Maternal polycystic ovary syndrome (PCOS) may have long-lasting adverse health consequences for offspring, according to a study published online May 11 and in the June issue of Obstetrics & Gynecology. Offspring of affected mothers had higher odds of congenital anomalies than peers of unaffected mothers and were 14% to 69% more likely to be hospitalized for various health conditions, with the elevated risk persisting into at least young adulthood.
“In view of our findings and the purported association of periconception, metabolic derangements with poor implantation and placentation[,] strategies to improve periconception health in women with PCOS may be expected to improve reproductive outcomes,” write Dorota A. Doherty, PhD, from the School of Women’s and Infants’ Health, University of Western Australia in Subiaco, and colleagues.
Both normal-weight status and metformin therapy have been linked to better pregnancy outcomes in this population, they note. “Hence, preconception identification of women with PCOS may enable early intervention to improve long-term outcomes, although it is not clear if all women with PCOS have this increased risk for adverse outcomes or whether there are certain features of PCOS that are associated with particular outcomes for the mother and her offspring,” they maintain.
The study is important as it is apparently the first to report a link between maternal PCOS and health outcomes of offspring in early life, according to Kathleen Hoeger, MD, a professor of obstetrics and gynecology and director of the Reproductive Endocrine Division, University of Rochester Medical Center, New York. In addition, PCOS is common among women of reproductive age but is often underappreciated in general pregnancy care.
“We should be counseling women who have PCOS that we need to be very attentive to any metabolic problems that may exist prior to becoming pregnant,” she told Medscape Medical News. “We in the healthcare community need to be aware of what potential things can we control, what can we change. We can’t change the fact that a woman has PCOS because we don’t believe that is something at this point that we can reverse. But we can change the quality of her healthcare prior to pregnancy and then obviously pay very close attention in pregnancy and then assess the children postbirth.”
At the same time, Dr Hoeger cited some study limitations that may temper the findings and should be kept in mind.
“We can’t say from this study alone that these [associations] are absolute. There is a suggestion, and we have to be careful not to overreach in the summary of this [study],” she cautioned, noting that the findings may not be generalizable and that the research will need to be replicated in other populations. Also, women were not matched on weight status, and overweight and obesity, seen in at least half of the PCOS population, are potential confounders. Finally, as the women with PCOS were identified through hospitalizations, they may have represented a more severely affected subset of patients.
For the study, the researchers used statewide data linkage systems of Western Australia (a remote region with a very low migration rate) to compare pregnancy and offspring outcomes between 2566 women who had a hospitalization with a PCOS diagnosis and at least one pregnancy of 20 weeks’ gestation or greater and 25,660 randomly selected age-matched women who did not have any hospitalization with a PCOS diagnosis.
Overall, 69.7% (n = 1789) of women with PCOS and 62.9% (n = 16,139) of women without PCOS had at least one birth. The researchers analyzed hospitalizations for the 38,028 offspring. The median age at hospital discharge was 8.6 years; 80% of the offspring were followed until at least 15 years of age, with a maximum of 30 years of age.
Results showed that relative to the offspring of unaffected mothers, those of mothers with PCOS had significantly higher adjusted odds of preterm birth (7.6% unaffected vs 15.5% affected; odds ratio [OR], 1.74; 95% confidence interval [CI], 1.53 – 1.98), low Apgar scores at 5 minutes (46%), perinatal mortality (0.7% vs 2.3%; OR, 1.49; 95% CI, 1.02 – 2.18), and congenital anomalies (4.9% vs 6.3%; OR, 1.20; 95% CI, 1.03 – 1.40), especially those of the cardiovascular system (1.0% vs 1.5%; OR, 1.37; 95% CI, 1.01 – 1.87) and urogenital system (1.4% vs 2.0%; OR, 1.36; 95% CI, 1.03 – 1.81).
In addition, the offspring of mothers with PCOS had significantly higher adjusted risks for hospitalizations beyond the perinatal period for a variety of diagnoses, including endocrine, nutritional, and metabolic disorders (44% higher), digestive disorders (14%), metabolic disorders (43%), neurologic conditions (17%), psychological development issues (69%), asthma (32%), and male genital conditions (38%).
The authors have disclosed no relevant financial relationships.
Obstet Gynecol. 2015;125:1399-1408. Abstract
— Susan London
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