should be considered ‘high risk’ obstetric patients and that midwives, general practitioners, and obstetricians should monitor these women as such.”

But he cautioned that “more evidence is required to support the use of currently used interventions designed to reduce perinatal risk, and this requires a greater understanding of the different polycystic ovary syndrome phenotypes and the underlying mechanisms by which this common condition alters pregnancy outcomes.”

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