Pregnant women with Polycystic ovarian syndrome and Diabetes have Adverse Pregnancy Outcomes: Study

Polycystic ovarian syndrome (PCOS) is the most prevalent endocrine disorder among reproductive-age women. It can result in various reproductive and metabolic consequences. Women with PCOS have high complications during pregnancy and perinatal period. Previous literature showed the association between preexisting diabetes and increased adverse outcomes. Increased rates of preeclampsia, cesarean delivery, operative delivery, and spontaneous preterm birth have been observed in women with preexisting diabetes mellitus (DM). Due to common pathogenesis, PCOS is often found to coexist with type 2 diabetes. However, there is ambiguity on the association between pregestational DM and pregnancy outcomes in PCOS. Hence, researchers conducted a study to establish the association between the two.

A retrospective population-based study was carried out by using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database. Using the ICD-9, all deliveries between 2004 and 2014 were studied. During this period about 14,882 women had a diagnosis of PCOS, of which 673 (4.7%) had a diagnosis of pregestational diabetes. Demographics were compared using the Chi-squared tests. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI), controlling for confounding effects.

Findings:

• Women with PCOS and pre-gestational DM were more likely to develop pregnancy complications.
• After controlling for confounding demographics, the pregnancy outcomes were found to be pregnancy-induced hypertension, preeclampsia, preeclampsia or eclampsia superimposed on pre-existing hypertension, and placenta previa.
• Women with PCOS who had pregestational diabetes were at increased risk of preterm delivery and delivery by cesarean section.
• No difference was found in the rate of women between the two groups who gave birth to small for gestational age (SGA) infants, the rate of intrauterine fetal demises (IUFD), and the rate of infants with congenital anomalies.

Thus, the study concluded that pregestational diabetes in women with PCOS increased the risk of pregnancy complications like pregnancy-induced hypertension, preeclampsia, preeclampsia or eclampsia superimposed on pre-existing hypertension, and placenta previa. The researchers highlight the importance of considering the effect of preexisting diabetes in managing pregnant women with PCOS to optimize perinatal care.

Further reading: Association between pre-gestational diabetes in women with polycystic ovary syndrome and adverse obstetric outcomes. Doi: https://doi.org/10.1016/j.ejogrb.2024.11.021.

Take home points:

• Women with PCOS and pre-gestational diabetes develop adverse pregnancy outcomes.
• These include pregnancy-induced hypertension, preeclampsia, preeclampsia or eclampsia superimposed on pre-existing hypertension, placenta previa, preterm delivery, and delivery by cesarean section.
• Hence, the effect of pre-existing DM and PCOS on pregnancy outcomes should be considered when counseling and planning care for pregnant women for improved outcomes.