Polycystic Ovary Syndrome and Risk of Adverse Pregnancy Outcomes: A Registry Linkage Study From Massachusetts
Authors: Farland Leslie V. , Stern Judy E. , Liu Chia-Ling , Cabral Howard J. , Coddington Charles C. , Diop Hafsatou , Dukhovny Dmitry , Hwang Sunah , Missmer Stacey A. 
Published: March 2023

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women, affecting approximately 6% to 15% of reproductive-aged women. Polycystic ovarian syndrome is associated with obesity, metabolic syndrome, impaired glucose tolerance, insulin resistance, adverse pregnancy outcomes, and infertility. Previous meta-analyses and reviews have suggested that women with PCOS are at an increased risk of pregnancy complications, although many of the studies included are small and may not be generalizable.

This population-based study aimed to investigate whether women with a previous history of PCOS had greater risk of adverse maternal and pregnancy outcomes compared with women without a diagnosis of PCOS accounting for potential confounding factors. Data were obtained from 3 sources: the Massachusetts Pregnancy to Early Life Longitudinal Data System, the Society for Assisted Reproductive Technology Clinic Outcome Reporting System, and the Massachusetts All-Payers Claims Database. Maternal outcomes investigated included gestational diabetes, hypertensive disorders of pregnancy, cesarean delivery, and placental abnormalities. Neonatal outcomes investigated were size for gestational age, low birth weight, prematurity, prolonged delivery, and hospital stay. Infant conditions and diagnoses during the first year of life were also investigated. Deliveries were classified into groups of noninfertile, subfertile/infertile, or assisted reproductive technology. The relative risks (RRs) and 95% confidence intervals (CIs) of adverse outcomes were estimated with a log-link and Poisson distribution, and multivariable models were a priori adjusted for potential confounding factors.

A total of 3552 deliveries to women with a history of PCOS and 88,273 deliveries to women without a diagnosis of PCOS were included. When adjusting for maternal age, prepregnancy body mass index (BMI), education, race/ethnicity, plurality, birth year, and history of hypertension and diabetes, women with a history of PCOS had a 51% greater risk of gestational diabetes (RR, 1.51; 95% CI, 1.38–1.65). Women with a history of PCOS were also at a greater risk of pregnancy-induced hypertension, preeclampsia, and eclampsia (RR, 1.25; 95% CI, 1.15–1.35) and higher risk of cesarean delivery (RR, 1.07; 95% CI, 1.02–1.11). Women with a history of PCOS were more likely to deliver prematurely (RR, 1.17; 95% CI, 1.06–1.29), and infants born to mothers with a history of PCOS were more likely to have a prolonged neonatal hospital stay (RR, 1.23; 95% CI, 1.01–1.19). Among women with a BMI <30 kg/m2, PCOS was associated with a greater risk of gestational diabetes (RR, 1.60; 95% CI, 1.42–1.80) than among those with a BMI >30 kg/m2 (gestational diabetes: RR, 1.37; 95% CI, 1.21–1.57).

The results of this study demonstrate that women with a history of PCOS were more likely to experience gestational diabetes, hypertensive disorders of pregnancy, and cesarean delivery, and their neonates were more likely to be born premature and have a prolonged neonatal hospital stay.