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Polycystic ovarian syndrome and pregnancy outcome

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Abstract

Introduction

Polycystic ovarian syndrome (PCOS) is a common disease of the endocrine system among the women of reproductive age with an incidence ranging from 5 to 10%.

Method

This study is a mini-review of pregnancy and perinatal outcome in women with PCOS.

Results

The syndrome is associated with increased risk of pregnancy complications such as gestational diabetes, gestational hypertension, preeclampsia, and preterm labor, while no strong association was found with congenital anomalies or spontaneous miscarriages. Furthermore, women with PCOS seem to experience increased risk of cesarean delivery while their newborns face increased perinatal morbidity and mortality. Metformin use seems to reduce the risk of obstetrical complications; however, prospective studies are necessary on the field.

Conclusion

Further studies should be organised in order to evaluate the role of PCOS in pregnancy.

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References

  1. Lane DE (2006) Polycystic ovary syndrome and its differential diagnosis. Obstet Gynecol Surv 61(2):125–135

    Article  PubMed  Google Scholar 

  2. Azziz R (2004) PCOS: a diagnostic challenge. Reprod Biomed Online 8(6):644–648

    Article  PubMed  Google Scholar 

  3. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19(1):41–47

    Google Scholar 

  4. Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS (2006) A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update 12(6):673–683

    Article  PubMed  CAS  Google Scholar 

  5. Godoy-Matos AF, Vaisman F, Pedrosa AP, Farias ML, Mendonηa LM et al (2009) Central-to-peripheral fat ratio, but not peripheral body fat, is related to insulin resistance and androgen markers in polycystic ovary syndrome. Gynecol Endocrinol 25(12):793–798

    Article  PubMed  CAS  Google Scholar 

  6. de Boo HA, Harding JE (2006) The developmental origins of adult disease (Barker) hypothesis. Aust N Z J Obstet Gynaecol 46(1):4–14

    Article  PubMed  Google Scholar 

  7. Clapauch R, Mattos TM (2008) Τriplet pregnancy after metformin in a woman with polycystic ovary syndrome. Fertil Steril 89(5):1260.e1-2

    Article  PubMed  Google Scholar 

  8. Palomba S, Falbo A, Russo T, Battista L, Tolino A, Orio F, Zullo F (2010) Uterine blood flow in pregnant patients with polycystic ovary syndrome: relationships with clinical outcomes. BJOG 117(6):711–721

    Google Scholar 

  9. Nawaz FH, Rizvi J (2009) Continuation of metformin reduces early pregnancy loss in obese Pakistani women with polycystic ovarian syndrome. Gynecol Obstet Invest 69(3):184–189

    Article  PubMed  CAS  Google Scholar 

  10. Carlsen SM, Vanky E (2010) Metformin influence on hormone levels at birth, in PCOS mothers and their newborns. Hum Reprod 25(3):786–790

    Article  PubMed  CAS  Google Scholar 

  11. Palomba S, Falbo A, Russo T, Tolino A, Orio F, Zullo F (2009) Pregnancy in women with polycystic ovary syndrome: the effect of different phenotypes and features on obstetric and neonatal outcomes. Fertil Steril doi:10.1016/j.fertnstert.2009.10.043

  12. Legro RS, Roller RL, Dodson WC, Stetter CM, Kunselman AR, Dunaif A (2010) Associations of birthweight and gestational age with reproductive and metabolic phenotypes in women with polycystic ovarian syndrome and their first-degree relatives. J Clin Endocrinol Metab 95(2):789–799

    Article  PubMed  CAS  Google Scholar 

  13. Alshammari A, Hanley A, Ni A, Tomlinson G, Feig DS (2010) Does the presence of polycystic ovary syndrome increase the risk of obstetrical complications in women with gestational diabetes? J Matern Fetal Neonatal Med 27:1–5

    Google Scholar 

  14. Palomba S, Falbo A, Orio F Jr, Zullo F (2009) Effect of preconceptional metformin on abortion risk in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril 92(5):1646–1658

    Article  PubMed  CAS  Google Scholar 

  15. Toulis KA, Goulis DG, Kolibianakis EM, Venetis CA, Tarlatzis BC, Papadimas I (2009) Risk of gestational diabetes mellitus in women with polycystic ovary syndrome: a systematic review and a meta-analysis. Fertil Steril 92(2):667–677

    Article  PubMed  Google Scholar 

  16. Bolton S, Cleary B, Walsh J, Dempsey E, Turner MJ (2009) Continuation of metformin in the first trimester of women with polycystic ovarian syndrome is not associated with increased perinatal morbidity. Eur J Pediatr 168(2):203–206

    Article  PubMed  CAS  Google Scholar 

  17. Siassakos D, Wardle P (2007) Polycystic ovary syndrome and pregnancy outcome: red herring or red flag? BJOG 114(8):922–932

    Article  PubMed  CAS  Google Scholar 

  18. Ibαρez L, Jaramillo AM, Ferrer A, de Zegher F (2005) High neutrophil count in girls and women with hyperinsulinaemic hyperandrogenism: normalization with metformin and flutamide overcomes the aggravation by oral contraception. Hum Reprod 20(9):2457–2462

    Article  CAS  Google Scholar 

  19. Talbott EO, Zborowski JV, Boudreaux MY, McHugh-Pemu KP, Sutton-Tyrrell K, Guzick DS (2004) The relationship between C-reactive protein and carotid intima-media wall thickness in middle-aged women with polycystic ovary syndrome. J Clin Endocrinol Metab 89(12):6061–6067

    Article  PubMed  CAS  Google Scholar 

  20. Diamanti-Kandarakis E, Paterakis T, Alexandraki K, Piperi C, Aessopos A, Katsikis I et al (2006) Indices of low-grade chronic inflammation in polycystic ovary syndrome and the beneficial effect of metformin. Hum Reprod 21(6):1426–1431

    Article  PubMed  CAS  Google Scholar 

  21. Orio F Jr, Palomba S, Cascella T, Di Biase S, Manguso F, Tauchmanovΰ L et al (2005) The increase of leukocytes as a new putative marker of low-grade chronic inflammation and early cardiovascular risk in polycystic ovary syndrome. J Clin Endocrinol Metab 90(1):2–5

    Article  PubMed  CAS  Google Scholar 

  22. Mφhlig M, Spranger J, Osterhoff M, Ristow M, Pfeiffer AF, Schill T et al (2004) The polycystic ovary syndrome per se is not associated with increased chronic inflammation. Eur J Endocrinol 150(4):525–532

    Article  Google Scholar 

  23. Puder JJ, Varga S, Kraenzlin M, De Geyter C, Keller U, Mόller B (2005) Central fat excess in polycystic ovary syndrome: relation to low-grade inflammation and insulin resistance. J Clin Endocrinol Metab 90(11):6014–6021

    Article  PubMed  CAS  Google Scholar 

  24. Glueck CJ, Wang P, Fontaine RN, Sieve-Smith L, Tracy T, Moore SK (1999) Plasminogen activator inhibitor activity: an independent risk factor for the high miscarriage rate during pregnancy in women with polycystic ovary syndrome. Metabolism 48(12):1589–1595

    Article  PubMed  CAS  Google Scholar 

  25. Glueck CJ, Goldenberg N, Pranikoff J, Loftspring M, Sieve L, Wang P (2004) Height, weight, and motor-social development during the first 18 months of life in 126 infants born to 109 mothers with polycystic ovary syndrome who conceived on and continued metformin through pregnancy. Hum Reprod 19(6):1323–1330

    Article  PubMed  CAS  Google Scholar 

  26. Gilbert C, Valois M, Koren G (2006) Pregnancy outcome after first-trimester exposure to metformin: a meta-analysis. Fertil Steril 86(3):658–663

    Article  PubMed  CAS  Google Scholar 

  27. Sir-Petermann T, Hitchsfeld C, Maliqueo M, Codner E, Echiburϊ B, Gazitϊa R et al (2005) Birth weight in offspring of mothers with polycystic ovarian syndrome. Hum Reprod 20(8):2122–2126

    Article  PubMed  Google Scholar 

  28. Jakubowicz DJ, Iuorno MJ, Jakubowicz S, Roberts KA, Nestler JE (2002) Εffects of metformin on early pregnancy loss in the polycystic ovary syndrome. J Clin Endocrinol Metab 87(2):524–529

    Article  PubMed  CAS  Google Scholar 

  29. Rai R, Backos M, Rushworth F, Regan L (2000) Polycystic ovaries and recurrent miscarriage—a reappraisal. Hum Reprod 15(3):612–615

    Article  PubMed  CAS  Google Scholar 

  30. Sugiura-Ogasawara M, Sato T, Suzumori N, Kitaori T, Kumagai K, Ozaki Y (2009) The polycystic ovary syndrome does not predict further miscarriage in Japanese couples experiencing recurrent miscarriages. Am J Reprod Immunol 61(1):62–67

    Article  PubMed  Google Scholar 

  31. Tian L, Shen H, Lu Q, Norman RJ, Wang J (2007) Insulin resistance increases the risk of spontaneous abortion after assisted reproduction technology treatment. J Clin Endocrinol Metab 92(4):1430–1433

    Article  PubMed  CAS  Google Scholar 

  32. Homburg R, Levy T, Berkovitz D, Farchi J, Feldberg D, Ashkenazi J, Ben-Rafael Z (1993) Gonadotropin-releasing hormone agonist reduces the miscarriage rate for pregnancies achieved in women with polycystic ovarian syndrome. Fertil Steril 59(3):527–531

    PubMed  CAS  Google Scholar 

  33. Glueck CJ, Sieve L, Zhu B, Wang P (2006) Plasminogen activator inhibitor activity, 4G5G polymorphism of the plasminogen activator inhibitor 1 gene, and first-trimester miscarriage in women with polycystic ovary syndrome. Metabolism 55(3):345–352

    Article  PubMed  CAS  Google Scholar 

  34. Palomba S, Orio F Jr, Falbo A, Russo T, Tolino A, Zullo F (2005) Plasminogen activator inhibitor 1 and miscarriage after metformin treatment and laparoscopic ovarian drilling in patients with polycystic ovary syndrome. Fertil Steril 84(3):761–765

    Article  PubMed  CAS  Google Scholar 

  35. Bayraktar F, Dereli D, Ozgen AG, Yilmaz C (2004) Plasma homocysteine levels in polycystic ovary syndrome and congenital adrenal hyperplasia. Endocr J 51(6):601–608

    Article  PubMed  CAS  Google Scholar 

  36. Jakubowicz DJ, Essah PA, Seppδlδ M, Jakubowicz S, Baillargeon JP, Koistinen R, Nestler JE (2004) Reduced serum glycodelin and insulin-like growth factor-binding protein-1 in women with polycystic ovary syndrome during first trimester of pregnancy. J Clin Endocrinol Metab 89(2):833–839

    Article  PubMed  CAS  Google Scholar 

  37. Balen AH, Tan SL, MacDougall J, Jacobs HS (1993) Miscarriage rates following in vitro fertilization are increased in women with polycystic ovaries and reduced by pituitary desensitization with buserelin. Hum Reprod 8(6):959–964

    PubMed  CAS  Google Scholar 

  38. Engmann L, Maconochie N, Sladkevicius P, Bekir J, Campbell S, Tan SL (1999) The outcome of in vitro fertilization treatment in women with sonographic evidence of polycystic ovarian morphology. Hum Reprod 14(1):167–171

    Article  PubMed  CAS  Google Scholar 

  39. Winter E, Wang J, Davies MJ, Norman R (2002) Early pregnancy loss following assisted reproductive technology treatment. Hum Reprod 17(12):3220–3223

    Article  PubMed  Google Scholar 

  40. Wang JX, Davies MJ, Norman RJ (2002) Obesity increases the risk of spontaneous abortion during infertility treatment. Obes Res 10(6):551–554

    Article  PubMed  Google Scholar 

  41. Bellver J, Rossal LP, Bosch E, Zϊρiga A, Corona JT, Melιndez F et al (2003) Obesity and the risk of spontaneous abortion after oocyte donation. Fertil Steril 79(5):1136–1140

    Article  PubMed  Google Scholar 

  42. Nardo LG, Rai R, Backos M, El-Gaddal S, Regan L (2002) High serum luteinizing hormone and testosterone concentrations do not predict pregnancy outcome in women with recurrent miscarriage. Fertil Steril 77(2):348–352

    Article  PubMed  Google Scholar 

  43. Holte J (1998) Polycystic ovary syndrome and insulin resistance: thrifty genes struggling with over-feeding and sedentary life style? J Endocrinol Invest 21(9):589–601

    PubMed  CAS  Google Scholar 

  44. Mikola M, Hiilesmaa V, Halttunen M, Suhonen L, Tiitinen A (2001) Obstetric outcome in women with polycystic ovarian syndrome. Hum Reprod 16(2):226–229

    Article  PubMed  CAS  Google Scholar 

  45. Jensen RB, Chellakooty M, Vielwerth S, Vaag A, Larsen T, Greisen G et al (2003) Intrauterine growth retardation and consequences for endocrine and cardiovascular diseases in adult life: does insulin-like growth factor-I play a role? Horm Res 60(Suppl 3):136–148

    Article  PubMed  CAS  Google Scholar 

  46. Diamant YZ, Rimon E, Evron S (1982) High incidence of preeclamptic toxemia in patients with polycystic ovarian disease. Eur J Obstet Gynecol Reprod Biol 14(3):199–204

    Article  PubMed  CAS  Google Scholar 

  47. Fridstrφm M, Nisell H, Sjφblom P, Hillensjφ T (1999) Are women with polycystic ovary syndrome at an increased risk of pregnancy-induced hypertension and/or preeclampsia? Hypertens Pregnancy 18(1):73–80

    Article  Google Scholar 

  48. Kashyap S, Claman P (2000) Polycystic ovary disease and the risk of pregnancy-induced hypertension. J Reprod Med 45(12):991–994

    PubMed  CAS  Google Scholar 

  49. Glueck CJ, Wang P, Goldenberg N, Sieve-Smith L (2002) Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin. Hum Reprod 17(11):2858–2864

    Article  PubMed  CAS  Google Scholar 

  50. Gjψnnaess H (1989) The course and outcome of pregnancy after ovarian electrocautery in women with polycystic ovarian syndrome: the influence of body-weight. Br J Obstet Gynaecol 96(6):714–719

    Google Scholar 

  51. Sir-Petermann T, Angel B, Maliqueo M, Carvajal F, Santos JL, Pιrez-Bravo F (2002) Prevalence of Type II diabetes mellitus and insulin resistance in parents of women with polycystic ovary syndrome. Diabetologia 45(7):959–964

    Article  PubMed  CAS  Google Scholar 

  52. Bjercke S, Dale PO, Tanbo T, Storeng R, Ertzeid G, Abyholm T (2002) Impact of insulin resistance on pregnancy complications and outcome in women with polycystic ovary syndrome. Gynecol Obstet Invest 54(2):94–98

    Article  PubMed  CAS  Google Scholar 

  53. Hu S, Leonard A, Seifalian A, Hardiman P (2007) Vascular dysfunction during pregnancy in women with polycystic ovary syndrome. Hum Reprod 22(6):1532–1539

    Article  PubMed  Google Scholar 

  54. Boomsma CM, Fauser BC, Macklon NS (2008) Pregnancy complications in women with polycystic ovary syndrome. Semin Reprod Med 26(1):72–84

    Article  PubMed  Google Scholar 

  55. Weerakiet S, Srisombut C, Rojanasakul A, Panburana P, Thakkinstian A, Herabutya Y (2004) Prevalence of gestational diabetes mellitus and pregnancy outcomes in Asian women with polycystic ovary syndrome. Gynecol Endocrinol 19(3):134–140

    Article  PubMed  CAS  Google Scholar 

  56. Glueck CJ, Bornovali S, Pranikoff J, Goldenberg N, Dharashivkar S, Wang P (2004) Metformin, pre-eclampsia, and pregnancy outcomes in women with polycystic ovary syndrome. Diabet Med 21(8):829–836

    Article  PubMed  CAS  Google Scholar 

  57. Schachter M, Raziel A, Friedler S, Strassburger D, Bern O, Ron-El R (2003) Insulin resistance in patients with polycystic ovary syndrome is associated with elevated plasma homocysteine. Hum Reprod 18(4):721–727

    Article  PubMed  CAS  Google Scholar 

  58. Morin-Papunen L, Rautio K, Ruokonen A, Hedberg P, Puukka M, Tapanainen JS (2003) Metformin reduces serum C-reactive protein levels in women with polycystic ovary syndrome. J Clin Endocrinol Metab 88(10):4649–4654

    Article  PubMed  CAS  Google Scholar 

  59. Heard MJ, Pierce A, Carson SA, Buster JE (2002) Pregnancies following use of metformin for ovulation induction in patients with polycystic ovary syndrome. Fertil Steril 77(4):669–673

    Article  PubMed  Google Scholar 

  60. Hale TW, Kristensen JH, Hackett LP, Kohan R, Ilett KF (2002) Transfer of metformin into human milk. Diabetologia 45(11):1509–1514

    Article  PubMed  CAS  Google Scholar 

  61. Briggs GG, Ambrose PJ, Nageotte MP, Padilla G, Wan S (2005) Excretion of metformin into breast milk and the effect on nursing infants. Obstet Gynecol 105(6):1437–1441

    PubMed  CAS  Google Scholar 

  62. Gardiner SJ, Begg EJ, Kirkpatrick CM, Buckham RB (2004) Metformin therapy and diabetes in pregnancy. Med J Aust 181(3):174–175

    PubMed  Google Scholar 

  63. Checa MA, Requena A, Salvador C, Tur R, Callejo J, Espinós JJ et al (2005) The Reproductive Endocrinology Interest Group of the Spanish Society of Fertility. Insulin-sensitizing agents: use in pregnancy and as therapy in polycystic ovary syndrome. Hum Reprod Update 11(4):375–390

    Article  PubMed  CAS  Google Scholar 

  64. Simmons D, Walters BN, Rowan JA, McIntyre HD (2004) Metformin therapy and diabetes in pregnancy. Med J Aust 180(9):462–464

    PubMed  Google Scholar 

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Iavazzo, C., Vitoratos, N. Polycystic ovarian syndrome and pregnancy outcome. Arch Gynecol Obstet 282, 235–239 (2010). https://doi.org/10.1007/s00404-010-1495-0

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