Maternal polycystic ovary syndrome (PCOS) and Antenatal (ANC) Complications: A Case Control Study
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. Evidences shows variable finding regarding it's effect on pregnancy outcomes. This present study was conducted to determine whether maternal polycystic ovary syndrome (PCOS) is associated with adverse pregnancy outcomes in antenatal period. Prospective observational study, carried out in the department of Obstetrics and Gynecology, Indraprastha Apollo Hospitals, New Delhi, including 64 women with PCOS and 64 normal pregnant women between January 2013 and November 2014. It was found that Gestational diabetes mellitus (GDM) was significantly more frequent in the PCOS group than in the control group (p value = 0.009; OR=2.698 (1.213-6.001), this difference was not found statistically significant. Pregnancy induced hypertension (PIH) was also found significantly more frequent in the PCOS group than in the control group (p value=0.014; OR=3.41 (1.176-9.885). Miscarriage rate was not significantly different among two groups. So it can be concluded that women affected by PCOS carry an increased risk of adverse pregnancy outcomes specially GDM and PIH.
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Introduction
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women, with prevalence as high as 15% when the broader Rotterdam Criteria are applied. 1 Despite its prevalence, PCOS is a disease with an unclear cause, varying diagnostic criteria, expansive clinical effects, and debatable management.
As per Rotterdam criteria2 PCOS is characterized by presence of any two out of these three criterias i.e. Oligo/amenorrhea, Clinical or laboratory evidence of hyperandrogenemia and Ultrasound imaging of polycystic ovaries (either 12 or more follicles measuring 2-9 mm in diameter or increased ovarian volume (>10cm3 ).
In non pregnant women, PCOS is known to be associated with menstrual irregularities, decreased fertility, insulin resistance, diabetes mellitus, and hyperandrogenism. 3 For this population to become pregnant, many women require assisted reproductive techniques in addition to the medical treatment of insulin insensitivity. 4-6 .Once this previously sub fertile population becomes pregnant, the effect of maternal insulin insensitivity and hyperandrogenism on the fetus must be considered.
Hyperandrogenism and insulin resistance from the metabolic hallmark of PCOS women. Several studies in diverse populations of PCOS women have demonstrated an increased risk of hyperinsulinemia, 7 insulin resistance, dyslipidemia, 8,9 glucose intolerance, 10 hypertension7 and metabolic syndrome. 11
Conclusion
Pregnant Indian women with a history of PCOS are at increased risk for developing GDM and PIH, but they are not at increased risk of miscarriage. These complications are more likely to occur in obese women with PCOS. These results, Obtained from a small sample of PCOS women, are in accordance with growing evidence that PCOS may be associated to a higher prevalence of adverse pregnancy outcomes. These findings warrant counseling of women with PCOS especially prior to IVF on the potential benefits of weight loss prior to pregnancy. These women may need increased surveillance during pregnancy and parturition.